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Cameron Vascular > Miscellaneous1 > Flashcards

Miscellaneous1 Flashcards

1
Q

Preop workup prior to vascular access

A

eval veins and arteries with duplex, arteriograms and venograms

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2
Q

Should vascular access start more distally or proximally

A

distally

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3
Q

What is the most distal fistula

A

radio-cephalic (Bescia-Cimino-Appel fistula)

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4
Q

What fistula can be created if a radio-cephalic fails

A

brachial-cephalic or brachial-basilic

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5
Q

What should be used if a patient does not have an autologous vein to use in a fistula

A

use a graft

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6
Q

What type of graft is best placed in the lower arm

A

loop-graft from brachial artery to cephalic vein

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7
Q

MC complication of vascular access

A

thrombosis

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8
Q

If thrombosis occurs post op from a fistula where is it MC found

A

proximal vein

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9
Q

Tx for post op thrombosis in new fistula

A

endovascular repair, angioplasty or stent

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10
Q

Organisms MC cultured from vascular access

A

Staph aureus, MRSA

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11
Q

Complications of vascular access

A

infection, seroma, aneurysms, pseudoaneurysms, proximal vein occlusion due to central vein stenosis, bleeding

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12
Q

What syndrome can iliac vein obstruction lead to

A

May-Thurner syndrome

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13
Q

Primary tx for VTE

A

systemic anticoagulation

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14
Q

Why is systemic VTE important

A

reduces risk of PE, extension of thrombosis and recurrence of thrombosis

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15
Q

What is the recommendation after a second episode of VTE or unprovoked VTE

A

prolonged warfarin

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16
Q

When is catheter directed thrombolysis accepted when used for VTE

A

axillary and subclavian VTE�s

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17
Q

What does May-Thurner syndrome put a patient at risk for

A

VTE

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18
Q

Descrive May Thurner syndrome

A

iliac vein obstruction leading to leg edema

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19
Q

Name 2 classes of agents for VTE treatment for oral therapy

A

direct thrombin inhibitors and direct factor Xa inhibitors

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20
Q

How is Rivaroxiban (anti-factor Xa) excreted

A

renally

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21
Q

Primary indications for IVC filter

A

complication of anticoagulation, contraindication to anticoagulation and or failure of anticoagulation

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22
Q

Indications for suprarenal IVC filter placement

A

IVC clot, pregnancy, women of childbearing age, previous filter clotted, previous filter that failed

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23
Q

Complications of IVC filter

A

migration, device failure: recurrent PE, fracture

24
Q

How is an IVC with acute thrombus treated

A

full anticoagulation with heparin followed by catheter directed thrombolysis

25
Q

Common tx for uncomplicated VTE

A

LMWH with transition to vitamin K antagonist for 3 months

26
Q

When is aggressive thrombus removal considered in VTE

A

iliofemoral DVT and effort thrombosis and for those with PE and significant right heart strain

27
Q

Etiology of sx�s of a PE

A
  1. obstruction of pulmonary arteries leading to decreased oxygenation and right heart strain 2. platelet activation the pulmonary circulation, with inherent release of vasospastic and bronchospastic substances
28
Q

Initial workup of a PE

A

ECG, ABG, CXR

29
Q

What are the findings on EKG for PE

A

right heart strain, S wave in lead I, Q wave in lead III and T waves in leads III VI and V3

30
Q

3 occasional findings on CXR to indicate PE

A

Hampton hump and Westermark sign and Fleischer knuckle sign

31
Q

Define Hamptons hump

A

CXR finding indicative of PE: : peripheral wedge shaped opacity at the costophrenic angle representing a pulmonary infract

32
Q

Define Westermark sign

A

CXR finding indicative of PE: an area of focal ishcemia

33
Q

Define Fleischer knuckle sign

A

CXR finding indicative of PE: enlargement of the central pulmonary artery

34
Q

What does a positive VQ scan show with PE

A

wedge shaped perfusion defect with normal ventilation

35
Q

What does a negative VQ scan mean with PE

A

exclude the diagnosis of PE

36
Q

Modality of choice for detecting a DVT

A

venous duplex US

37
Q

Describe a patient at low risk for DVT

A

minor surgery under 40yo, no additional risk factors

38
Q

Describe a patient at moderate risk for DVT

A

minor surgery, 40-60yo, no additional risk factors

39
Q

Describe a patient at high risk for DVT

A

patients older than 60, 40-60yo with additional risk factors (prior DVT, prior PE, cancer, hypercoagulability)

40
Q

What stops propagation of the thrombus

A

anticoagulation

41
Q

Indication for Vena Cava Filters

A

venous thromboembolism with contraindication to or failure of therapeutic anticoagulation, free floating thrombus in the IVC or iliac veins, critically ill patients with limited cardiopulmonary reserves

42
Q

When should suprarenal IVC filters be considered

A

women of childbearing age, those with an inadequate �landing zone� in the infrarenal position

43
Q

Criteria vena cava filter retrieval

A

PE has returned to an acceptably low level or that the patient can be therapeutically anticoagulated, life expectancy more than 6 months, any filter that has migrated, fractured or tilted

44
Q

What causes lymphedema

A

lymphatic dysfunction that results in accumulation of protein rich fluid in the interstitium of extremities or other regions

45
Q

What reactions occur secondary to protein stasis

A

inflammatory response with macrophages and fibroblasts replacing elastic interstitium with fibrosclerotic thickened congested tissue

46
Q

What condition can arise from chronic lymphedema

A

Stewart-Treves syndrome: aggressive lymphangiosarcoma

47
Q

Name primary etiologies of lymphedema (congenital)

A

Milroy disease, Meigs disease, Tarda

48
Q

Describe Milroy disease

A

lymphedema that presents within the first 2 years of life: affects females moreso, bilateral LE edema, not progressive and may spontaneously resolve

49
Q

Describe lymphedema praecox or Meigs disease

A

presents at puberty (before at 35), affects females, unilateral lower extremity involvement

50
Q

Describe lymphedema tarda

A

presents spontaneously after the age of 35, rarest form

51
Q

What are causes of secondary lymphedema

A

Wuchereria bancrofti, post-operatively

52
Q

How is lymphedema diagnosed

A

lymphangioscintigraphy

53
Q

Describe conservative management of lymphedema

A

hygiene, compression, elevation, physical therapy and diuretics

54
Q

Name the surgical treatments for lymphedema

A

debulking, liposuction, shunt, Charles or Sistrunk procedure

55
Q

Describe the Charles procedure

A

remove the tissue to the fascia and then perform a skin gift

56
Q

Describe the Sistrunk procedure

A

staged excision of sub-Q tissues with incorporation of dermal and skin flaps

Cameron Vascular (26 decks)

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