Chapter 27 - Vascular III Flashcards by Ryan Cohen

What is Paget-von-Schrotter disease?

effort induced thrombosis of subclabian vein
Venography gold standard for evaluation
men, pain swelling with activity
80% have thoracic outlet problem
thrombolytics, heparin, warfarin. Repair.

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What is mortality from mesenteric ischemia?

50-70%

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What are fintings of mesenteric ischemia on CT?

bowel thickening, intrabural gas, portal venous gas, vascular occlusion

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Wat are causes of visceral ischemia?

Acute embolic occlusion 50%
Thrombotic occlusion 25%
low-flow state 15%
Venous thrombosis 5%

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Superior mesenteric embolism occurs in what area of SMA?

origin of SMA
pain out of proportion
sudden onset
hematochezia
peritoneal signs late finding
Tx: volume resusc. antibiotics, embolectomy, resect infarcted bowe, heparin

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What are signs of mesenteric artery thrombosis?

food fear
wt loss
Thrombectomy, SMA bypass, resect infarcted bowe

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What are signs of mesenteric vein thrombosis?

short segments of intestine involved
bloody diarrhea, crampy abdominal pain
Heparin, thrombolytics, can try mesenteric vein thrombectomy if dx early, resect bowel

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Non-occlusive mesenteric ischemia happens when?

Spasm
low flow states
hypovolemia
hemoconcentration
Digoxin
Water shed areas most common
Tx volume resuscitation, glucagon, papaverine, nitrates, increase CO, resect bowel

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What is Median arcuate ligament syndrome?

celiac compression
bruit near epigastrium
chronic pain
weight loss
diarrhea
Tx: transect median arcuate ligament, may need arterial reconstruction

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Chronic mesenteric angina?

food fear
30 minutes after meals
may need PTA, bypass, endarterectomy

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What is the collateral between SMA and celiac?

arc of riolan

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What is the most common complication of aneurysms above inguinal ligament?

Rupture

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What is the most common complication of aneurysms below inguinal ligament?

thrombosis and emboli

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What do you do with splanchnic aneurysms?

repair, 50% rupture rate

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What do you do with splenic artery aneurysms?

most common visceral aneurysm.
more common in women
Repair if symptomatic, pregnant, women of childbearing age

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What dilatation of visceral arteries is considered aneurysmal?

> 2cm

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What can you do with splenic and common hepatic aneurysms?

can exclude- have good collaterals

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What are the surgical indications for iliac a aneurysms?

symptomatic- thrombosis, emboli, compression, >3.0cm, mycotic
bypass with exclusion

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What are surgical indications for femoral a aneurysm?

symptomatic, >2.5cm

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What are the surgical indications for popliteal aneurysms?

exclusion and bypass of >2cm, mycotic, symptomatic
1/2 bilateral, 1/2 have another aneurysm elsewhere
thrombosis and emboli with limb ischemia most common with these

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What do you do with a femoral pseudoaneurysm?

if acter percutaneous intervention need US guided compression with thrombin injection. May need surgical repair if this fails
-collection of blood in continuity with the arterial system but unenclosed by all 3 layers of the wall

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What are the surgical indications for renal A aneurysms?

symptomatic, expansion, >1.5 com, women who want to get knocked up.
reconstruction with vein patch; nephrectomy with rupture

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Fibromuscular dysplasia?

young women, HTN if involves renals
renal most commonly involved vessel (right), carotid next, iliac next
string of (anal) beads
medial fibrodysplasia most common variant
PTA or bypass

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What is Buerger’s disease?

you men, smokers, corkscrew collateral on angiogram and severe distal disease
severe rest pain
gangrene of digits
normal arterial tree proximal to popliteal and brachial
stop smoking or amputate

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What diseases cause cystic medial necrosis?

marfan's- type I collagen Ehlers-danlos - tendency for arterial rupture Can't do angiogram- risk of laceration of vessel

What is temporal arteritis?

giant cell arteritis- granulomatous disease inflammation of large vessels long segments of smooth stenosis alternating with segments of larger diameter fever, arthralgia, myalgia, anorexia Steroids, bypass, no endarterectomy

What is takayasu's?

same path, syx, and treatment of temporal artheritis

What is polyarteritis Nodos?

