Chapter 57 - Upper extremity vascular exposure Flashcards

1
Q

Three zones of the upper extremity

A

1) intrathoracic zone (aortic arch, innominate, subclavian, SVC)
2) thoracic outlet (based of neck to axilla): subclavian, vertebral, axillary
3) arm (axilla to fingers)

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2
Q

Rate of aberrant right subclavian

A

2%

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3
Q

Course of the aberrant right subclavian

A

1) arise distal to left subclavian

2) course behind esophagus

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4
Q

Rate of left vert from aortic arch

A

2-5%

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5
Q

Exposure to get proximal left subclavian control

A

Anterolateral third interspace thoracotomy

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6
Q

Medium sternotomy good for these arterial controls

A

1) proximal right subclavian
2) proximal left carotid
3) innominate

limited to 3rd interspace if aorta not needed

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7
Q

Exposure of the proximal arch vessels

A

1) median sternotomy
2) ligate or preserve left innominate vein
3) protect right recurrent laryngeal and right phrenic
4) tease away fatty tissue and retract overlying veins

more distal exposure

5) extend incision to neck or supraclavicular area
6) partially divide SCM and anterior scalene

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8
Q

Course of the right recurrent laryngeal nerve

A

loops around right subclavian artery just as it arises from innominate

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9
Q

Course of the right phrenic

A

passes behind jugular and right innominate vein
anterior to right subclavian artery
anterolateral to innominate artery

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10
Q

Course of the left recurrent laryngeal nerve

A

loops around aorta in area of ligamentum arteriosum

ascends anterior to arteries

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11
Q

Trapdoor thoracotomy

A

3rd space sternotomy, supraclavicular incision

3rd space anterolateral thoracotomy

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12
Q

Exposure of the proximal innominate vein

A

Sternoclavicular rotation

1) first space sternotomy
2) reattach after done

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13
Q

Exposure of the right atrial appendage

A

1) use as outflow for complex venous occlusive disease
2) limited anterior 3rd interspace thoracotomy
3) enter pericardial sace
4) clamp with satinsky -type clamp

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14
Q

Which SCM head is more easily sacrificed without consequence

A

Clavicular head

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15
Q

When does the subclavian artery change name to the axillary artery

A

after crosses over the lateral border of the first rib

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16
Q

Subclavian vein in relation to the artery

A

Inferior/caudal

17
Q

Exposure of the subclavian vein

A

Infraclavicular incision

18
Q

Proximal brachial exposure key points

A

1) Lies deep to vein and nerve
2) superficial nerves are sensory and can be sacrificed
3) deep brachial artery can also be sacrificed

19
Q

Vein coming up forearm that divides branches to the cephalic and basilic vein

A

Median antecubital vein

20
Q

Nerve to watch out for in the exposure of the radial artery

A

Radial sensory nerve