General Flashcards
What arteries produce a monophasic flow pulsed Doppler spectral waveform and why?
Arteries with low ressitance arterial flow will product monophase wave form. The arteries are: - Internal carotid - Vertebral - Renal - Celiac - Splenic - Hepatic
What are the effects of Unfractionated heparin other then anticoagulation?
Unfractionated heparin has been shown to modulate endothelial cell permeability and pH.
מה המדדים שמעידים על failing vein graft?
ירידה באינדקס זרוע קרסול ב-0.15
PSV>300
MRA vs CTA.
Who is overestimates and who is underestimates the degree of stenosis.
CTA Underestimate
MRA Overestimate
What is the most common location for Adventitial Cystic Disease?
Popliteal artery 80% of cases.
What is the content of Adventitial Cystic?
Filled with a gelatinous mucoid material.
Microscopic: simple cuboid cell lining in the adventitial layer, with absence of any atherosclerotic disease.
What is the content of Popliteal artery adventitial cysts?
Filled with a gelatinous mucoid material.
Microscopic: simple cuboid cell lining in the adventitial layer, with absence of any atherosclerotic disease.
What is the advantage of vein cuffs?
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
How is the renal resistive index measured?
(PSV-EDV) / PSV of interlobular vessels of kidney
What is normal velocity in the intracranial vessels?
60 cm/sec
What are low resistance circulations in the body that would have persistence of flow throughout diastole?
brain, kidneys, spleen, liver
What kind of waveform would a ICA dissection have?
to and fro
Absolute Indications for fasciotomy
Tense compartment+
- Pain with passive motion of muscles traversing the same compartment
- Paresis or paresthesias refer able to the same component
- Tense compartment in a patient who cannot be examined serially due to obtundation or need for other operations
- ICP minus mean blood pressure
Potential indications for fasciotomy
- Acute ischemia >6 hrs with few collaterals
- Combined arterial and venous injuries
- Phlegmasia cerulean dozens
- Tense compartment after crush injury
- Tense compartment after fracture
Contraindications to fasciotomy
Extremity is nonviable
Crush injuries
What are the four diagnostic criteria for Marfan’s syndrome?
Ectopia lentis, pectus excavatum, height, evidence of dissection
What is the mutation in Marfan syndrome?
Fibrillin 1
What are the signs of malignant hyperthermia?
Early signs: Masseter rigidity Tachycardia Muscle rigidity Hypercarbia
Late signs:
Hyperthermia, hyperkalemia, arrhythmia, myoglobinuria
What is the treatment of malignant hyperthermia?
Discontinue volatile anesthetic agents
Administer dantrolene
Treat hyperkalemia
Monitor for DIC
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
location of subclavian vein?
between anterior scalene and subclavius muscle
What’s the interscalene triangle
Between anterior and middle scalene
Subclsvian artery and brachial plexus are in it
What’s the classification for cervical rib and what are the stages
Gruber classification
- Less than 2.5 cm
- More than 2.5 cm
- Connected to the first rib with fibrous band
- Connected with an actual articulation joint
Adson test
Sitting with hands on the knees Turn head to concerned side Deep inhale Radical pulse disappears High false positive rate
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.
What is the preferred treatment in Renal Artery Stenosis in atherosclerotic lesions (90% of cases)?
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.
What is the preferred treatment in symptomatic Innominate Artery Stenosis?
Endovascular stenting.
What is the preferred treatment for thoracoabdominal aneurysems?
Endovascolar in degenerative aneurysems.
Open in connective tissue dessease.
What is the preferred treatment of acute aortic dissection type B?
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.
What is the preferred treatment in Takayasu?
Steroids tretreatment.
What is the preferred treatment in symptomatic mid aortic syndrom (Life limitting cludication, severe stenosis, uncontroled hypertension) in Takayasu?
Open Aorto-Aortic bypass
What is the preferred treatment in renal stenosis due to Takayasu with uncontroled hypertension?
Endovascular with stent graft.
If failure, open bypasses.
What is the preferred treatment in symptomatic carotid stenosis (cerebelar ischemia or 70% symptomatic stenosis) due to Takayasu?
