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vascular surgery > 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

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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3
Q

מה המדדים שמעידים על failing vein graft?

A

ירידה באינדקס זרוע קרסול ב-0.15

PSV>300

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4
Q

MRA vs CTA.

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

A

CTA Underestimate

MRA Overestimate

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5
Q

What is the most common location for Adventitial Cystic Disease?

A

Popliteal artery 80% of cases.

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6
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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7
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.

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8
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

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9
Q

How is the renal resistive index measured?

A

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

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10
Q

What is normal velocity in the intracranial vessels?

A

60 cm/sec

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11
Q

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

A

brain, kidneys, spleen, liver

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12
Q

What kind of waveform would a ICA dissection have?

A

to and fro

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13
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
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14
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
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15
Q

Contraindications to fasciotomy

A

Extremity is nonviable

Crush injuries

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16
Q

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

A

Ectopia lentis, pectus excavatum, height, evidence of dissection

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17
Q

What is the mutation in Marfan syndrome?

A

Fibrillin 1

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18
Q

What are the signs of malignant hyperthermia?

A 
Early signs:
Masseter rigidity
Tachycardia
Muscle rigidity
Hypercarbia

Late signs:
Hyperthermia, hyperkalemia, arrhythmia, myoglobinuria

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19
Q

What is the treatment of malignant hyperthermia?

A

Discontinue volatile anesthetic agents
Administer dantrolene
Treat hyperkalemia
Monitor for DIC

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20
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

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21
Q

location of subclavian vein?

A

between anterior scalene and subclavius muscle

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22
Q

What’s the interscalene triangle

A

Between anterior and middle scalene

Subclsvian artery and brachial plexus are in it

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23
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
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24
Q

Adson test

A 
Sitting with hands on the knees
Turn head to concerned side
Deep inhale
Radical pulse disappears
High false positive rate
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25
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.

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26
Q

What is the preferred treatment in Renal Artery Stenosis in atherosclerotic lesions (90% of cases)?

A

Most lesions are at the ostia (connecion to aorta).
ASTRAL and CORAL trials showed no advantage for stenting over medical treatment.

Intervention is in severe disease that fails to respond to aggressive medical therapy.

Open surgery in good risk patients with bilateral RAS or branched vessel disease who fali medical treatment and children with developmental RAS.

Balloon-expandable stents may be concidered, over open surgery, in low volume centers and for unilateral stenosis.

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27
Q

What is the preferred treatment in symptomatic Innominate Artery Stenosis?

A

Endovascular stenting.

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28
Q

What is the preferred treatment for thoracoabdominal aneurysems?

A

Endovascolar in degenerative aneurysems.

Open in connective tissue dessease.

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29
Q

What is the preferred treatment of acute aortic dissection type B?

A

Acute is up-to 14 days.
Id dissection is not complicated (pending rupture, endorgan malperfusion) conservative controling BP with BB in ICU to control symptoms.
If symptomatic in sub-acute (14-90 days): endovascular treatment.

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30
Q

What is the preferred treatment in Takayasu?

A

Steroids tretreatment.

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31
Q

What is the preferred treatment in symptomatic mid aortic syndrom (Life limitting cludication, severe stenosis, uncontroled hypertension) in Takayasu?

A

Open Aorto-Aortic bypass

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32
Q

What is the preferred treatment in renal stenosis due to Takayasu with uncontroled hypertension?

A

Endovascular with stent graft.

If failure, open bypasses.

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33
Q

What is the preferred treatment in symptomatic carotid stenosis (cerebelar ischemia or 70% symptomatic stenosis) due to Takayasu?

A

Open bypass from aortic arch.

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34
Q

What is the preferred treatment in symptomatic subclavian stenosis due to Takayasu?

A

Open bypass from aortic arch.

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35
Q

What is the preferred treatment in symptomatic coronary artery stenosis due to Takayasu?

A

CABG

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36
Q

What is the preferred treatment in Renal Artery Stenosis in fibromuscular dysplasia (FMD)?

A

This cases are less common.
Stenosis is usauly at the main renal artery (string of beads).
Treatment is PTA

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37
Q

What is the treatment of Adventitial Cystic Disease?

