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Vascular Surgery by Emi > Lower extremity > Flashcards

Lower extremity Flashcards

1
Q

Highest bypass risk on duplex

A

PSV>300 or VR >3.5 or EDV >100
graft flow <45cm/sec
ABI reduction >0.15

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2
Q

high bypass risk on duplex

A

PSV >300 or Vr >3.5
graft flow >45 cm/sec
ABI reduction <0.15

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3
Q

Intermediate bypass risk on duplex

A

PSV 180-300 or Vr>2
graft flow >45 cm/sec
ABI reduction <0.15

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4
Q

low bypass risk on duplex

A

PSV <180
graft flow >45 cm/sec
ABI <0.15

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5
Q

definition of VR

A

PSV within lesion / PSV in proximal normal graft

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6
Q

acute lim ischemia class I

A

viable limb
no sensory or motor deficit
audible arterial and venous signal

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7
Q

acute limb ischemia class IIa

A 
marginally threatened
minimal sensory loss
no motor loss
inaudible arterial signal
audible venous signal
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8
Q

acute limb ischemia class IIb

A 
immediatelly threatened
sensory loss more than toes + rest pain
mild to moderate motor loss
inaudible arterial signl
audible venous signal
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9
Q

acute limb ischemia class III

A

irreversible
profound sensory loss
paralysis and rigor
inaudible arterial and venous signal

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10
Q

anterior lower leg compartment

A 
tibialis anterior
extensors
peroneus tertium
anterior tibial artery
deep peroneal nerve
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11
Q

lateral lower leg compartment

A

peroneus longus and brevis

superficial peroneal nerve

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12
Q

superficial posterior lower leg compartment

A

gastrocnemius
soleus
plantaris
tibial nerve

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13
Q

deep posterior lower leg compartment

A

tibialis posterior

flexor popliteus muscle

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14
Q

anterior compartment of thigh

A

sartorius
quadriceps (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)
femoral nerve

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15
Q

posterior compartment of thigh

A

biceps
semimembranosus
semitendinosus
sciatic nerve

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16
Q

medial compartment of thigh

A 
pectineus
gracilis
obturator
externus
adductor
obturator nerve
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17
Q

L3 function

A

hip flexion

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18
Q

L4 function

A

knee extention

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19
Q

L5 function

A

foot dorsiflexion
2nd web space sensation
(injury causes foot drop)

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20
Q

S1 function

A

plantar flexion
Achilles reflex
lateral foot sensation

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21
Q

C5 function

A

deltoid and biceps

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22
Q

C6 function

A

biceps, weak wrist extention

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23
Q

C7 function

A

triceps

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24
Q

C8 function

A

intrinsic muscle of the hand

wrist flexion

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25
Q

arterial lysis Rochester trial

A

57 patients in urikinase and 57 patients in OR group

@ 1 year amp free: 75% vs 52%

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26
Q

arterial lysis STILE trial

A

393 patients -> surgery vs lysis with tPA and urokinase
If symptoms longer than 14 days –> amputation lower in OR (3vs 12%)
if symptoms shorter than 14 days –> amputation lower in lysis (11 vs 30%)

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27
Q

arterial lysis TOPAZ trial

A

better clinical outcomes in lysis group

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28
Q

what is 5 year patency of aorto - bifemoral bypass?

A

90%

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29
Q

what is 5 year patency of femorl - femoral bypass?

A

70%

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30
Q

what is 5 year patency of fem - BK pop bypass with vein?

A

70%

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31
Q

what is 5 year patency of iliac angioplasty?

A

70%

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32
Q

what is 5 year patency of axillary - bifemoral bypass?

A

70%

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33
Q

what is 5 year patency of ax-unifemoral bypass?

A

50-55%

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34
Q

what is 5 year patency of SFA patency for stenosis?

A

50-55%

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35
Q

what is 5 year patency of SFA angioplasty for occlusion?

A

40%

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36
Q

what is 5 year patency of fem - distal bypass?

A

40%

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37
Q

what is 5 year patency of of fem - BK pop with PTFE?

A

30%

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38
Q

what is a TASC A (Aorto - iliac)?

A

unilateral or bilateral stenosis of CIA

unilateral or bilateral single <= 3cm EIA stenosis

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39
Q

what is a TASC B (Aorto - iliac)?

A

<= 3cm stenosis of infrarenal aorta
unilateral CIA occlusion
stenosis 3-10cm involving EIA but not CFA
unilateral EIA occlusion (not CFA)

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40
Q

what is a TASC C (Aorto - iliac)?

A

bilateral CIA occlusion
bilateral EIA stenosis 3-10cm extending to CFA
unilateral EIA occlusion including IIA or CFA
heavily calcified unilateral EIA occlusion involving IIA or CFA

41
Q

what is a TASC D (Aorto - iliac)?

