Misc Arterial Flashcards
What is an abnormal connection between high-pressure arterial system and low-pressure venous system; marked anatomic and hemodynamic changes?
arteriovenous fistulae (AVF)
An AVF can be created how?
congenital or traumatic
The potential for cardiac failure increases when a fistula is located where?
Close to the heart
A fistula located peripherally is more likely to cause?
ischemia
AVF may involve prox and distal arteries/veins as well as collateral arteries/veins. What values predicts resistance?
diameter and length
Flow through the AVF has _____ velocities, _____ resistant flow
higher, lower
What is compartment syndrome?
After a tibial artery repair there may be swelling. The compartment is bound by bone, fascia and interosseous membrane, which does not allow for expansion.
Compression on the tibial arteries can result in what?
necrosis of the muscles causing severe pain, tenderness, foot drop and other neurological changes
What is important to determine about a pseudoaneurysm?
location of the neck, size, and location
How long should the compression on the pseudoaneurysm neck last?
alternating compression and rest periods, compressions lasting 10-15 min each
procedure lasts up to 30 to 60 minutes
When compressing on the pseudoaneurysm, what should be used to monitor arterial pulses are continued during compression?
distal monitoring of the great toe
What occurs when the popliteal artery is compressed by the medial head of the gastrocnemius muscle or fibrous bands?
popliteal artery entrapment syndrome
Who does popliteal artery entrapment syndrome affect most often and what are possible symptoms?
- young men
- symptoms of arterial occlusion or intermittent claudication
- repeated trauma may result in aneurysm, thrombosis, emboli
What tests can be preformed to determine popliteal artery entrapment syndrome?
a) flow to great toe monitored with an end point detector such as a PPG
b) knee extended and active plantar flexion of the foot with PPG pads may diminish or obliterate suggesting entrapment.
What is the terminal branch of the internal mammary artery?
deep superior epigastric artery
The rectus abdominis muscle, sub-q fat, arteries, preforators, overlaying skin all make up what?
transverse rectus abdominis myocutaneous (TRAM) flap
Why is the epigastric artery mapped?
surgeon wants to use the best arterially supplied muscle section for TRAM flap for autogenous breast reconstruction
What artery arises off the subclavian artery, descending on posterior side of carilage of upper 6 ribs, about 1 cm from sternum?
internal mammary artery (internal thoracic artery)
Why is the internal mammary artery mapped?
- Utilized as a recipient site for free flaps in breast reconstruction
- Also can be used as a graft to the left anterior descending (LAD) coronary artery
What can the radial artery be used for?
coronary artery bypass
What is the process of mapping the radial artery?
- use PPG’s and monitor pulses with and without compression of the radial artery. If pulse disappears, no need to continue
- observe for focal elevated PSV, abnormal doppler, intimal thickening, aneurysm, calcification
- measure radial artery prox, mid, and dist
Preoperative vein mapping is done to determine suitability of veins for?
extremity or coronary bypass
dialysis access/graft
What vein is typically mapped in the legs?
GSV, sometimes LSV/SSV
What vein is typically mapped in the arms?
cephalic and basilic veins
How should the vein AP diameter be obtained?
outer edge to outer edge
What should the vein dimensions be at least?
2-3 mm
basilic vein is often larger than cephalic vein
What occurs when the neurovascular bundle is compressed by shoulder structures in certain arm positions?
thoracic outlet syndrome
Most symptoms of TOS are due to neurogenic compression of brachial plexus (97%); a small percentage is due to what?
subclavian vein or artery compression
Symptoms of TOS:
numbness/tingling of arm
pain/aching of shoulder/forearm
exercise/upward positions increase discomfort/symptoms
25-30% have asymptomatic compression
What arm positions are used to evaluate TOS?
a) resting position- hand in lap
b) arm at 90 degrees
c) arm at 180 degrees
d) exaggerated military stance
e) Adson maneuver positioning
- head turned to rt
- head turned to lt
f) causative position described by patient
What treatment is used for TOS?
shoulder exercises or surgical treatment to resect rib with/without scalene splitting