A

Resection and reconstruction in oclussion secondary to thrombosis. Posterior approach.

In none thrombosed artery, imaging-guided cyst aspiration or operative cyst evacuation and excision, offer good short-term outcomes (lowest recurrence in cyst recession).

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38
Q

What is the preferred treatment in case of Blunt Thoracic Aortic Injury?

A

In case of stage 1-3 and stable patient, the 1st line is medical treatment to control BP and later definitive TEVAR.

In Stage 4 and unstable patient TEVAR is preferred when applicable and open surgery is an option.

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39
Q

What is the preferred treatment for popliteal artery aneurysm?

A

Open medial approch. bypass + exclusion/ligation of the aneurysm.

Posterior approch is preferred for large, confined to the popliteal space and aneurysms causing symptoms from compression.

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40
Q

What is the preferred treatment for cervical trauma with hard signs?

A

Open surgicl approach.

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41
Q

What is the preferred treatment for cervical trauma with soft signs?

A

Zone I and Zone 3 - endovascular

Zone II - Operative repair.

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42
Q

What is the preferred treatment for Symptomatic Chronic Mesenteric Ischemia?

A

Endovascular treatment with balloon expandable covered stent.

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43
Q

Name histological findings of scalene muscle in TOS?

A

a. Predominance of Type I fibres
b. Increase in connective tissue
c. Endomysial fibrosis
d. Mitochondrial changes

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44
Q

List causes of emboli in ALI.

A

Cardiac (80-90%)
Atrial fibrillation
Post MI
Valvular prosthesis
Intracardiac tumour
Septic embolus
Non-cardiac (10%)
Atheroembolism from aneurysm or proximal aortic disease
Non-cardiac tumour
Paradoxical embolism
Foreign body
Microemboli
Most commonly femoral artery origin

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45
Q
  1. Name 3 groups that should be screened for AAA according to the vascular society
A

All men 65-75 years of age
Women over 65 years with high risk (smoking, family history, CVD)
Men below 65 years with family history

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46
Q

Name 3 studies that support surgery for symptomatic stenosis

A

NASCET
ECST
VAST

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47
Q

Name 2 studies that support surgery for asymptomatic stenosis

A

ACAS
VA asympto trial

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48
Q

About carotid artery stenting. Name 4-5 studies on carotid stenosis and their results (inferior, superior, similar or results pending)

A

ICSS (inferior)
CREST (inferior or same)
EVA-3S (inferior)
SPACE (inferior or similar)
SAPPHIRE (superior)
CAVATAS (similar, poor study)

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49
Q

What are side effects of scelrotherapy.

A

Anaphylaxis, allergic reaction
Thrombophlebitis (superficial and DVT)
Cutaneous necrosis
Pigmentation
Neoangiogenesis

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50
Q

List ways to avoid hyper pigmentation after sclerotherapy.

A

Use weaker concentration of sclerosing solution
Minimize intravascular pressure during injection
Remove postsclerotherapy coagula (use No 21 or 18 needle to allow expulsion of entrapped blood under pressure)

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51
Q

List technique to salvage stent deployment if balloon ruptures after 50% deployment.

A

a. Maintain wire access, replace balloon and deploy stent at original target
b. Maintain wire access, replace smaller balloon, “capture” stent and deploy in safe location (external iliac artery)
c. Snare stent and remove percutaneously or from surgically accessible location

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52
Q

List anomalies of IVC and renal vein.

A

retroaortic renal vein
cirumaortic renal vein
duplicated IVC
absent infrarenal IVC
Double IVC with Retroaortic Right Renal Vein and Hemiazygos Continuation of the IVC
Double IVC with Retroaortic Left Renal Vein and Azygos Continuation of the IVC
Azygos Continuation of the IVC

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53
Q

List causes of IC other then atheromatous.