A

infrarenal aortic occlusion
diffuse disease of aorta and both iliacs
diffuse multiple stenosis of CIA, EIA, CFA
unilateral occlusion of CIA + EIA
bilateral EIA occlusion
iliac stenosis + AAA not amenable for endovascular repair

42
Q

Plantar arch

A

PT bifurcation : medial and lateral plantar arteries + DP –> plantar metatarsal artery

43
Q

toe - brachial index claudication

A

0.2-0.5

44
Q

toe - brachial index rest pain

A

<0.2

45
Q

toe - brachial index normal

A

> =0.8

46
Q

most common risk factor for popliteal artery aneurysm

A

HTN

47
Q

popliteal aneurysm growth rate

A

1.5mm/year for PAA <20mm
3mm/year for PAA 20-30mm
3.7mm/year for PAA >30mm

48
Q

incidence of popliteal aneurysms

A

7.4/100000 for men

1/100000 for women

49
Q

other aneurysms association with popliteal aneurysms

A

50% will have bilateral popliteal aneurysms
30-50% with popliteal aneurys will have AAA
10% of AAA will have popliteal aneurysms

50
Q

criteria for endovascular treatment of popliteal aneurysms

A
  1. 2 cm landing zones
  2. no large discrepancy in size between zones
  3. lack of turtuosity
51
Q

exclusion for endovascular repair of popliteal aneurysm

A
  1. people who frequently bent their knees >90*

2. inability to use antiplatelets

52
Q

sizing of stent for popliteal aneurysms

A

oversize 10-15% more than internal diameter of popliteal vessel below and above the aneurysm

53
Q

major SFA and popliteal branches

A
  1. supreme geniculate artery
  2. Medial and lateral superior geniculate branches
  3. sural artery
  4. medial and lateral inferior geniculate branches
  5. division: At and TP trunk
54
Q

profunda femoris branches

A
  1. medial circumflex
  2. lateral circumflex
  3. descending branches
  4. perforating branches
55
Q

PT branches

A
  1. circumflex fibular artery

2. common plantar artery: medial and lateral plantarartery

56
Q

AT branches

A
  1. recurrent tibial artery
  2. anterior lateral and medial malleolar (tarsal) artery
  3. dorsalis pedis: 1st dorsal metatarsal, arquate artery, depp palmar artery
57
Q

How many claudicants will deteriorate significantly

A

2-3% per year

58
Q

what is infrainguinal TASC A?

A
  1. signle SFA stenosis <=10cm in length

2. single SFA occlusion <= 5cm in length

59
Q

what is infrainguinal TASC B?

A
  1. multiple lesions each <= 5cm
  2. single stenosis or occlusion <=15 not involving the infrageniculate popliteal artery
  3. single or multiple lesions in the absence of continuous tibial vessel to improve inflow for a distal bypass
  4. heavily calcified occlusion <=5cm in length
  5. single popliteal stenosis
60
Q

what is infrainguinal TASC C?

A
  1. multiple stenosis or occlusions totaling >15 cm with or without heavy calcifications
  2. recurrent stenosis or occlusions that need treatment after 2 endovascular procedures
61
Q

what is infrainguinal TASC D?

A
  1. chronic total occlusion of popliteal artery and proximal trifurcation vessels
  2. chronic total occlusion of CFA and SFA (>20 cm involving popliteal artery)
62
Q

What does BASIL trial say

A

450 patients randomized into bypass or PTA in severe limb ischemia.
Amputation free survival the same after 6 months.
After 2 years AFS and overall survival was better in surgical group

63
Q

Obturator bypass

A

tunnel anteromedially - vessels are posterolateral then tunnel in potential space between adductor longus and brevis anteriorly and adductor magnus posteriorly

64
Q

normal CFA size

A

0.8-1cm

65
Q

Division of internal iliac artery

A

anterior and posterior

66
Q

Anterior division of IIA branches

A
  1. umbilical (only in fetus)
  2. superior vesical artery (branch of umbilical)
  3. obturator artery (in 25% will branch of inferior epigastric artery)
  4. vaginal artery
  5. inferior vesical / vaginal artery
  6. uterine artery
  7. middle rectal artery
  8. internal pudendal artery
  9. inferior gluteal artery
67
Q

posterior division of IIA braches

A
  1. iliolumbar
  2. lateral sacral superior and inferior
  3. superior gluteal
68
Q

how many intermittent claudicants will deteriorate?

A

2-3% per year

69
Q

How many popliteal aneurysms are bilateral?

A

40-50%

70
Q

How many people with popliteal aneurysms have AAA?

A

50-60%

71
Q

I how many AAA have a peripheral aneurysm?