Open bypass from aortic arch.
What is the preferred treatment in symptomatic subclavian stenosis due to Takayasu?
Open bypass from aortic arch.
What is the preferred treatment in symptomatic coronary artery stenosis due to Takayasu?
CABG
What is the preferred treatment in Renal Artery Stenosis in fibromuscular dysplasia (FMD)?
This cases are less common.
Stenosis is usauly at the main renal artery (string of beads).
Treatment is PTA
What is the treatment of Adventitial Cystic Disease?
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).
What is the preferred treatment in case of Blunt Thoracic Aortic Injury?
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.
What is the preferred treatment for popliteal artery aneurysm?
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.
What is the preferred treatment for cervical trauma with hard signs?
Open surgicl approach.
What is the preferred treatment for cervical trauma with soft signs?
Zone I and Zone 3 - endovascular
Zone II - Operative repair.
What is the preferred treatment for Symptomatic Chronic Mesenteric Ischemia?
Endovascular treatment with balloon expandable covered stent.
Name histological findings of scalene muscle in TOS?
a. Predominance of Type I fibres
b. Increase in connective tissue
c. Endomysial fibrosis
d. Mitochondrial changes
List causes of emboli in ALI.
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
- Name 3 groups that should be screened for AAA according to the vascular society
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
Name 3 studies that support surgery for symptomatic stenosis
NASCET
ECST
VAST
Name 2 studies that support surgery for asymptomatic stenosis
ACAS
VA asympto trial
About carotid artery stenting. Name 4-5 studies on carotid stenosis and their results (inferior, superior, similar or results pending)
ICSS (inferior)
CREST (inferior or same)
EVA-3S (inferior)
SPACE (inferior or similar)
SAPPHIRE (superior)
CAVATAS (similar, poor study)
What are side effects of scelrotherapy.
Anaphylaxis, allergic reaction
Thrombophlebitis (superficial and DVT)
Cutaneous necrosis
Pigmentation
Neoangiogenesis
List ways to avoid hyper pigmentation after sclerotherapy.
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)
List technique to salvage stent deployment if balloon ruptures after 50% deployment.
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
List anomalies of IVC and renal vein.
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
List causes of IC other then atheromatous.
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
Pseudoaneurysm with AVF (hemodialysis) List 4-5 reasons to repair
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)
List 5 pathogens involved in infected aneurysm
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
Name different types of infected aneurysm.
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)
List 6 ways to predict success of a profundaplasty
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)
List facts that favour AKA over BKA.
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
Name clinical differences b/w primary and secondary Raynauds
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
Renal artery aneurysm.
Most common presentation
Most common location
Most common morphological characteristic.
incidental
90% extraparynchymal
75% saccular
What is indication for intervention on RAA?
>2-3cm
pregnancy
rupture
HTN (DBP >90 despite 3 antihtn
dissection if viability treatened
What is the difference between first and second generation fibrinolytics?
List 2nd generation.
2nd are fibrin selective
avoid systemic depletion of circulating fibrinogen and plasminogen
tPA (alteplase)
pro-urokinase
What is a type I error?
Incorrect rejection of a true null hypothesis
What is a type II error?
Failure to reject a false null hypothesis
What is alpha error?
type I error
What is beta error?
type II error
How do you calculate Odds ratio?
AD/BC
How do you calculate PPV?
true positives/(#true positives + number of false positives)
How do you calculate NPV?
of true negatives/(# of true negatives + # of false negatives)
How to calculate NNT?
1/ARR
How to calculate ARR?
control event rate-experimental event rate
What is the definition of primary assisted patency?
time from access placement to access thrombosis with intervention designed to maintain functionality of an access
What is functional patency?
indicate patent start date of first successful cannulation
List the seven roles of the CanMEDS framework.
medical expert
scholar
professional
health advocate
manager
communicator
collaborator
What are symptoms of delirium tremens?
hallucinations
fever
HTN
sweating
tachycardia
tremors
anxiey
confusion
seizure
List large-vessel vasculitis.
Giant cell arteritis
takayasu
PMR
List medium vessel vasculitis.