Get aneurysms that thrombose or rupture renals most common steroids

What is Kawasaki's disease?

affects douchebags in affliction T's on lime green motorcycles children- get dilated coronaries and brachiocephalic vessels die from arrhythmias steroids, possible CABG

What is hypersensitivity angiitis?

secondary to drug/tumor antigens rash, fever, end-organ dysfunction Ca+ channel blockers, pentoxifylline

What happens with radiation arteritis?

sloughing and thrmobosis early fibrosis, scar, stenosis 1-10 years Advanced atherosclerosis 3-30 years

Raynaud's disease?

young women, pallor, cyanosis, rubor | Ca2+ blockers, warmth

Where is the great saphenous vein?

joins femoral vein near groin- runs medially

Where is the lesser saphenous vein?

joins popliteal in lower leg- runs lateral at first

Can you clamp the IVC?

No- will tear

Can you ligate left renal vein?

yes- gonadal/adrenal vein collaterals

What is the most common cause of failure of AV grafts?

venous obstruction secondary to intimal hyperplasia

What is a Cimino graft?

radial artery to cephalic vein- wait 6 weeks

How long before an interposition graft can be used?

6 weeks to allow fibrous scar to form

How do you get an acquired AV fistula

Trauma can get peripheral insufficiency, CHF, aneurysm, limb length problems -repair with lateral venous suture, may need bypass of arterial side

Varicose veins

smoking, obesity, low activity | tx with stockings, elevation, exercise, sclerotherapy

Venous ulcers

secondary to venous valve incompitence | -unna boot cures 90%

Venous insufficiency symptoms?

aching, swelling, night cramps, brawny edema ulceration above and posterior to malleoli edema secondary to incompetent perforators

How do you perform a trendelenburg test?

elevate leg, occlude greater saphenofemoral vein junction, lower leg, rapid filling of greater saphenous vein suggests incompetent perforators 2 if first part did not fill, release pressure on saphenofemoral jxn- rapid filling suggests incompetent valves in greater saphenous

What is superficial thrombophlebitis?

nonbacterial inflammation | NSAIDS, warm packs, ambulation

What is suppurtive thrombophlebitis?

fever, increased WBC, erythema, fluctuance- resect vein

What is migrating thrombophlebitis a sign of?

pancreatic CA

what is Mondor's Disease?

self limiting thrombophlebitis of the breast

How do SCD's work?

help prevent blood clots by decreasing venous stasis, increasing AT-III, tPA, increased fibrinolysis

Where is DVT most common?

calf

what is Virchow's triad?

stasis, hypercoagulability, vessel wall injury

what do you get with calf DVT?

minimal swelling

What do you get with femoral DVT?

ankle and calf swelling

what do you get with iliofemoral DVT?

severe leg swelling

What is phlegmasia alba dolens?

tenderness, pallor, edema with DVT

What is phelgmasia cerulea dolens

tenderness, cyanosis, massive edema

Treatment for long term DVT?

1st- coumadin for 6 months 2nd- coumadin for 1 year 3rd or PE- coumadin for life

when do you put in a greenfield filter?

contraindication for anticoagulation PE on coumadin free floating ileofemoral thrombi after pulmonary embolectomy

what can you get a PE with filter in place?

ovarian veins, inferior vena cava, upper extremity

what do you do with venous thrombosis with a central line?

pull out if not needed, try to tx with heparin or TPA down line

what do you see with PE?

decreased paO2, decreased PaCO2, increased RR, alkalosis most arise from above knee if in shock- OR for pulmonary artery thrombectomy

do lymphatics have a basement membrane?

Where are lymphatics not found?

bone, muscle, tendon, cartilage, brain, cornea

When does lymphedema occur?

obstruction, too few in number, nonfunctional woody edema secondary to fibrous tissue in subcutaneous tissue cellulitis aand lymphantitis secondary to minor trauma -strep most common infection

What side is congenital lymphedema most common?

Left

What do you see with lymphangiosarcoma?

raised blue/red coloring | early mets to lung

What is stewart treves syndrome?

lymphangiosarcoma associated with breast axillary dissection

what is lymphangiectasia?

dilation of preexisting lymphatic channels dx with lymphangiography tx with resection

When do you get lymphocele?

after surgery- usually groun | rule out infectious source first

How do you identify lymphatic channels going to a lymphocele?

inject isosulfan blue into foot to id channels | resect lymphocele and ligate supplying channel

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Chapter 27 - Vascular III Flashcards

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