A

10%

72
Q

Femoral artery aneurysm classification (Cutler and Darling) type 1

A

Involve only the CFA and end proximal to the femoral bifurcation

73
Q

Femoral artery aneurysm classification (Cutler and Darling) type 2

A

Aneurysms extend into the origin of the deep femoral artery

74
Q

Indications for intervention with popliteal artery aneurysm

A 
Size 2-2.5 cm
Presence of mural thrombus
Evidence of distal embolization
Rupture
Acute thrombosis
 Chronic thrombosis with critical limb ischemia
75
Q

How do you reconstruct type 2femoral aneurysms

A

Interposition graft between CFA to either SFA or profound a, with rimplantation of the other branch on top of the graft

76
Q

Treatment of acutely thrombosis popliteal aneurysm

A

If Rutherford 1 and 2a - thrombolysis first to open distal target

77
Q

Graft patency in interposition graft for popliteal aneurysm repair

A

> 90% at 2 years

78
Q

What approach is better for primary patency in popliteal aneurysm repair

A

Posterior

79
Q

Patency of endovascular repair of popliteal artery aneurysm

A

83% at 1 year

80
Q

Comparison of endo and open popliteal aneurysm repair

A

Longe length of stay in open (7vs 3)
Higher 30 day graft occlusion in endo (9% vs 2%)
Higher reintervention rates in endo (9% vs 4%)
No significant difference in survival, limb loss and primary patency
4 year PP: 54-86% in endo and 63-88%in open

81
Q

Most important factor influencing success of endo repair in popliteal artery aneurysms

A

Number of runoff vessels

82
Q

Best predictor of primary healing of a toe wound

A

Toe pressure >30 Maggie

83
Q

Critical limb ischemia outcomes

A

At 1 year:
Alive with two legs 50%
Amputation 25%
CV mortality 25%

84
Q

Outcomes from claudicants

A 
5 years: 
Mortality 15-30% (out of that 75% from CV causes)
CLI: 1-2%
Worsening claudixstion 10-20%
Stable claudicstion 70-70%
85
Q

Characteristics of balloon expendable stent

A 
High radial force, 
Low flexibility, 
Requires sheath delivery
High radiopacity
No oversized recommended
No to treatment of lesions with variable diameter
No resistance to ezxternal compression and bending
High precision of deployment
86
Q

Self expending stents characteristics

A 
Low radial force
High flexibility
Does not require sheath delivery
Variable radiopacity
Oversized is recommended
Can treat lesions with variable diameter
Lower precision in deployment
87
Q

What’s infrapoplieal TASC A

A

Single stenosis <1cm in the tibial or peroneal vessel

88
Q

What’s infrapoplieal TASC B

A
  1. Multiple focal stenosis of the tibial or peroneal vessel, each less than or equal to 1 cm in length
  2. One or two focal stenosis, each less than 1 cm long, at the tibial trifurcation
  3. Short tibial or peroneal stenosis in conjunction with femoropopliteal PTA
89
Q

What’s infrapoplieal TASC C

A

Stenosis 1-4 cm in length
Occlusion 1-2 cm in length of the tibial or peroneal vessels
Extensive stenosis of the tibial trifurcation

90
Q

What’s infrapoplieal TASC D

A

Tibia or peroneal occlusion slinger than 2 cm

Diffusely disease tibial or peroneal vessels

91
Q

Infrapopliteal stentinf trials results

A

DES showed improved primary patency in 2-3 cm lesions comparing to PTA and to BMS

92
Q

Mechanism of action of paclitaxel

A

Microtubule inhibitor

93
Q

What did ZilverPTX trial show

A

Improvement in event free survival and improved primary patency in the drug eluding stent cohort when compared to bare metal stent cohort

94
Q

Popliteal entrapment Type 1

A

Popliteal artery completes its development before migration of the medial head of the gastrocnemius muscle which then pushes the artery medically during migration. Popliteal artery lies medically to normal location

95
Q

Popliteal entrapment Type II

A

Artery is discplace medically but the gastrocnemius muscle has a variable attachment on the lateral aspect of the medial femoral condyle or intercondyllar area.
The artery forms prematurely and partially arrests the migration of the gastrocnemius muscle, resulting in the artery being positioned medical to abnormally attached muscle

96
Q

Popliteal entrapment Type III

A

Abnormal muscle slip or band that arises from either media or lateral femora condyle.
Embryologic remnants of the gastrocnemius muscle remain posterior to the popliteal artery or the artery develops within this muscle mass

97
Q

Popliteal entrapment Type IV

A

Persistence of the axial artery as the nature distal popliteal artery. This remnant remains in the embryologic position deep to the popliteal muscle and fibrous band

98
Q

Popliteal entrapment Type V

A

Both artery and vein are involved or entrapped via any of the previously described mechanisms

99
Q

Popliteal entrapment Type VI

A

Functional entrapment

Compression of artery with stress maneuvers in the absence of an explanatory anatomical abnormality

Vascular Surgery by Emi (15 decks)

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