Chapter 118 - UE arterial disease treatment

Question 1

Arteries proximal to wrist as a total cause of ischemia

Answer 1

< 10% of total

Question 2

Arm emboli sources

Answer 2

75% Cardiac Lodges in: Brachial 60% Axillary 26%

Question 3

Acute arm ischemia types

Answer 3

Thromboembolic 92% Iatrogenic 1.5%

Question 4

Conservative management in acute arm ischemia results in this rate of disability

Answer 4

32-75% 50% is exercise induced

Question 5

Surgery for treatment of acute arm ischemia mortality

Answer 5

12% 95% symptom free if survive

Question 6

Subclavian stent patency 1 + 5 year

Answer 6

90% 1 year 81% 5 year

Question 7

Axillary artery exposure for embolectomy

Answer 7

Expose 1st 1/3 of artery 1) Transverse 2cm below middle 1/3 of clavicle 2) split pec major between clavicular and sternal portion 3) divide clavipectoral fascia 4) axillary artery cephalad to vein Expose 2nd portion 1) divide pec minor Expose 3rd portion 1) oblique incision along lateral margin of pec major with arm at 90 degrees 2) axillary near posterior and inferior boarder of coracobrachialis

Question 8

Exposure of 1/3 and 2/3 brachial artery

Answer 8

1) medial incision bicipital groove 2) avoid basilic vein and median antebrachial cutaneous nerve 3) incise brachial sheath 4) avoid median nerve

Question 9

Nerve that runs with the basilic vein

Answer 9

Median antebrachial cutaneous nerve sensation to medial dorsal forearm

Question 10

Exposure of 3/3 brachial artery

Answer 10

1) S shape incision 2) avoid median antecubital vein 3) expose between bicep tendon and median nerve 4) radial cutaneous with brachial 5) ulnar dives 2-3 cm after its medial takeoff

Question 11

Radial forearm exposure

Answer 11

1) medial to brachioradialis 2) lateral to flexor carpi radialis

Question 12

Radial wrist exposure

Answer 12

1) between flexor carpi radialis and brachioradialis 2) avoid superficial branch of radial nerve (controls lateral thumb

Question 13

Ulnar forearm exposure

Answer 13

1) deep fascia between flexor digitorum laterally and flexor carpi ulnaris medially 2) ulnar nerve joins at distal 2/3

Question 14

Ulnar wrist exposure

Answer 14

1) Lateral to flexor carpi ulnaris (most medial tendon in wrist) 2) avoid palmar cutaneous branches

Question 15

Interosseous artery exposure

Answer 15

Off ulnar artery, similar exposure

Question 16

Anterior/volar interosseous exposure

Answer 16

1) same as mid ulnar 2) elevate superficial flexor digitorum with median nerve 3) flexor pollicis longus elevate towards radius

Question 17

Posterior/dorsal interosseous exposure

Answer 17

Dorsal forearm along medial radius

Question 18

Snuffbox artery exposure

Answer 18

Incisie over between extensor pollicis longus and extensor pollicis brevis and abductor pollicis longus

Question 19

Distal ulnar and superficial palmar arch exposure

Answer 19

Curved incision lateral boarder of hypothenar emenance

Question 20

Tunnel of Guyon definition

Answer 20

Semi rigid longitudinal canal alows passage of ulnar artery and nerve

Question 21

Tunnelling bypass for UE

Answer 21

Axillary: anatomical Brachial: superficial Distal radial: subcutaneous over extensor pollicis tendon toward snuff box onto dorsum of hand Distal ulnar: superficial to flexor retinaculum at wrist lateral to pisiform to join superficial palmar arch

Question 22

Concern with proximal brachial embolectomy

Answer 22

Vertebral emboli

Question 23

Routine angio post embolectomy benefit

Answer 23

12 vs 2% 2 year reocclusion rate 4 vs 26% extension of procedure to fix problem

Question 24

Post bypass patency and limb salveage

Answer 24

90% primary patency, 100% limb salvage

Question 25

Recurrence of emboli for UE ischemia

Answer 25

1/3 without AC, 11% with AC

Question 26

Thrombolysis rate of success in UE emboli

Answer 26

50%

Question 27

Forearm anatomy

Answer 27

Question 28

Axillary artery and branches

Answer 28

Question 29

Brachial plexus

Answer 29