Polyarteritis nodosa
Burgers
kawasaki
List small vessel vasculitis.
bechets
churg strauss
henoch-scholein
How is PAN divided?
idopathic secondary (hep B)
What vasculidities have circulating ANCA?
wegners
microscopic polyangitis
What are three clinical features of coogans?
interstitial keratitis
vestibular dysfunction
sensorineural hearing loss
What are clinical features of Bechets?
recurrent mucocutaneous lesion
genital ulcers
opthalmic complications
What is the most common cause of death in kawasaki?
MI
what are clinical features of Giant cell?
H/A
modularity of temporal artery
constitutional symptoms
TIA
What are criteria to reopen a CEA on intra-op duplex?
Wall irregularity or small flap <3mm
Stenosis PSV >150cm/s and turbulent flow spectra
Lumen thrombosis
What are duplex criteria of carotid occlusion?
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
What are components of metabolic syndrome?
Central obesity
Elevated BP
Elevated fasting glucose
High serum cholesterol
Low HDL
What are the branches of the external iliac?
Inferior epigastric
Deep circumflex iliac
What are the branches of the common femoral?
Superficial epigastric
Superficial iliac circumflex
Superficial external pudendal
Deep external pudendal
What are the branches of the internal iliac?
Obturator
Superior vesical
Inferior vesical
Middle rectal
Internal pudendal
Inferior gluteal
Superior gluteal
Lateral sacral
What are key elements for cholesterol embolization syndrome?
Plaque in large arteries
Spontaneous, traumatic plaque rupture
Embolization of material
Lodging of emboli in small artery
Foreign body inflammatory response
End organ damage
What are clinical manifestations of cholesterol emboli?
Purple toes
Gangrenous digits
Ulcerations
Renal failure
Htn
Tia
Stroke
Hollenhorst plaque
Mi
GI bleeding
Ischemic bowel
What is medical therapy for cholesterol emboli syndrome?
Corticosteroids
Statins
Iloprost
Anti PLT
What are the phases of growth of infantile hemangiomas?
Growth <8
Resting 8-14
Involution 1-5
What are findings on thoracic aorta on TEE that indicate high risk for atheroembolism?
Thickness >4mm
Lack of plaque
Mobile plaque
What is the blood supply to the spinal cord?
Vertebrals-one anterior spinal artery
PICA-paired posterior spinal artery
Spinal arteries supplied by radicular artery
What occupational vascular syndromes are caused by manual labor?
Hand-arm vibration syndrome
Hypothenar hammer syndrome
What are symptoms of HAVS?
intermittent numbness or tingling progressing to extensive blanching
1 hour attack with reactive hyperaemia
How is diagnosis made of HAVS?
provocation and history of raynauds with vibration tool
What are arteriographic changes in HAVS?
multiple segmental occlusions of digits
corkscrew configuration of vessels in hand
incomplete palmar arch
What is HAVS treatment
CCB
IV prostanoids
cervical of digital sympathectomy
Where and how does injury occur in HHS?
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
What are symptoms in HHS?
raynauds, involves ulanr three digits (not thumb)
What are treatments for HHS?
smoking cessation
anticoag
CCB
reconstruction/ligation
Name three exposure injuries.
occupation acro-osteolysis
electrical burns
thermal injuries
What is acro-osteolysis?
exposure to polyvinyl chloride
raunauds, clubbin
angio–multiple stenosis with hypervascularity adjacent to the bone of reabsorption
What is the vascular run jury with electrical burns?
Arterial necorsis, thrombus, bleeding, and gangrene of digits, aneurysm formation
What profession get thermal injuries?
exposure to cold, slaughterhouse, canning factories, fisheries
What are some injuries that athletes get?
hand ischemia
quadrilateral space syndrome
humeral head compression of axillary artery
TOS
What kind of athletes get these injuries and what are the symptoms?
baseball, volleyball, karate, swimming, golf, weightlifting
raynauds, aterial occlusion, embo to digits
What is the mechanism of injury in hand ischemia?
digital artery injury
embolization from proximal source
What are the mechanisms which cause hand ischemia?
direct injury (baseball catchers) compression of digital artery by cleland ligament
What is treatment for hand ischemia?
