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Vascular surgery - Rutherford's 9th ed > General > Flashcards

General Flashcards

1
Q

What arteries produce a monophasic flow pulsed Doppler spectral waveform and why?

A 
Arteries with low ressitance arterial flow will product monophase wave form.
The arteries are:
- Internal carotid
- Vertebral
- Renal
- Celiac
- Splenic
- Hepatic
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2
Q

איך מחושב IR - Resistive Index?
למה הוא משמש?
מה טווח הערכים שלו?

A

(PSV-EDV)/PSV
משמש להערכת התנגדות פריפרית לא תקינה בכליות ובמוח.
ערכים נורמאלים הם מתחת ל-0.7.
ערכים גבוהים מ-0.85 קשורים בהתנגדות (Resistance) וסקולרית גבוהה וירידה בפרפוזיה הרקמתית של איבר המטרה.

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3
Q

איך מחשבים PI - pulsatility index?
למה הוא משמש?
מה הערכים שלו?

A

מחלקים את מהירות ה-Peak-to-peak בעקומת הזרימה במהירות הממוצאת.
בעורקים תקינים הערך הוא מעל 4 (פמורלי מעל 6, פופליטאלי מעל 8).
ערל מתחת ל-4 משקף הצרות או חסימה פרוקסימלית.

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4
Q

מה זה “dumping factor”?

A

חלוקת PI דיסטאלי ב-PI פרוקסימלי.

ערך מתחת ל-0.9 הוא אבחנתי למחלה חסימתית.

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5
Q

מה זה גל tardus-parvus?

A

גל בעקומת דולפר עם זמן האצה סיסטולית של יותר מ-200ms (האצה איטית) ושיפוע מתעגל בקצהו. מרמז על PSV מאורך.

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6
Q

מה מוגדר כהצרות קריטית?

A

הצרות לומן של 50% או הצרות חתך רוחבי של 75%.

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7
Q

מה משפיע יותר על הזרימה, אורך ההצרות או קוטר ההצרות?

A

בעוד היחס בין הזרימה לאורך הוא הפוך לינארי, היחס בין הקוטר לזרימה הפוך הוא בחזקת 4.

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8
Q

What are the effects of Unfractionated heparin other then anticoagulation?

A

Unfractionated heparin has been shown to modulate endothelial cell permeability and pH.

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9
Q

מה המדדים שמעידים על failing vein graft?

A

ירידה באינדקס זרוע קרסול ב-0.15

PSV>300

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10
Q

מה הסיבה הכי שכיחה לכשלון מעקף בטווח הקצר (30 יום מהניתוח)?

A

בעיה טכנית בניתוח.

כולל בעיות בהשקה, בחירת אתר כניסה ויציאה עם זרימה נכנסת ויוצאת שאינה טובה ואחרות

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11
Q

מה הסיבה השכיחה ביותר לכשלון מעקף במשך טווח הזמן הבינוני (6-24 חודשים)?

A

מיואינטימאל היפרפלזיה באנסטמוזה.

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12
Q

מה הסיבה השכיחה לכשלון מעקף בטווח הארוך?

A

התקדמות פרוקסימלית או דיסטאלית של המחלה האטרוסקלרוטית.

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13
Q

MRA vs CTA.

Who is overestimates and who is underestimates the degree of stenosis.

A

CTA Underestimate

MRA Overestimate

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14
Q

What is the most common location for Adventitial Cystic Disease?

A

Popliteal artery 80% of cases.

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15
Q

What is the content of Adventitial Cystic?

A

Filled with a gelatinous mucoid material.

Microscopic: simple cuboid cell lining in the adventitial layer, with absence of any atherosclerotic disease.

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16
Q

What is the content of Popliteal artery adventitial cysts?

A

Filled with a gelatinous mucoid material.

Microscopic: simple cuboid cell lining in the adventitial layer, with absence of any atherosclerotic disease.

17
Q

What is the advantage of vein cuffs?

A

significantly improves patency for below the knee prostetic bypass.
2 years patency 52% with vs. 29% without vein cuff.
Also improves limb salvage (84% vs. 62%)
Still inferior to those of vein bypasses

18
Q

How is the renal resistive index measured?

A

(PSV-EDV) / PSV of interlobular vessels of kidney

19
Q

What is normal velocity in the intracranial vessels?

20
Q

What are low resistance circulations in the body that would have persistence of flow throughout diastole?

A

brain, kidneys, spleen, liver

21
Q

What kind of waveform would a ICA dissection have?

A

to and fro

22
Q

Absolute Indications for fasciotomy

A

Tense compartment+

  1. Pain with passive motion of muscles traversing the same compartment
  2. Paresis or paresthesias refer able to the same component
  3. Tense compartment in a patient who cannot be examined serially due to obtundation or need for other operations
  4. ICP minus mean blood pressure
23
Q

Potential indications for fasciotomy

A
  1. Acute ischemia >6 hrs with few collaterals
  2. Combined arterial and venous injuries
  3. Phlegmasia cerulean dozens
  4. Tense compartment after crush injury
  5. Tense compartment after fracture
24
Q

Contraindications to fasciotomy

A

Extremity is nonviable

Crush injuries

25
What are the four diagnostic criteria for Marfan's syndrome?
Ectopia lentis, pectus excavatum, height, evidence of dissection
26
What is the mutation in Marfan syndrome?
Fibrillin 1
27
What are the signs of malignant hyperthermia?
``` Early signs: Masseter rigidity Tachycardia Muscle rigidity Hypercarbia ``` Late signs: Hyperthermia, hyperkalemia, arrhythmia, myoglobinuria
28
What is the treatment of malignant hyperthermia?
Discontinue volatile anesthetic agents Administer dantrolene Treat hyperkalemia Monitor for DIC
29
What is the maximum dose of lidocaine and lidocaine with epi?
5 mg/kg for lidocaine plain 7 mg/kg for lidocaine with epi So for a 70kg person, 35 ml plain or 49ml with epi
30
location of subclavian vein?
between anterior scalene and subclavius muscle
31
What’s the interscalene triangle
Between anterior and middle scalene | Subclsvian artery and brachial plexus are in it
32
What’s the classification for cervical rib and what are the stages
Gruber classification 1. Less than 2.5 cm 2. More than 2.5 cm 3. Connected to the first rib with fibrous band 4. Connected with an actual articulation joint
33
Adson test
``` Sitting with hands on the knees Turn head to concerned side Deep inhale Radical pulse disappears High false positive rate ```
34
What is Profunda-popliteal collateral index and what is it used for?
PPCI is calculated as the difference between the above-knee and below-knee blood pressure divided by the above-knee pressure. Low index indicates good collateral development (little pressure drop across the knee) An index < 0.25 predicts a good result from profundaplasty without infrainguinal bypass. PPCI of greater than 0.50 predicts no improvement with profundaplasty alone.
35
What is tht main banifit of Antiplatlets?
Secondery cardiovascular prevention. | 20-30% risk reduction of nonfatal MI, nonfatal Stroke or vascular death.
36
What is tht main banifit of Statin?
22% relative risk reducation in the rate of first major vascular event regardless of LDL baseline. Reducation in amputation rate in CLI and improvment in walking distance.
37
What ACEi is recommended as first line for the treatment of HTN in patients with PAD?
Ramipril i

Vascular surgery - Rutherford's 9th ed (16 decks)

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