Past Exams Flashcards
4 causes of aTOS
- Cervical rib 2. Anamolous first rib 3. Fibrocartilaginous band 4. Clavicular fracture
4 reasons to use a deeper tunnel for a fem fem
- Obesity/pannus 2. Skin breakdown (radiation) 3. Thin subcu layer 4. Prior surgery
5 causes for abdominal coarctation
- Vasculitis (takayasu) 2. Neurofibromatosis type 1 3. Tuberous sclerosis 4. William’s syndrome 5. Alagille syndrome
2 reasons to treat perforations during endo
- Hemodynamic instability 2. Large hematoma or pseudoaneurysm
7 Well’s criteria
- Previous DVT 2. Immobile 3. Recent surgery 4. Tenderness along venous distribution 5. Single calf swelling 6. Pitting edema 7. Entire leg swollen
5 Acute DVT ultrasound findings
- Dilated vein 2. No flow 3. Soft/compressible 4. Hypoechoic thrombus 5. Thrombus may be free-flowing
5 Angio findings of Buerger’s disease
- Corkscrew collaterals 2. Normal proximal arteries 3. More severe distally 4. Segmental occlusive lesions 5. Involves small and medium arteries (digital, plantar, tibials)
5 clinical features of abdominal compartment syndrome
- Elevated bladder pressures > 20 2. Tense abdomen 3. Oliguria 4. Higher ventilation settings required 5. Decreased cardiac output
Reasons ESRD patients are coagulopathic
- Uremia 2. Anemia 3. Heparinization with hemodialysis
What is a marjolin ulcer?
Benign chronic would becomes squamous cell carcinoma
Diagnostic criteria (5) for giant cell arteritis
- Age > 50 2. Temporal artery abnormality (tender) 3. New onset headache 4. ESR elevation > 50 mm/hr 5. Biopsy shows multinucleated giant cells.
How does shear stress contribute to intimal hyperplasia?
shear stress principally exerts its frictional forces on ECs at the interface of the blood and vessel wall. ECs align in the direction of stress, and the greater the shear stress, the more elongated the cells. 54 55 Such changes are correlated with a redistribution of intracellular stress fibers and fiber quantity. In areas of high shear stress, ECs express higher amounts of stress fibers, including actin, myosin, and other contractile proteins.
5 things during dialysis that indicate failing access
- Static venous pressure measurement: >50% greater than MAP 2. Flow < 600-800 ml/min 3. Failure to mature (cannot cannulate) 4. Prolonged bleeding (increased venous pressure) 5. Collateral veins/edema.
Identify: 1. Tib ant 2. Soleus 3. Superficial peroneal nerve 4. Tibial nerve
2 Duplex criteria for renal artery stenosis > 60%
- PSV > 200 cm/s
- Renal to aortic PSV ratio > 3.5
What are 6 factors associated with delayed femoral pseudoaneurysm of graft
1 Arterial wall degeneration
2 Suture line disruption
3 Prosthetic graft failure
4 Infection/inflammation
5 Technical errors
6 Mechanical stress
What is the classic triad associated with Loeys Dietz syndrome?
- Hypertelorism
- Craniofacial abnormality
- Arterial tortuosity/aneurysm
What are features associated with Klippel Trenaunay syndrome?
- Port wine stain
- Limb hypertrophy
- Varicose vein clusters
- Enlarged lateral vein (marginal vein)
What is the difference between KTS and parkes-weber syndrome?
PWS has fast flow arteriovenous malformations and can have significant AV shunting
What is the causative organism for filariasis?
Wuchereria Bancrofti
What are 5 other causes of lymphedema (other than filiriasis)?
- Trauma (e.g. burns, surgery LN dissection/rads)
- Pregnancy
- Snake bites/insect bites
- Contact dermatitis
- Rheumatoid arthritis
What type of FMD affects carotid?
Medial fibrodysplasia
What are 3 CTA features of FMD of carotid?
- String of beads
- Kinking/tortuosity
- Absence of disease (atherosclerosis) at carotid bifurcation
What are 5 non-atherosclerotic causes of chronic mesenteric ischemia?
1 - FMD
2- SLE
3- Median arcuate ligament syndrome
4 - Vasculitis
5 - Buerger’s
(Also: NF - 1, drugs cocaine ergot, dissection, radiation arteritis)
What are 4 symptoms of subclavian artery aneurysms
1 - local nerve compression (hoarseness, brachial plexus injury)
2 - distal emboli/ischemia of digits or stroke
3 - hemorrhage
4 - shoulder or chest pain
What causes for McCleery syndrome?
Anterior scalene and subclavius tendon compression of subclavian vein, worse with arm abduction
Aortic dissection - drug class to start?
What is the most commonly injured zone in penetrating abdominal trauma?
