Grafts

Question 1

What is a miller cuff?

Answer 1

Question 2

What is a taylor patch?

Answer 2

Question 3

What are disadvantages of miller cuff?

Answer 3

Turbulence

Question 4

What are disadvantages of Taylor patch?

Answer 4

Lose venous endothelium on half anastomosis and need a lot of vein

Question 5

What is a distal vein patch?

Answer 5

Venous patch, prosthetic anast to it

Question 6

If you can’t use vein for tibial bypass, what is the best alternative?

Answer 6

Heparin bonded ePTFE - some recent studies shows noninferiority

Question 7

Which graft theoretically promotes lateral flow to decrease shear and decrease adhesion molecules/intimal hyperplasia?

Answer 7

Spiral flow graft

Question 8

What graft technique is available for poor arterial runoff

Answer 8

“Patchula” AV fistula to decrease outflow resistance

Question 9

Is there any benefit to dual antiplatelet therapy for peripheral bypass?

Answer 9

CASPAR trial - maybe benefit in prosthetic grafts. ASA of benefit in prosthetic grafts based on Cochrane review

Question 10

How often should you survey peripheral bypass grafts?

Answer 10

3, 6 months then annually

Question 11

What is the Bandyk criteria for graft stenosis?

Answer 11

PSV > 300. Ratio > 3.5

Question 12

How low of a velocity predicts mid graft failure?

Answer 12

< 45 cm/s

Question 13

What causes early (< 6 months) graft failures?

Answer 13

Technical - poor inflow/outflow, thrombophilia

Question 14

When do grafts fail due to myointimal hyperplasia?

Answer 14

Mid term - 6-24 months

Question 15

When do grafts fail due to progression of disease?

Answer 15

Late, > 24 months

Question 16

What is more effective for graft occlusions - thrombolysis or thrombectomy?

Answer 16

< 2 weeks of symptoms - thrombolysis, > 2 weeks - thrombectomy. STILE and TOPAS trials

Question 17

What are 4 contraindications to thrombolysis?

Answer 17

1. Recent surgery
2. Non viable limb
3. Bleeding disorders
4. Hemorhagic stroke

Question 18

What are 4 CT findings consistent with graft infection?

Answer 18

1. Peri graft air
2. Peri graft fluid
3. Pseudoaneurysm
4. Soft tissue attenuation

Question 19

Which types of graft infection organisms mandate removal?

Answer 19

Pseudomonas, MRSA

Question 20

Which procedure has the highest incidence of graft infection?

Answer 20

Ax-fem (5-8%)

Question 21

What is the incidence of graft infection for fem pop or fem tib?

Answer 21

Fem pop 1-5%, Fem tib 2 - 4%

Question 22

What is the risk of graft infection with a peripheral stent?

Answer 22

Very low < 0.1%

Question 23

What is the risk of aortofemoral graft infection?

Answer 23

< 3%

Question 24

What is an early versus late graft infection?

Answer 24

early < 4 mo, late > 4 mo

Question 25

What is a Szilagyi Grade 1 graft infection?

Answer 25

cellulitis involving the wound

Question 26

What is a Szilagyi grade 2 graft infection?

Answer 26

infection involving subcutaneous tissue

Question 27

What is a Szalgyi type 3 graft infection?

Answer 27

Infection of the vascular prosthesis

Question 28

What is a P0 graft infection?

Answer 28

infection of a cavitargy graft (abdo/thoracic)

Question 29

What is a P1 graft infection?

Answer 29

Infection of graft which entire course is non cavitary (ax fem, carotid subclavian etc)

Question 30

What is a P2 graft infection?

Answer 30

Infection of the extracavitary portion of a graft whos origin is cavitary (e.g. femoral portion of ABF)

Question 31

What is a P3 graft infection?

Answer 31

infection involving prosthetic patch angioplasty (femoral patch, carotid patch)

Question 32

What are the 3 most severe Bunt’s classification of graft infections?

Answer 32

Graft enteric erosion

Graft enteric fistula

Aortic stump sepsis after excision of infected graft

Question 33

When do most cavitary graft infections (e.g. aortic) occur?

Answer 33

Late - mean time more than 40 months