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10: Cardiovascular System > Chapter 108 Vascular Surgery > Flashcards

Chapter 108 Vascular Surgery Flashcards

1
Q

What are the three layers of the vein/artery?

A

Tunica externa (fibroblasts + collagen)

  • Tunica media* (smooth muscle)
  • Tunica intima* (endothelial cells)
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2
Q

List 5 tissues where arteries are not found

A
  • Nails
  • Hair
  • Epidermis
  • Cornea
  • Cartilage
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3
Q

Name a key step re vascular prep when performing anastomisis

A

Dissect adventitia (to avoid inadvertent inclusion in lumen)

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4
Q

Name the instruments

A

From left to right:

Diamond-jawed needle holder

DeBakey atraumatic forceps

Metzenbaum scissors

Potts scissors

Small and large right-angled forceps.

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5
Q

Name the instruments

A

From left to right:

Microvascular needle holders, without catch

Curved Vannas microvascular dissecting scissors

Straight adventitial scissors

Jeweler’s forceps

Curved and straight mosquito hemostats

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6
Q

Name the instruments

A

From left to right:

DeBakey atraumatic angled vascular clamp

DeBakey atraumatic tangential clamps

DeBakey-Satinsky atraumatic tangential clamp

Cooley atraumatic clamp

DeBakey atraumatic multipurpose curved clamp

Castaneda atraumatic neonatal clamp.

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7
Q

Name the instrument

A

Arteriotomy clamp

(open tip allows accurate assessment of depth of arteriotomy)

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8
Q

List 3 techniques for temporary vascular occlusion

A

Potts (double) loop, Rumel tourniquet, vascular clamp

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9
Q

What are the recommended suture sizes for the following vessel sizes (internal diameter):

  • 4 - 6 mm
  • 2 - 3 mm
  • <2 mm
A
  • 4 - 6 mm: 4/0 - 5/0
  • 2 - 3 mm: 6/0
  • <2 mm: 7/0 - 8/0
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10
Q

How are vascular grafts and patches categorized?

A
  • Biologic
  • Synthetic
    • Textile (Dacron)
    • Non-textile (PTFE)
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11
Q

What concoction do the chapter authors advise for local anticoagulation during vessel anastomosis?

A

Ice-cold solution of 2% lidocaine, heparin and 0.9% saline

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12
Q

What is the recommended dose of unfractionated heparin for systemic anti-coagulation for bypass?

What is the target ACT?

A

300U/kg unfractionated heparin, IV, before cannulation

ACT >480s (ref range 60 - 120)

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13
Q

When division is not possible, what technique is recommended to reduce the risk of re-cannalization?

A

Encircling ligature placed at each end of intervening vessel, and transfixing ligature between them.

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14
Q

List two advantages of a longitudinal venotomty/arteriotomy. And one disadvantage

A

Advantages

Can be extended for greater exposure

Can accomodate end-to-side anastomosis

Disadvantages

Luminal narrowing when closed

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15
Q

Below which size is transverse ventotomy/arteriotomy recommended (to reduced risk of luminal narrowing)

A

Transverse incision recommended in vessels <4mm

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16
Q

What is Kunlin’s technique.

A

Using double swaged suture, place mattress suture in each corner to create eversion.

17
Q

What is recommended suture spacing for vascular surgery?

A

1mm apart and 1mm from cut edge

18
Q

List 2 techniques for end-to-end anastomosis when mobility is limited

A
  • Transluminal suturing of far half.
  • Traingulation (suture corners spaced 120º apart to allow rotation)

The triangulation technique. Three corner sutures are placed 120 degrees apart (A). This allows for accurate circumferential suturing upon retraction of the vessel (B-D). A disparity in size between the two vessel ends may be accommodated among the three patterns.

19
Q

Name one scenario for deliberate creation of AV fistula

A

Long-term venous access.

20
Q

What is the optimal and acceptable angle of anastomosis for end-to-side vessel anastomosis

And same re ratio of length of recipient vessel opening vs donor vessel diameter

A

Angle of insertion

Optimal: 35-45º

Acceptable: 75º or more

Recipient opening:donor diameter

Optimal: 1:2

Acceptable: 1:1

21
Q

What is the most common autologous vascular graft harvested?

What are the components of the solution it should be ‘stored’ in?

A

Jugular vein

100ml chilled 0.9% saline, 3ml heparin (1000U/ml), 0.2ml papaverine (30 mg/ml)

22
Q

What material are guidewires made from

A

Stainless steel

23
Q

What is the diameter and length range for balloons?

A

1.5 - 18mm diameter

2 - 10cm length

24
Q

What are nitinol stents made of

A

Nickel + titanium

25
Q

How are intravascular stents classified?

List and advantage of each

A

Self expandable

  • Delivered without vascular sheath
  • More flexible

Balloon expandable

  • Final diameter more variable
26
Q

List 2 disadvantaged and 1 advantage of stainless steel brainded stents vs nitinol stents

A

Disadvantages

  • Foreshortening
  • Less radial strength

Advantage

  • Can be re-captures after partial deployment
27
Q

List possible indications for placement of a vascular access port

A
  • serial sedation or anesthesia episodes for long-term wound management or radiation therapy
  • serial blood sampling
  • serial or long-term administration of intravenous medications such as antimicrobials or chemotherapeutics.
28
Q

List an example of each of the following embolization agents:

Particulate

Liquid

Mechanical

A

Particulate

  • Polyvinyl alcohol (non-absorbable)

Liquid

  • Cyanoacrylate
  • Lipiodol (iodized poppy seed oil)

Mechanical

  • Metallic coils
  • Ductal occluders
29
Q

What is the most significant complication of embolization procedures?

A

Inadvertent occlusion of non-target vessels

30
Q

List two methods of embolectomy

A
  • Incision (i.e arteriotomy or venotomy)
  • Embolectomy catheter (pass catheter beyond thrombus, inflate ballooon and withdraw to incision).
  • (Catheter directed thrombolytic therapy)
31
Q

List specific clinical signs for a peripheral AV fisula.

List two diagnostic tests for wok up

A

PE findings:

Murmur/bruit/palpable thrill at site of fistula

Tortuous dilated veins in area

Diagnostic tests:

Contrast angiography

Colour flow doppler US

32
Q

How should endovascular catehters be prepared before cyanoacrylate infusion.

A

Flush with 5% dextrose because cyanoacrylate hardening begins with blood or endovascular contact

10: Cardiovascular System (3 decks)

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