Pretest_9_Peripheral_Vascular_Problems Flashcards
In evaluating oliguria, you want to make sure you provide enough fluid replacement such that the Swan Ganz catheter in the left atrium measures around __ mm Hg
15
Abdominal distention, fever, elevation of white blood cell count, and/or bloody diarrhea in the postoperative period should raise suspicion for
colon ischemia
What accounts for 90% of primary lymphedema?
Hypolasia of the lymphatic drainage of the lower extremity
Acute onset, persistent back pain, hypotension =
ruptured abdominal aortic aneurysm
T/F: The IMA is typically ligated at the time of an abdominal aortic aneurysm repair
True!
Which part of the colon is most likely to be affected after the rupture of an abdominal aortic aneurysm?
Sigmoid! (after repairs (and IMA ligation), the marginal artery of Drummond from the SMA and the inferior and middle hemorrhoidal vessels are responsible for perfusing tbe left colon. If SMA is stenotic or occluded, patient is screwed!)
What is the name of the artery that anastamoses the SMA and IMA?
The marginal artery of Drummond
T/F: Though Carotid arteriography remains the gold standard for quantifying carotid stenosis, it is usually performed after noninvasive testing suggests significant stenosis.
True
Even if carotid artery stenosis is asymptomatic, if it exceeds ___% reduction in diameter and the patient is in good health/good candidate for surgery, they should have carotid endarterectomy.
70% or greater
What are common causes of compartment syndrome (x3)?
- acute areterial occlusion without colalteral inflow
- rapid reperfusion of ischemic muscle
- orthopedic trauma
T/F: If a fasciotomy is indicated for compartment syndrome, only the compartment involved should be opened.
False! All 4 compartments (anterior, lateral, superficial posterior, and deep posterior)
Most patients with limb claudication will stabilize or improve with instituting a program of _______________________ daily, vs. surgical intervention
exercise, cessation of smoking, weight loss
What are indications for arterial reconstructive surgery?
rest pain, gangrene
T/F: Most antiplatelet agents work by enhancing prostaglandin synthesis.
False! Aspirin inhibits the synthesis of thromboxane A2 and the subsequent production of prostaglandins. The platelet does not have a nucleus and thus cannot remanufacture the prostaglandins necessary for its functioning.
What is the “anatomic situation” that results in subclavian steal syndrome?
atherosclerotic occlusion of the subclavian artery proximal to the vertebral artery. Ischemia results in reversal of flow in the vertebral artery, with consequent diminished flow to brain = light headed on exertion, esp with lifting of arms
Which extremity is more prone to subclavian atherosclerosis?
The left (likely due to turbulence near the more acute angle at which the left subclavian artery leaves the aorta.)
What is the treatment for subclavian steal?
carotid-subclavian bypass, subclavian-carotid transposition, or dilating/stenting of the subclavian artery by endovascular techniques
What is Leriche syndrome?
Aortoiliac atherosclerotic disease resulting in claudicatio nof hte hips, buttocks, and thighs; absent femoral pulses; and impotence
What are important collateral arterial pathways around the aortic bifucation and common iliac segmetns important in patients with aortoiliac atherosclerotic disease?
1) intercostal and lumbar arteries to circumflex iliac and iliolumbar arteries
2) superior to inferior epigastric arteries
3) superior and inferior mesenteric arteries to rectal and internal pudendal
What are important collateral arterial pathways around the external iliac arteries important in patients with aortoiliac atherosclerotic disease?
hypogastric to circumflex femoral channels
can meet metabolic needs, but not levels necessary for exercise
T/F: Reduced hypogastric perfusion can also lead to retrograde ejaculation
True
What surgical error leads to retrograde ejaculation?
Disruption of the sympathetic chain overlying the distal aorta and left iliac after dissection around those vessels during vascular reconstructions
What test is most predictive of postoperative ischemic cardiac events following peripheral vascular surgery?
1) Gated-blood pool (MUGA) scan demonstrating ejection fractions of 35% or less and reversible perfusion defects
2) Reversible perfusion defects on dipyridamole-thallium imaging
What is the preferred thrombolytic agent: urokinase or streptokinase?
Urokinase: fewer allergic reactions
Without surgical revision following lysis of a clot in acute graft occlusion, a reocclusion rate of ___% is expected within 3 months. Even with surgical revision, a rate of __% is expected within 1 year.
w/o surgery 3 months: 50%
w/ surgery 1 year: 20%
What is the difference in management of acute arterial insufficiency WITH and WITHOUT neurologic compromise?
With neurologic compromise: immediate surgical intervention
Without neurologic compromise: either surgical intervention or arteriography with directed thrombolysis
T/F: Embolectomy of the femoral artery can be performed under local anesthesia.
True
Why should the contralateral groin be prepared in a femoral embolectomy?
In case flow is not restored via simple thrombectomy and a fem-fem bypass is needed to provide inflow to the affected limb
What are the most common peripheral arterial aneurysms?
Popliteal artery aneurysms
Popliteal artery aneurysms are bilateral up to ___% of the time and are associatd with extrapopliteal aneurysms ____% of the time
bilateral: 70%
extrapopliteal: 55%