A

Popliteal entrapment
Popliteal aneurysm
Cystic adventitial disease of popliteal artery
Pseudoxanthoma elasticum
Thromboangiitis obliterans
Peripheral emboli
Aortic coarctation
Takayasu’s disease
Remote trauma or radiation injury
Arterial fibrodysplasia
Persistent sciatic artery
Iliac syndrome of the cyclist
Primary vascular tumors

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54
Q

Pseudoaneurysm with AVF (hemodialysis) List 4-5 reasons to repair

A

o Increase in size
o Distal ischemia
o Overlying skin changes (may predispose pseudoaneurysm rupture)
o Persistent bleeding from puncture site
o Rupture
o Cosmesis (if AV fistula no longer needed, ie post renal transplant)

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55
Q

List 5 pathogens involved in infected aneurysm

A

o Salmonella spp (30%)
o Staphylococcus spp (19%)
o Streptococcus spp (9%)
o E Coli (9%)
o Bacteroides spp (5%)
o Enterococcus group (3%)
o Clostridium spp (3%)
candida
mycobacterium
treponema pallidum

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56
Q

Name different types of infected aneurysm.

A

o Mycotic aneurysm (gr + cocci: Strep viridans and faecalis, Staph aureus and epidermidis, )
o Microbial arteritis (Salmonella, Staph spp, E Coli and Bacteroides fragilis)
o Infection of existing aneurysm (Staph spp)
o Post-traumatic infected false aneurysm (Staph aureus, polymicrobial – Staph aureus, e Coli, Strep fecalis, Pseudomonas, various Enterobacter)

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57
Q

List 6 ways to predict success of a profundaplasty

A

a. Significant profunda stenosis or occlusion
b. Rest pain or minimal tissue loss
c. Good inflow
d. Occluded SFA
e. Healthy distal profunda
f. Good collaterals to tibial vessels (preferably 2 out of 3)

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58
Q

List facts that favour AKA over BKA.

A

i. Physical exam (ie. lack of femoral pulse)
ii. Skin temperature < 90°F
iii. Absolute ankle pressure < 60 mmHg
iv. Skin perfusion pressure < 20 mmHg at BKA level
v. Trans-cutaneous O2 below 30 mmHg at BKA level

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59
Q

Name clinical differences b/w primary and secondary Raynauds

A

Primary
female
teens-20s
family history
live in colder climates
Attacks triggered by exposure to cold and/or stress
Symmetric bilateral involvement
Absence of necrosis
Absence of a detectable underlying cause
Normal capillaroscopy findings
Normal laboratory findings for inflammation
Absence of antinuclear factors

Secondary
male or female
40s
Single digit involved
Abnormal pulse examination
Vascular laboratory abnormalities
Positive autoantibodies

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60
Q

Renal artery aneurysm.
Most common presentation
Most common location
Most common morphological characteristic.

A

incidental
90% extraparynchymal
75% saccular

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61
Q

What is indication for intervention on RAA?

A

>2-3cm
pregnancy
rupture
HTN (DBP >90 despite 3 antihtn
dissection if viability treatened

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62
Q

What is the difference between first and second generation fibrinolytics?
List 2nd generation.

A

2nd are fibrin selective
avoid systemic depletion of circulating fibrinogen and plasminogen

tPA (alteplase)
pro-urokinase

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63
Q

What is a type I error?

A

Incorrect rejection of a true null hypothesis

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64
Q

What is a type II error?

A

Failure to reject a false null hypothesis

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65
Q

What is alpha error?

A

type I error

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66
Q

What is beta error?

A

type II error

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67
Q

How do you calculate Odds ratio?

A

AD/BC

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68
Q

How do you calculate PPV?

A

true positives/(#true positives + number of false positives)

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69
Q

How do you calculate NPV?

A

of true negatives/(# of true negatives + # of false negatives)

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70
Q

How to calculate NNT?

A

1/ARR

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71
Q

How to calculate ARR?

A

control event rate-experimental event rate

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72
Q

What is the definition of primary assisted patency?

A

time from access placement to access thrombosis with intervention designed to maintain functionality of an access

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73
Q

What is functional patency?

A

indicate patent start date of first successful cannulation

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74
Q

List the seven roles of the CanMEDS framework.

A

medical expert
scholar
professional
health advocate
manager
communicator
collaborator

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75
Q

What are symptoms of delirium tremens?

A

hallucinations
fever
HTN
sweating
tachycardia
tremors
anxiey
confusion
seizure

76
Q

List large-vessel vasculitis.