IV dextran and pain control
sx–digital sympathectomy, release of clelands ligament
prevention
Describe the quadrilateral space. What travels in it?
Bordered by teres minor, humeral shaft, tere minor, and long head of tricpes
Within the space posterior humeral circumflex artery and axillary nerve
Who gets QSS? What vascular abnormalities do they get?
pitcher, volleyball (cocked position)
aneurysm with embo (to hand), occlusions
from compression of the posterior circumflex artery
What is the aetiology of HHCAA?
compression of third portion of axillary artery by head of humerus
What are the symptoms of HHCAA?
numbness of fingers, raynauds, cutaneous embolization
What is treatment?
modification of throwing
saphenous vein patch, bypass
Name sites or injury and the vessel injured that can digital symptoms.
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
How is raynauds with HHS distinguishable from other presentation of raynauds?
Predominance male smokers
Usually lacks reactive hyperaemia
Usually dominant hand
Repetitive trauma to hand
Describe the mechanism of an erection.
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.
Describe the blood supply to the penis.
Which artery affects tumescence?
IIA
branch internal pudendal
becomes common penile after
subdivides into coral, cavernosal and bulbourethral
accessory pudendals from EIA, obturator, vesicle, and femoral arteries
cavernosal
What nerve supply is interrupted in AAA surgery?
parasympathetic and visceral afferent nerve fibers
they supply the erectile tissue
How many men suffer from ED post AAA repair?
What are the specific erectile issues?
20-30%
retrograde ejaculate
difficult achieving or maintaining erection
What are the different causes of ED?
psychogenic
neurogenic
endocrinologic
vasculogenic
drug induced
What are risk factors for vasculogenic ED?
HNT
DM
DLP
obesity
smoking
What are different diagnostic techniques for ED?
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
What are duplex findings suggestive of vascular ED?
PSV 10cm/sec asymmetry
Name different pharmacological tx for ED.
PDE5 inhibitor
sildenafil
vardenafil
tadalafil
avanafil
intracavernosal injection
PGE1
phentolamin
papaverine
intraurethral PGE1 suppository
How to PDE5 inhibitors work?
inhibit PDE5 enzyme which degrade cGMP
cGMP in the downstream effector of NO
prolonged cGMP decrease intracellular ca and maintains SM relaxation
What are mechanical and sx tx of ED?
vacuum constriction devices
penile implant surgery
penile revasclarization
(inf epigastric to dorsal artery bypass)
ligation of crural vein for veno-occlusive dz
What incision best for T3-T6?
T7-12
right thoracotomy
left thoracotomy
What are different approaches to the lumbosacral spine?
Transperitoneal exposure
Transperitoneal laparoscopic
Retroperitoneal
What are different methods of acquiring an AVF?
traumatic
iatrogenic
spontaneously
What is the natural hx of an iatrogenic AVF?
shunt volumes <500
50% close spon
usually benign
List disease associated with spontaneous AVF.
aneurysm
syphillis
HIV
CTD
What are the aAVF connection for carotid and vert?
to internal jugular
What are RF for femoral aAVF?
Older age
Female
Htn
Anticoagulation
Higher dose heparin
Warfarin
Left sided puncture
Multiple puncture
Low puncture
Large sheath
High BMI
What anatomical parameters determine flow in the distal artery?
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
What are changes to vessels in chronic aAVF?
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
What are cath findings with large aAVF?
increased CO
elevated RA, RV, wedge P
decease in PVR
What are findings on duplex for aAVF?
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
What are findings of aAVF on angio?
Early venous filling
Failure of distal vessels to opacify
What are treatment strategies?
conservative for 1 year, indefinitely if really small and no sequallae
US guided compression –poor success rate
endovascular
embolization
covered stent
aortic endografts
surgery
List occlusive clamps.
Debakey aortic aneurysm clamp
Fogarty aortic clamp
Lambert-kay aortic clamp
Wylie hypogastric clamp
List partially occluding clamps.
Lemole-strong aortic clamp
Statinsky
Cooley anastomosis
List self compressing clamps.
