Miscellaneous Conditions/ Testing

Question 1

Pseudo (false) aneurysm

Answer 1

A defect or hole in the arterial wall typically from trauma and iatrogenic (hospital acquired)

False because it does not involve all three layers

Question 2

Most common site of pseudo aneurysm

Answer 2

CFA

Question 3

How is pseudo aneurysm diagnosed

Answer 3

Identification of the sac with active blood flow. Flow into and out of this sac (a to and from flow pattern) is the hallmark of a pseudo aneurysm

Question 4

Arteriovenous fistula (AVF)

Answer 4

Abnormal connection between the high pressure arterial system and low pressure venous system.

Congenital or traumatic

Question 5

Thoracic Outlet Syndrome (TOS)

Answer 5

Compression of nerves, arteries, or veins

The result of an extra first rib (cervical rib) an old fracture of the clavicle (collarbone), or over developed muscle.

Common among athletes using repetitive motions of the arm and shoulder

Question 6

What are the main types of TOS

Answer 6

Neurogenic - MOST COMMON (95% of all cases) present with pain and weakness

Venous - reduced venous outflow: swelling, pain, and possibly a bluish discoloration of the arm

Arterial - reduced arterial blood flow: pain, coldness, and paleness of the arm

Question 7

Popliteal Artery Entrapment Syndrome (PAES)

Answer 7

Symptomatic compression or occlusion of the popliteal artery due to a developmentally abnormal relationship with the medial head of gastrocnemius (MHG) or less commonly with popliteus muscle or fibrous bands.

Dorsiflexion (gastrocnemius muscle contraction) results in compression of the popliteal artery.

common in young athletic persons (=60% are <30 years old), with male to female ratio of 15:1

Question 8

Arteritis: Buerger’s Disease

Answer 8

affects small vessels in the upper and lower extremities

inflammation may lead to vessel thrombosis

occurs primarily in men <40 years old, heavy tobacco abuse

presents with hand or foot ischemia, rest pain and/or ulceration

Question 9

Arteritis: Takayasu’s Arteritis

Answer 9

intimal fibrosis and vascular narrowing

MOST COMMONLY affecting large arteries usually the aorta and its main branches

often young or middle aged women of Asian descent

referred to as “pulseless disease” as patient often present with weak or absent pulses in the upper extremities on physical exams (arms, hands and wrists)

Question 10

Arteritis: Temporal Arteritis

Answer 10

inflammation of the arterial wall of the superficial temporal artery or its branches

lack of proper diagnosis and treatment may lead to blindness

often described as an anechoic or hpoechoic “halo” surround the vessel

a biopsy is considered the definitive diagnostic “gold standard”

Question 11

Raynaud’s phenomenon (Disease/Syndrome)

Answer 11

arterial spasm results in decreased blood flow, typically affecting the fingers, and less commonly toes, incidence = 4% of people have Raynaud’s

symptoms include: pallar, rubor, and/or cyanosis skin discoloration of the affected part, often numbness or pain

Question 12

primary raynaud’s

Answer 12

MOST COMMON, vasospasm only, unknown etiology

Question 13

secondary raynaud’s

Answer 13

vasospasm with the presence of a secondary cause (connection tissue disorder, fixed obstruction, smoking) and tissue necrosis, ulceration, gangrene

Question 14

penile brachial index, what is considered normal and abnormal

Answer 14

normal >0.75
marginal 0.65-0.74
abnormal < 0.65

Question 15

what types of arterial pathology can trauma cause

Answer 15

may result in intimal tear/dissection or transection of the vessel

Question 16

compartment syndrome

Answer 16

groups of organs or muscles are organized into areas called compartments divided by strong connective tissue called fascia

most compartment syndromes are the result of injury are therefore acute and possibly a medical emergency

Question 17

transcutaneous oximetry (TcPO2)

Answer 17

assess wound healing and determination of amputation level

PO2 <30mm/Hg - poor healing potential - wound unlikely to heal

Question 18

hydrophone

Answer 18

used in the development of ultrasound equipment to include testing of power and intensity levels generated by the ultrasound beam as it passes through the medium

Question 19

allen’s test

Answer 19

method to assess the potency of the palmar arch

radial and ulnar arteries are manually compressed, ulnar is released, and the hand observed for refilling

Question 20

what is considered normal and abnormal in a Allen’s test

Answer 20

normal - color should return in <10seconds
abnormal - hand remains blanched

Question 21

what is the purpose of pre operative arterial mapping

Answer 21

to determine the potency, size, and suitability of a vessel for use as a surgical bypass

to determine the suitability of the upper extremity arterial system for dialysis access AV fistula creation

Question 22

what is radial artery mapping

Answer 22

determine suitability for use as a graft for peripheral/coronary artery bypass-creation of dialysis access fistula

assess the potency of the palmar arch using a modified Allen’s test

if abnormal do NOT proceed as the harvest of the radial artery will compromise hand blood flow

observe for abnormalities

measure the diameter o artery in prox, mid, distal, these should be >2mm

Question 23

upper extremity arteries mapping

Answer 23

used for: creation of dialysis access AV fistula

measurement: anatomic variants, high/low brachial bifurcation, presence of disease

Question 24

what is epigastric artery mapping

Answer 24

identify adequate arterial supplied muscle section for autogenous breast reconstruction (transverse rectus abdomens muscle [TRAM])

measurement: identify best-arterialized muscle segment

Question 25

what is internal mammary artery (internal thoracic artery)

Answer 25

determines a normal or adequate vessel for: used as a recipient site for free flaps in breast reconstruction

use as a graft to the left anterior descending artery (LAD) in coronary bypass grafting