A

Giant cell arteritis
takayasu
PMR

77
Q

List medium vessel vasculitis.

A

Polyarteritis nodosa
Burgers
kawasaki

78
Q

List small vessel vasculitis.

A

bechets
churg strauss
henoch-scholein

79
Q

How is PAN divided?

A 
idopathic 
secondary (hep B)
80
Q

What vasculidities have circulating ANCA?

A

wegners
microscopic polyangitis

81
Q

What are three clinical features of coogans?

A

interstitial keratitis
vestibular dysfunction
sensorineural hearing loss

82
Q

What are clinical features of Bechets?

A

recurrent mucocutaneous lesion
genital ulcers
opthalmic complications

83
Q

What is the most common cause of death in kawasaki?

A

MI

84
Q

what are clinical features of Giant cell?

A

H/A
modularity of temporal artery
constitutional symptoms
TIA

85
Q

What are criteria to reopen a CEA on intra-op duplex?

A

Wall irregularity or small flap <3mm
Stenosis PSV >150cm/s and turbulent flow spectra
Lumen thrombosis

86
Q

What are duplex criteria of carotid occlusion?

A

No flow distal ICA on low PRF settings
CCA low velocity high resistance pattern, possible reverse flow in diastole
Low flow resistance in ECA internalization of ECA(collaterals)
Flow thump recorded at prox ICA
Increased contralateral velocities in ICA CCA

87
Q

What are components of metabolic syndrome?

A

Central obesity
Elevated BP
Elevated fasting glucose
High serum cholesterol
Low HDL

88
Q

What are the branches of the external iliac?

A

Inferior epigastric
Deep circumflex iliac

89
Q

What are the branches of the common femoral?

A

Superficial epigastric
Superficial iliac circumflex
Superficial external pudendal
Deep external pudendal

90
Q

What are the branches of the internal iliac?

A

Obturator
Superior vesical
Inferior vesical
Middle rectal
Internal pudendal
Inferior gluteal
Superior gluteal
Lateral sacral

91
Q

What are key elements for cholesterol embolization syndrome?

A

Plaque in large arteries
Spontaneous, traumatic plaque rupture
Embolization of material
Lodging of emboli in small artery
Foreign body inflammatory response
End organ damage

92
Q

What are clinical manifestations of cholesterol emboli?

A

Purple toes
Gangrenous digits
Ulcerations
Renal failure
Htn
Tia
Stroke
Hollenhorst plaque
Mi
GI bleeding
Ischemic bowel

93
Q

What is medical therapy for cholesterol emboli syndrome?

A

Corticosteroids
Statins
Iloprost
Anti PLT

94
Q

What are the phases of growth of infantile hemangiomas?

A

Growth <8
Resting 8-14
Involution 1-5

95
Q

What are findings on thoracic aorta on TEE that indicate high risk for atheroembolism?

A

Thickness >4mm
Lack of plaque
Mobile plaque

96
Q

What is the blood supply to the spinal cord?

A

Vertebrals-one anterior spinal artery
PICA-paired posterior spinal artery
Spinal arteries supplied by radicular artery

97
Q

What occupational vascular syndromes are caused by manual labor?

A

Hand-arm vibration syndrome
Hypothenar hammer syndrome

98
Q

What are symptoms of HAVS?

A

intermittent numbness or tingling progressing to extensive blanching
1 hour attack with reactive hyperaemia

99
Q

How is diagnosis made of HAVS?

A

provocation and history of raynauds with vibration tool

100
Q

What are arteriographic changes in HAVS?

A

multiple segmental occlusions of digits
corkscrew configuration of vessels in hand
incomplete palmar arch

101
Q

What is HAVS treatment

A

CCB
IV prostanoids
cervical of digital sympathectomy

102
Q

Where and how does injury occur in HHS?

A

ulnar travels in guyon’s canal bound by pisiform and hamate bones, only covered by skin
repetitive injury to this site
vasospasm and plt aggregation and thrombus with distal embo

103
Q

What are symptoms in HHS?

A

raynauds, involves ulanr three digits (not thumb)

104
Q

What are treatments for HHS?

