PreTest Surgery: Peripheral Vascular Problems

Question 1

For the first 6 hours following a long and difficult surgical repair of a 7-cm abdominal aortic aneurysm, a 70-year-old man has a total urinary output of 25 mL since the operation. Which of the following is the most appropriate diagnostic test to evaluate the cause of his oliguria?

Answer 1

Left-heart preload pressures (with a Swan-Ganz catheter)

Per PreTest, the most likely cause of oliguria during a surgery is hypovolemia due to third-spacing. As such, the remedy is to give fluids to titrate the PCWP to 15 mm Hg.

Question 2

The best diagnostic step of postop colonic ischemia is _________________.

Answer 2

sigmoidoscopy

Barium should not be used due to poor accuracy. CT, MRI, and aortography are not useful in early ischemia.

Question 3

The two kinds of primary lymphedema are ________________.

Answer 3

congenital (present at birth) and praecox (onset in adolescence)

Question 4

The best test for evaluating carotid stenosis is _____________.

Answer 4

duplex ultrasonography

Question 5

Which two sets of criteria qualify a person for carotid endarterectomy?

Answer 5

• Greater than 80% stenosis

* Greater than 50% stenosis with symptoms

Question 6

Popliteal artery occlusion warrants fasciotomy of ______________.

Answer 6

all four compartments in the lower leg

Question 7

Occlusion of which vessel leads to subclavian steal syndrome?

Answer 7

The subclavian artery proximal to the vertebral artery

When this happens, the subclavian artery distal to the vertebral artery sucks blood retrograde from the vertebral artery (which anastomoses which carotid vessels) and produces presyncopal symptoms.

Question 8

What is dipyridamole-thallium imaging?

Answer 8

DT imaging is a way of assessing perfusion defects in the heart. Dipyridamole is a coronary vasodilator. Thallium is a radiotracer. Together these illustrate the maximum ability of the coronaries to vasodilate.

It is the most accurate way of predicting postoperative ischemic events.

Question 9

A patient has sudden onset of pain and numbness in the right extremity a couple days after an MI. What should you do?

Answer 9

Embolectomy

This presentation is classic for cardiac emboli traveling to the femoral artery. Since this is embolic and not atherosclerotic, you do not need to further evaluate the patient.

Question 10

Explain the management of popliteal aneurysms.

Answer 10

Popliteal aneurysms rarely rupture, so management is reassurance unless the patient is symptomatic. Aneurysms greater than 2 cm in diameter may be surgically considered if the patient desires due to the likelihood of rupture.

Question 11

Which artery leads to the popliteal, the superficial femoral or the profunda femoris?

Answer 11

Superficial femoral

Question 12

________________ should be used to diagnose suspected mesenteric ischemia.

Answer 12

Mesenteric angiography

This can diagnose and treat mesenteric ischemia (using vasodilators).

Question 13

List the treatment options for aortoiliac occlusion in healthy patients and those with severe comorbidities.

Answer 13

• Healthy: aortoiliac bypass

* Sick: axillofemoral bypass