- Zone 1: IVC
What are the 4 retroperitoneal zones of abdominal trauma?
- Zone 1:
- Supramesocolic – suprarenal aorta and major branches (celiac, SMA and renal arteries, supramesocolic IVC and SMV
- Inframesocolic – infrarenal aorta and IVC
- Zone 2 – left and right kidneys, paracolic gutter and renal vessels
- Zone 3 – pelvic retroperitoneum and contains iliac vessels
- Zone 4 – perihepatic area, hepatic artery, portal vein, retrohepatic IVC and hepatic veins
In a trauma total liver excision, what 4 vascular structures need to be controlled? Which first?
- Infradiaphragmatic Aorta
- Infrahepatic IVC
- Suprahepatic IVC
- Portal vein.
Aorta first.
6 GSV tributaries near the saphenofemoral junction
1 - inferior epigastric
2 - superficial circumflex iliac
3 - lateral accessory
4 - deep external pudental
5 - superficial external pudental
6 - medial accessory
Besides pre-existing renal impairment, what are 5 risk factors for contrast induced nephropathy?
1 - congestive heart failure
2 - dehydration
3 - age
4 - hyperosmolar states (e.g. multiple myeloma)
5 - severe proteinuria
Neurologic anomaly with aberrant right subclavian artery (1)
Non-recurrent right laryngeal nerve
5 pre-operative predictors for colon ischemia
1 - SMA stenosis
2 - Internal iliac occlusions
3 - Colonic resection
4 - Large patent IMA
5 - Insufficient collaterals
5 mechanisms of colonic ischemia during open AAA repairs
- Atheroembolism
- Ligation of internal iliac arteries
- Retractor injury
- Previous colonic resection
- Supraceliac clamp
What are 5 indications for renal stenting?
1 - FMD with severe HTN
2- Flash pulmonary edema
3 - Acute decompensation CKD
4 - Refractory HTN on 3 meds
5 - Pediatric patients
Anticoagulants secreted by endothelium (3)
- Nitric oxide
- PGI-2 (prostacyclin)
- Prostaglandin D
Mechanism and half-life of
- Dabigatran
- Apixaban
- Rivaroxaban
- Dabigatran
- Direct thrombin (IIa) inhibitor (12-17 hours)
- Apixaban
- Direct Xa inhibitor (9-14 hours)
- Rivaroxaban
- Direct Xa inhibitor (9 hours)
Aortic dissection - where to admit?
Admitted in ICU, with continuous BP monitoring, cardiac monitoring, foley, arterial line
Aortic dissection BP and HR target
sBP < 120, HR 60-80
Aortic dissection - time from admission to surveillance CTA?
- Get one before discharge, 6 months (when stable for 2 scans, do q1 year)
EVAR-1 inclusion criteria
1 - > 60 year old
2 - >= 5.5 cm AAA
- Fit for both open and EVAR
EVAR-1 endpoints
1 - Death
2 - aneurysm related detah, graft related complications, graft related interventions
30 day EVAR-1 results
EVAR had lower 30d mortality (2 vs 5%)
Long term EVAR-1 results
1 - No difference in mortality after 8 years
2 - No difference in aneurysm related mortality up to 4 years
3 - EVAR had more graft related secondary interventions (10 vs 6%)
CORAL
3 inclusion criteria (3)
- Severe renal artery stenosis: angio >80%, or >60% with 20mmHg gradient. Duplex >60%
- Hypertension on two or more meds
- CKD with GFR <60
Exclusion criteria
- FMD
- CKD from other cause
- Serum creatinine >354 mcmol/L
- Kidney <7cm
- Lesions could not be treated with single stent
CORAL results related to primary endpoint [they gave the endpoints] (1)
- No difference (composite stroke, MI, CHF, progressive CKD and dialysis)
CORAL results related to BP control
-2.3mmHg p=0.03 in stented group
CORAL results related to renal function
no difference
4 features of Budapest criteria for chronic regional pain syndrome
1 - Motor weakness
2 - Sensory hyperesthesia
3 - Autonomic sweating
4 - Psych - fear/anxiety
What is the difference between CRPS type 1 and 2?
- CRPS 1 – after inciting noxious event
- CRPS 2 – results specifically from a nerve injury
Rutherford objective criteria for chronic limb ischemia
What 2 variables affect the hemodynamics effects of a stenosis? Which equation? Why is one variable more important than the other?
1- Radius - more of an effect (4th power)
- Length
Describe Raynaud’s phenomenon
- Episodic pallor or cyanosis of fingers caused by vasoconstriction of digital arteries
- Triggered by cole or emotional stress
- Sudden onset pallor, cyanosis and then hyperemia
Name 6 ways of differentiating primary and secondary Raynauds
Name 3 benefits and 3 disadvantages of reversed vein grafts for infrainguinal bypass