A

smoking cessation
anticoag
CCB
reconstruction/ligation

105
Q

Name three exposure injuries.

A

occupation acro-osteolysis
electrical burns
thermal injuries

106
Q

What is acro-osteolysis?

A

exposure to polyvinyl chloride
raunauds, clubbin
angio–multiple stenosis with hypervascularity adjacent to the bone of reabsorption

107
Q

What is the vascular run jury with electrical burns?

A

Arterial necorsis, thrombus, bleeding, and gangrene of digits, aneurysm formation

108
Q

What profession get thermal injuries?

A

exposure to cold, slaughterhouse, canning factories, fisheries

109
Q

What are some injuries that athletes get?

A

hand ischemia
quadrilateral space syndrome
humeral head compression of axillary artery
TOS

110
Q

What kind of athletes get these injuries and what are the symptoms?

A

baseball, volleyball, karate, swimming, golf, weightlifting

raynauds, aterial occlusion, embo to digits

111
Q

What is the mechanism of injury in hand ischemia?

A

digital artery injury
embolization from proximal source

112
Q

What are the mechanisms which cause hand ischemia?

A 
direct injury (baseball catchers) 
compression of digital artery by cleland ligament
113
Q

What is treatment for hand ischemia?

A

IV dextran and pain control
sx–digital sympathectomy, release of clelands ligament
prevention

114
Q

Describe the quadrilateral space. What travels in it?

A

Bordered by teres minor, humeral shaft, tere minor, and long head of tricpes
Within the space posterior humeral circumflex artery and axillary nerve

115
Q

Who gets QSS? What vascular abnormalities do they get?

A

pitcher, volleyball (cocked position)
aneurysm with embo (to hand), occlusions
from compression of the posterior circumflex artery

116
Q

What is the aetiology of HHCAA?

A

compression of third portion of axillary artery by head of humerus

117
Q

What are the symptoms of HHCAA?

A

numbness of fingers, raynauds, cutaneous embolization

118
Q

What is treatment?

A

modification of throwing
saphenous vein patch, bypass

119
Q

Name sites or injury and the vessel injured that can digital symptoms.

A

Scalene triangle, subclavian artery
subcoracoid space, axillary artery
cleland ligament, digital artery
direct injury, digital artery
guyon’s space, ulnar artery
quadrilateral space, posterior circumflex artery
humeral head, axillary artery

120
Q

How is raynauds with HHS distinguishable from other presentation of raynauds?

A

Predominance male smokers
Usually lacks reactive hyperaemia
Usually dominant hand
Repetitive trauma to hand

121
Q

Describe the mechanism of an erection.

A

parasympathetic division of the ANS causes NO levels to rise in the trabecular arteries and smooth muscle of penis

vasodilation causes corpora cavernosa to fill

simultaneously the ischiocavernosus and bulbospongiosus muscles compress vein of corpora cavernosus preventing egress of blood.

122
Q

Describe the blood supply to the penis.
Which artery affects tumescence?

A

IIA
branch internal pudendal
becomes common penile after
subdivides into coral, cavernosal and bulbourethral

accessory pudendals from EIA, obturator, vesicle, and femoral arteries

cavernosal

123
Q

What nerve supply is interrupted in AAA surgery?

A

parasympathetic and visceral afferent nerve fibers

they supply the erectile tissue

124
Q

How many men suffer from ED post AAA repair?
What are the specific erectile issues?

A

20-30%
retrograde ejaculate
difficult achieving or maintaining erection

125
Q

What are the different causes of ED?

A

psychogenic
neurogenic
endocrinologic
vasculogenic
drug induced

126
Q

What are risk factors for vasculogenic ED?

A

HNT
DM
DLP
obesity
smoking

127
Q

What are different diagnostic techniques for ED?

A

nocturnal penile tumescence monitoring (can distinguish psychogenic from vascular)

penile brachial pressure (high inter-observer reliability)

office injection test (seldom performed)

Duplex
induce erection
PSV, EDV, RI of penile artery

pudendal and penile angiography

128
Q

What are duplex findings suggestive of vascular ED?

A

PSV 10cm/sec asymmetry

129
Q

Name different pharmacological tx for ED.

