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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?

A

60 cm/sec

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
Q

What are the four diagnostic criteria for Marfan’s syndrome?

A

Ectopia lentis, pectus excavatum, height, evidence of dissection

26
Q

What is the mutation in Marfan syndrome?

A

Fibrillin 1

27
Q

What are the signs of malignant hyperthermia?

A 
Early signs:
Masseter rigidity
Tachycardia
Muscle rigidity
Hypercarbia

Late signs:
Hyperthermia, hyperkalemia, arrhythmia, myoglobinuria

28
Q

What is the treatment of malignant hyperthermia?

A

Discontinue volatile anesthetic agents
Administer dantrolene
Treat hyperkalemia
Monitor for DIC

29
Q

What is the maximum dose of lidocaine and lidocaine with epi?

A

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
Q

location of subclavian vein?

A

between anterior scalene and subclavius muscle

31
Q

What’s the interscalene triangle

A

Between anterior and middle scalene

Subclsvian artery and brachial plexus are in it

32
Q

What’s the classification for cervical rib and what are the stages

A

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
Q

Adson test

A 
Sitting with hands on the knees
Turn head to concerned side
Deep inhale
Radical pulse disappears
High false positive rate
34
Q

What is Profunda-popliteal collateral index and what is it used for?

A

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
Q

What is tht main banifit of Antiplatlets?

A

Secondery cardiovascular prevention.

20-30% risk reduction of nonfatal MI, nonfatal Stroke or vascular death.

36
Q

What is tht main banifit of Statin?

A

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
Q

What ACEi is recommended as first line for the treatment of HTN in patients with PAD?

A

Ramipril i

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

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