SCORE VASCULAR Flashcards
Name, from Anterior to Posterior, the structures of the thoracic outlet
Anterior: subclavian vein–>anterior scalene muscle–>subclavian artery–>brachial plexus–>middle scalene muscle Image: transaxillary approach view for 1st rib resection
It often behooves a surgeon to perform a fasciotomy on a patient with compression injury caused by compartment syndrome 2/2 popliteal vessel injury. Which time of fasciotomy is performed?
FOUR-compartment fasciotomy–>to decompress both the anterior and lateral compartments of the leg, as well as the superficial and deep posterior compartments
Name the 4 neurovascular bundles and their associated compartment of the lower leg:
Anterior: -anterior tibial artery -deep peroneal nerve Lateral: -peroneal artery -superficial peroneal nerve -deep peroneal nerve Deep Posterior: -posterior tibial artery -peroneal artery -tibial nerve Superficial Posterior: -no significant neurovascular compartments
In knee dislocation, what should be done to the knee immediately?
It should be reduced and stabilized to allow for proper vascular exam
In a patient with traumatic knee injury, if post-reduction distal pulses are diminished and confirmed with ABI, then what will be your next 2-3 steps?
- heparin should be given 2. prompt imaging obtained if patient stable 3. proceed to vascular repair FIRST if skeletal trauma stable
Describe the ESCHAR trial(Effect of Surgery and Compression on Healing and Recurrence):
Study of 500 pts with open or recently healed venous ulcers and evidence of saphenous vein reflux and comparing compression alone or compression + surgery in these patients. What did they find? -surgery did NOT increase healing rates -surgery DID cut recurrence rate in half (to 12%)
Where is vWF synthesized and released?
endothelial cells
In someone who may be deficient in vWF, what may be used to increase endogenous vWF release?
desmopressin
In patients in the ICU who do NOT receive enteral feedings, what are they at risk for?
They are at risk of developing leaky intestinal mucosa, which allows for bacterial translocation. This impaired mucosal barrier may contribute to multisystem failure.
T or F: Enteral feedings can be initiated even in conditions such as adynamic ileus, a recent small bowel anastomosis, or an associated pancreatitis.
TRUE.
A recent cochrane review comparing catheter-directed intra-arterial thrombolysis to systemic IV thrombolysis demonstrated what?
Catheter-directed intra-arterial thrombolysis is MORE effective with FEWER complications.
Risk factors for compartment syndrome following revascularization for lower extremity ischemia include prolonged ischemia time (>6hrs) AND WHAT ELSE?
- young age
- HYPOtension
- poor back bleeding from the distal arterial tree at embolectomy
Which hypercoagulable state is most strongly associated with spontaneous ARTERIAL thrombosis?
Hyperhomocysteinemia
Where does low-dose dopamine act predominantly?
the dopamine-1 receptors in the renal, mesenteric, cerebral, and coronary beds, resulting in VASODILATION.
At a LOW dose, dopamine for instance, may be of benefit in something like non-occlusive mesenteric ischemia because it can vasodilate the vasculature of the mesentery.
The postoperative aortic patient with unexplained worsening acidosis, increasing fluid requirement, and bloody stools has what until proven otherwise?
ischemic colitis
Tx includes aggressive fluid resuscitation, IV Abx, close monitoring.
Patchy areas of ischemia may be managed nonoperatively, but large circumferential areas of necrosis may do better with reoperation and resection.