A

PDE5 inhibitor
sildenafil
vardenafil
tadalafil
avanafil

intracavernosal injection
PGE1
phentolamin
papaverine

intraurethral PGE1 suppository

130
Q

How to PDE5 inhibitors work?

A

inhibit PDE5 enzyme which degrade cGMP

cGMP in the downstream effector of NO

prolonged cGMP decrease intracellular ca and maintains SM relaxation

131
Q

What are mechanical and sx tx of ED?

A

vacuum constriction devices
penile implant surgery
penile revasclarization
(inf epigastric to dorsal artery bypass)
ligation of crural vein for veno-occlusive dz

132
Q

What incision best for T3-T6?
T7-12

A

right thoracotomy
left thoracotomy

133
Q

What are different approaches to the lumbosacral spine?

A

Transperitoneal exposure
Transperitoneal laparoscopic
Retroperitoneal

134
Q

What are different methods of acquiring an AVF?

A

traumatic
iatrogenic
spontaneously

135
Q

What is the natural hx of an iatrogenic AVF?

A

shunt volumes <500
50% close spon
usually benign

136
Q

List disease associated with spontaneous AVF.

A

aneurysm
syphillis
HIV
CTD

137
Q

What are the aAVF connection for carotid and vert?

A

to internal jugular

138
Q

What are RF for femoral aAVF?

A

Older age
Female
Htn
Anticoagulation
Higher dose heparin
Warfarin
Left sided puncture
Multiple puncture
Low puncture
Large sheath
High BMI

139
Q

What anatomical parameters determine flow in the distal artery?

A

CSA of fistula =/< then 1.5 d of inflow artery then distal flow in artery maintained

flow diminished or reversed if opening threefold size of artery

prox flow increase by x5 if 3

140
Q

What are changes to vessels in chronic aAVF?

A

Proximally artery elongates
Artery thins ultimately leading to aneurismal degen
Proximal vein enlarges and becomes tortuous
Distal artery flow often reversed
Venous collateral
Reversible if repaired within 2 years

141
Q

What are cath findings with large aAVF?

A

increased CO
elevated RA, RV, wedge P
decease in PVR

142
Q

What are findings on duplex for aAVF?

A

Fistilous connection
Clor mosaic at level of fistula
Color pixels in adjacent soft tissue
Loss of triphasic wave forms in prox artery
Decreased flow in distal artery
Continuous high velocity flow in vein cephalad

143
Q

What are findings of aAVF on angio?

A

Early venous filling
Failure of distal vessels to opacify

144
Q

What are treatment strategies?

A

conservative for 1 year, indefinitely if really small and no sequallae

US guided compression –poor success rate

endovascular
embolization
covered stent
aortic endografts

surgery

145
Q

List occlusive clamps.

A

Debakey aortic aneurysm clamp
Fogarty aortic clamp
Lambert-kay aortic clamp
Wylie hypogastric clamp

146
Q

List partially occluding clamps.

A

Lemole-strong aortic clamp
Statinsky
Cooley anastomosis

147
Q

List self compressing clamps.

A

Potts bulldog
Debakey bulldog
Dietrich bulldog

148
Q

List different needle types.

A

Calcific CC
Small BV
Medium C1
Large RB-1
Large aorta v7
Large MH

149
Q

List when to use what size fogarty.

A

2F small vessel pedal/hand
3F tibial
4F pop/SFA
5F external iliac
6-7 graft saddle aortic

150
Q

List adjunct to localizeing th eCFA for puncture.

A

palpation/landmarks
fluoro
US

151
Q

What is the gauge of a puncture needle? micro puncture?

A 
18 gauge (0.035) 
21 gauge (0.018)
152
Q

What is the pressure limit for flow through a multi holed and end hole catheter?

A

900 PSI
300-500 PSI

153
Q

List different flush catheters.

A

pigtail
omni
straight

154
Q

List different single curved.

A

kumpe
Bernstein
MPA
MPB

155
Q

List different double curved.

A

C1
C2
C3
head hunter
Rim
mammary
judkins

156
Q

List diffferent reverse curve

A

SOS
VS1-3
simmons

157
Q

Name different crossing catheters.

