Fiser Ch 27: Vascular Flashcards
most common acquired hypcoagulable disorder
smoking
1st branch off internal carotid artery?
ophthalmic aa
1st brach off external carotid artery?
superior thyroid aa
indications for CEA?
- Asymptomatic with >70% stenosis
2. Symptomatic with >50% stenosis
what part of vessel do you remove in CEA?
intima and part of media
why do 20% of ppl get hypertensive after CEA?
injury to carotid body, tx w nipride
what are the three aortic arch vessels?
- innominate aa (branches to right subclavian and right common carotid)
- left common carotid
- left subclavian
whats DeBakey Classification for AAAs?
Type I: ascending and descending
Type II: Ascending only
Type III: Descending only
where do dissections normally occur? (layer)
medial layer of blood vessel wall
how do you get paraplegia after a thoracic AAA repair? how can you prevent it?
- spinal cord ischemia due to occlusion of intercostal arteries and artery of Adamkiewicz
- reimplant intercostal arteries afte T8
most likely location of rupture of abdominal AAA?
left lateral wall 2-4cm below renals
when do you reimplant the IMA? indications (4)
- If backpressure <40mmHg
- Previous colonic surgery
- Stenosis at the SMA
- Flow to colon appears inadquate
1 causes of acute and late death after AAA repair?
acute: MI
late: renal failure
5 types of endoleaks
Type I: Proximal or distal attachment sits
Type II: Collaterals (observe)
Type III: Overlap sites of multiple grafts (secondary endograft to cover)
Type IV: Graft wall porosity or suture holes (observe)
Type V: expansion of aneurysm without evidence of leak (back to OR)
top 2 organisms that cause mycotic aneurysms and tx
- Staph
- Salmonella
extra-anatomic bypass (ax fem) and resection of infected aorta
top 2 organisms that cause aortic graft infections
- staph
2. E. Coli
whats leriche syndrome? tx?
- aortoiliac occlusive disease causing:
1. no femoral pulses
2. Buttock o thigh claudication
3. impotence
tx: aorto-bifem bypass
ABI: claudication
0.7-0.9
ABI: rest pain
0.5
ABI: ulcers
0.4
ABI gangrene
<0.3
when to use gortex (PTFE) vs saphenous v.
PTFE above the knee
saphenous below the knee bypasses
when do you use dacron graft?
aorta or large vessels
when do you use PTA?
percutaneous transluminal angioplasty, use:
- common iliac artery stenosis
- short stenoses
diagnosis of compartment syndrome
pressures >20-30mmHg
diagnosis of popliteal entrapment syndrome? tx?
loss of pulses with plantarflexion
tx: resection of head of gastroc
what arteries are used in CABG?
arterial autografts:
radial aa
IMA
most common site of peripheral obstruction from emboli
common femoral artery
management of acute arterial embolus
embolectomy
most common site of atheroma embolism
renals
management of acute arterial thrombus
threatened limb: give heparin and OR thrombectomy
nonthreatened limb: angiography for thrombolytics
renal artery stenosis, management if due to atherosclerosis or FMD
athero: PTA w stent
Fibromuscular dysplasia: PTA without stent
difference in presentation of renal artery stenosis between atherosclerosis and FMD
athero: left, proximal 1/3, men
FMD: right, distal 1/3, women
indications for nephrectomy w renal HTN
atrophic kidney <6cm with persistently high renin levels
most common site of upper extremity stenosis
subclavian artery
describe anatomy of thoracic outlet
subclavian v. and phenic n. lay anterior to anterior scalene, then subclavian a. and brachial plexus lie between ant and middle scalene muscles
what is Paget-von Schrotter disease
effort induced thrombosis of subclavian vein, acutely painful, swollen, blue limb
whats adsons test?
absent radial pulse with head turned to ipsilateral side of subclavian artery compression 2/2 ant. scalene hypertrophy
what is the arc of riolan?
collateral between SMA and IMA
most common visceral aneurysm
splenic artery aneurysm
when do you repair a splenic artery aneurysm? (3)
- if symptomatic
- If pt is pregnant or in childbearing age
- > 3-4cm
treatment of splenic artery aneurysm?
covered stent
treatment of popliteal artery aneurysm
exclusion and bypass
difference in collateral system between right and left renal vein
RIGHT has NO collaterals, thus you can ligate LEFT renal vein
migrating thrombophlebitis indicates what pathology?
pancreatic cancer
AEIOU of dialysis
A: acidosis E: electrolyte imbalances I: intoxication O: overload U: uremia
which artery has the highest patentcy after angioplasty?
iliac aa (decreases as you mov distally)
MC organism causing: early graft infection v late graft infection
early: staph aureus
late: staph epidemidis