Potts bulldog
Debakey bulldog
Dietrich bulldog
List different needle types.
Calcific CC
Small BV
Medium C1
Large RB-1
Large aorta v7
Large MH
List when to use what size fogarty.
2F small vessel pedal/hand
3F tibial
4F pop/SFA
5F external iliac
6-7 graft saddle aortic
List adjunct to localizeing th eCFA for puncture.
palpation/landmarks
fluoro
US
What is the gauge of a puncture needle? micro puncture?
18 gauge (0.035) 21 gauge (0.018)
What is the pressure limit for flow through a multi holed and end hole catheter?
900 PSI
300-500 PSI
List different flush catheters.
pigtail
omni
straight
List different single curved.
kumpe
Bernstein
MPA
MPB
List different double curved.
C1
C2
C3
head hunter
Rim
mammary
judkins
List diffferent reverse curve
SOS
VS1-3
simmons
Name different crossing catheters.
quick cross
trailblazer
crosscath
minnie
What is nominal pressure?
Pressure required to expand the balloon to stated diameter
What is rated burst pressure?
Pressure at which 99.9% of balloons tested will not burst
What is compliance?
Amount a balloon will expand beyond its diameter as inflation pressure is increased
Do lower compliance balloon have higher or lower burst P?
lower
What is trackability?
Ability to follow course of guide wire
What is push ability?
Columnar force transmitted to shaft of balloon catheter to tip of balloon
What size balloon for CIA?
EIA?
SFA?
pop?
tibial?
6-10
6-8
5-7
4-6
2-3
List three devices used for crossing CTO?
corsser device (vibrate) truepath (rotational) frontrunner (articulating)
What are pros for BE?
high radial force/ongitudinal force
precise placement
further expansion with larger balloons
radioopaque
What are cons for BE?
short lengths, prone to crushing
What are pros for SE?
flexible, longer length
continued radial force ir oversize
crush resistant
ability to clamp stent
What are cons for SE?
low radial force
less precise
limited radioopacity
What are indications for secondary stenting?
Dissection
Residual stenosis
Pressure gradient
Occlusion
Recurrence
What are indication for primary stenting?
Heavily calcified ostial lesions
Renal, mesenteric
Brachiocephalic
Aortic bifurcation
What are relative indications for aorta-uni?
Very small terminal aorta <15mm
Severe unilateral iliac occlusive disease
Secondary treatment of a short-body endograft migration
What are some anatomical considerations for EVAR?
neck 10-15mm
neck diameter accomodate 10-20% oversize
angulation <20mm
iliac coverage 2cm
careful thrombus, conical, calcified, posterior bulges in neck
what are relative CI for perch closure?
severly scarred groins
high fem bifurcation
frequen introducer changes
significant prox iliac occlusive disease
small ilio fem
anterior calcific femoral
What are adjunct to facilitate contra limb cannulation?
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
What to look for on completion angio?
confirm patency of renal hypo
assess precision of LZ
eval for iliac dz
endoleaks
How to manage Type Ia?
compliant balloon if 5mm then consider aortic cuff
palmaz (5cm at 10mm expansion
33mm at 28 mm)
How to manage type Ib?
angioplasty
extension
How to manage III?
angio
bridging stent
How to manage renal artery coverage?
Pull caudally (wire over flow divider)
Snorkerl (best from brachial)
Bypass
Open conversion
How to manage CIA aneurysm?
Can extend into EIA
Occlude the hypo
Branched graft
Bypass
When to treat type II endoleaks?
evidence of type II with growth of 5mm
what are treatment options for type II?
coil or glue embo
transarterial (branch vessel, behind limb)
translumbar
transcaval
laparascopic IMA clipping
open surgical
ligation
conversion
What are the landing zones of the arch?
0 up to distal in nom
1up to distal LCA
2 up to distal scla
3 prox DTA
4 mid-distal DTA
What are indications for spinal cord drainage?
prior AAA
extensive coverage thoracic aorta
coverage T8-L2
LSCLA without revasc
dissection with malperfusion
List indications for LSCA revasc.
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
What are techniques for management of branches?
debranching
parallel stents
BEVAR, FEVAR
Z-fen
