Chapter 14: Miscellaneous Conditions/ Tests (2%)

Question 1

What is an AV fistula

Answer 1

abnormal connection between high pressure arterial system and low pressure venous system

Question 2

AV fistulas can be

Answer 2

congenital or traumatic

Question 3

If a fistula is close to the heart what increases

Answer 3

potential for cardiac failure

Question 4

a fistula located peripherally is more likely to cause

Answer 4

ischemia

Question 5

AVF may involve

Answer 5

prx and dst arteries/veins as well as collaterals

Question 6

Proximal arterial flow (prox to AV fistula)

Answer 6

increase diastolic flow because fistula reduces resistance

Question 7

Depending on size of fistula, arterial flow distal to AV fistula may

Answer 7

resume its normal triphasic pattern or be somewhat reduced

Question 8

Flow throughout the AV fistula

Answer 8

higher velocities

low resistance

Question 9

Venous outflow of AV fistula

Answer 9

takes on flow quality of fistulas low resistant pulsatile flow

Question 10

Compartment syndrome

Answer 10

compression of tibial arteries due to swelling

leads to necrosis of muscle

Question 11

compartment syndrome can be caused by

Answer 11

repair of tibial artery (from trauma or occlusion)

compartment is bound by bone, fascia and interosseous membrane that does not allow for expansion

Question 12

pts with compartment syndrome present with

Answer 12

severe pain
tenderness
foot drop

Question 13

treatment for anterior compartment syndrome

Answer 13

fasciotomy (cutting of fascia to relieve pressure)

Question 14

Treatment for Pseudoaneurysms

Answer 14

US guided compression

US guided thrombin injection

Question 15

US guided compression for pseudos technique

Answer 15

compression of 10-15 min with short rest period performed with MD present
monitoring of distal perfusion necessary
length of time varies

Question 16

US guided compression for pseudo contraindications

Answer 16

inability to uniformly compress neck
pt anticoagulated
multiple communicating channels

Question 17

key to success of compression of pseudo

Answer 17

neck between native artery and PSA must be uniformly and completely compressed

Question 18

US guided thrombin injection of PSA contraindications

Answer 18

allergy to thrombin or bovine
infection in groin
ischemia of overlying skin
short/wide neck

Question 19

Popliteal artery entrapment syndrome is when

Answer 19

pop artery is compressed by medial head of gastrocnemius muscle or fibrous band

Question 20

pop artery entrapment syndrome is found commonly

Answer 20

in young men

Question 21

patients with pop artery entrapment syndrome present with

Answer 21

symptomatic arterial occlusion or intermittent claudication

Question 22

Epigastric artery is

Answer 22

terminal branch of internal mammary artery

Question 23

epigastic arteries and perforators

Answer 23

take blood to rectus abdominis muscle

Question 24

TRAM flap

Answer 24

rectus abdominis muscle, sub q fat, arteries, perforators, overlying skin

Question 25

reason for mapping epigastric artery

Answer 25

surgeon wants to use the best arterially supplied muscle section for TRAM flap for autogenous breast reconstruction

Question 26

Internal mammary artery (internal thoracic artery) arises

Answer 26

off arch of subclavian artery
descending posterior side of upper 6 ribs
1cm from sternum

Question 27

reason for mapping internal mammary artery

Answer 27

free flaps for breast reconstruction

graft left anterior descending coronary artery

Question 28

radial artery mapping is used to

Answer 28

determine suitability for use as graft for coronary artery bypass

Question 29

radial artery mapping technique

Answer 29

assess patency of palmar arch (allen test)
pt does not make a fist, use PPG with radial compression instead
PPG pulsations should continue with rad art compression, if they do not do not proceed because removal of artery will compromise hand
measure diameter of rad artery

Question 30

Vein mapping is used to determine

Answer 30

use for coronary bypass

use for dialysis access/graft

Question 31

vein mapping technique lower extremity

Answer 31

GSV used (sometimes lesser saf) mapped prx to distal
measurements obtained along extemity 
high mid distal thigh
knee
behind knee
prx mid dist calf and ankle

Question 32

upper extremity vein mapping

Answer 32

cephalic or basillic are used

measurements prx bicep, above elbow, elbow, forearm prx mid dist and wrist

Question 33

vein mapping general techniques

Answer 33

tourniquet used to expand vessel
compressibility assessed
outer to outer edge diameter measurement along extremity
vein length cm obtained

Question 34

vein dimension for vein mapping

Answer 34

at least 2-3mm

basilic vein is often larger than cephalic

Question 35

thoracic outlet syndrome is

Answer 35

neurovascular bundle compression by should structures

occurs in certain arm positions

Question 36

most common compression of thoracic outlet syndrome

Answer 36

compression of brachial plexus (97%)

small percentage due to subclavian artery or vein

Question 37

symptoms of thoracic outlet syndrome

Answer 37

numbness/tingling of arm
pain/aching of shoulder or forearm
upward position increase pain/symptoms
25-30% of people are asymptomatic

Question 38

ruling out thoracic outlet syndrome

Answer 38

PPG and doppler

arm resting and placed in various positions

Question 39

thoracic outlet test normal and abnormal results

Answer 39

normal: resting waveforms maintained
abnormal: flattening of waveforms in one or more positions