A

quick cross
trailblazer
crosscath
minnie

158
Q

What is nominal pressure?

A

Pressure required to expand the balloon to stated diameter

159
Q

What is rated burst pressure?

A

Pressure at which 99.9% of balloons tested will not burst

160
Q

What is compliance?

A

Amount a balloon will expand beyond its diameter as inflation pressure is increased

161
Q

Do lower compliance balloon have higher or lower burst P?

A

lower

162
Q

What is trackability?

A

Ability to follow course of guide wire

163
Q

What is push ability?

A

Columnar force transmitted to shaft of balloon catheter to tip of balloon

164
Q

What size balloon for CIA?
EIA?
SFA?
pop?
tibial?

A

6-10
6-8
5-7
4-6
2-3

165
Q

List three devices used for crossing CTO?

A 
corsser device (vibrate) 
truepath (rotational) 
frontrunner (articulating)
166
Q

What are pros for BE?

A

high radial force/ongitudinal force
precise placement
further expansion with larger balloons
radioopaque

167
Q

What are cons for BE?

A

short lengths, prone to crushing

168
Q

What are pros for SE?

A

flexible, longer length
continued radial force ir oversize
crush resistant
ability to clamp stent

169
Q

What are cons for SE?

A

low radial force
less precise
limited radioopacity

170
Q

What are indications for secondary stenting?

A

Dissection
Residual stenosis
Pressure gradient
Occlusion
Recurrence

171
Q

What are indication for primary stenting?

A

Heavily calcified ostial lesions
Renal, mesenteric
Brachiocephalic
Aortic bifurcation

172
Q

What are relative indications for aorta-uni?

A

Very small terminal aorta <15mm
Severe unilateral iliac occlusive disease
Secondary treatment of a short-body endograft migration

173
Q

What are some anatomical considerations for EVAR?

A

neck 10-15mm
neck diameter accomodate 10-20% oversize
angulation <20mm
iliac coverage 2cm
careful thrombus, conical, calcified, posterior bulges in neck

174
Q

what are relative CI for perch closure?

A

severly scarred groins
high fem bifurcation
frequen introducer changes
significant prox iliac occlusive disease
small ilio fem
anterior calcific femoral

175
Q

What are adjunct to facilitate contra limb cannulation?

A

don’t loose wire access on contra side/may be difficult to regain if tortuose
choose steerable angled wire
oblique fluoro view
antegrade access from brachial
convert to aorto-uni

176
Q

What to look for on completion angio?

A

confirm patency of renal hypo
assess precision of LZ
eval for iliac dz
endoleaks

177
Q

How to manage Type Ia?

A

compliant balloon if 5mm then consider aortic cuff
palmaz (5cm at 10mm expansion
33mm at 28 mm)

178
Q

How to manage type Ib?

A

angioplasty
extension

179
Q

How to manage III?

A

angio
bridging stent

180
Q

How to manage renal artery coverage?

A

Pull caudally (wire over flow divider)
Snorkerl (best from brachial)
Bypass
Open conversion

181
Q

How to manage CIA aneurysm?

A

Can extend into EIA
Occlude the hypo
Branched graft
Bypass

182
Q

When to treat type II endoleaks?

A

evidence of type II with growth of 5mm

183
Q

what are treatment options for type II?

A

coil or glue embo
transarterial (branch vessel, behind limb)
translumbar
transcaval

laparascopic IMA clipping

open surgical
ligation
conversion

184
Q

What are the landing zones of the arch?

A

0 up to distal in nom
1up to distal LCA
2 up to distal scla
3 prox DTA
4 mid-distal DTA

185
Q

What are indications for spinal cord drainage?

A

prior AAA
extensive coverage thoracic aorta
coverage T8-L2
LSCLA without revasc
dissection with malperfusion

186
Q

List indications for LSCA revasc.

A

patent LIMA bypass
dominant l vert
left vert with terminate PICA
aortic arch origin of left vert
hypo or stenotic right vert artery
AVF in dialysis patient

187
Q

What are techniques for management of branches?

A

debranching
parallel stents
BEVAR, FEVAR
Z-fen

vascular surgery (37 decks)

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