SESAP - Vascular

Question 1

Lines
IJ v. SC
What complications with each line?
What decreases this risk?

Answer 1

IJ - higher risk for arterial puncture
SC - higher risk for pneumothorax, hemothorax

Ultrasound. Transducing before dilation to be sure.

Question 2

Chronic Mesenteria Ischemia
Presentation?
Gold standard study?

Answer 2

90 min -2 hr after meal
weight loss

Elderly patients with ulcers, H. Pylori negative, No NSAID use.

CT Angio

Question 3

AAA -

when to operate?

Answer 3

Male - 5.5 cm
Female - 5.0 cm.

Open = endovascular

Question 4

Dx of osteomyelitis?

Answer 4

1. visible bone
2. probe bone
3. ulcer duration > 1-2 wks
4. ulcer size > 2 cm2

Question 5

VTE

Treatment?

Answer 5

proximal DVT - anticoagulation for 3 months

distal DVT - either anticoagulation v. surveillance US. isolated distal DVT has a 15% chance of propagating so US surveillance is okay.

calf muscles - soleus, gastrocnemius – low likelihood versus. axial - deep , peroneal/tibial

Question 6

VTE

PE Treament?

Answer 6

1. 3 months of anticoagulation - DTI > VitK antag

if HYPOTENSIVE - then consider thrombolytics,

Question 7

Role of temporary arterial shunts

MC use?

Answer 7

1. Rapid hemorrhage control and re-establishment of distal circulation while you work elsewhere.
2. peripheral arterial injuries from penetrating trauma

Question 8

Aortoduodenal fistula management

Answer 8

1. HD stable. Fistula takedown w/ graft removal, extra-anatomic bypass
2. proximal aorta to distal duodenum
3. After fistula repair and graft excision, the aorta is oversewn, and the distal perfusion is restored with an extra-anatomic bypass to avoid graft contamination.

stenting can be used as a bridge to overall above repair in the HD unstable patient. 50% re-infection risk

Question 9

Access

postop/post-trauma
AKI with RRT needs but not longterm

where to start with short term access?

Answer 9

R. IJ

Question 10

VTE
Isolated calf thrombosis
healthy, ambulatory pt
Tx?

Answer 10

NO AC.

Observe. serial U/S Duplex.

Question 11

VTE
Recurrent VTE with cancer
Tamoxifen
Tx?

Answer 11

Tamoxifen (pro-thrombotic) and recurrent = lifelong AC versus IVC filter placement.

Question 12

VTE
Straightforward DVT
Tx?

Answer 12

3 months of AC.
No superior regimen but
DTI > Warfarin because of no need for surveillance

Question 13

VTE
Superficial thrombophlebitis
Tx?

Answer 13

2012 CHEST guidelines

45 days of fondaparinux and NSAIDS

Question 14

VTE
Catheter-associated VTE
Tx?

Answer 14

remove cathether
3 months of AC

or consideration of local thrombolytics.

Question 15

SVC syndrome
What is it?
workup?
Tx?

Answer 15

1. Compression of SVC - usually malignancy (60%) versus catheters
2. Face/neck swelling, HA, conjunctival edema, cough, dyspnea –> Venogram
3. Malignant - XRT
   Benign - remove the catheter or devide.
   + AC

Question 16

Paget-Schroetter’s
What is it?
Workup?
Tx?

Answer 16

1. Compression of axillary-SC vv at thoracic outlet –> effort thrombosis
   why? first rib/clavicle, subclavius/costoclav lig, costoclavicular triangle compression
2. Venogram
3. surgical decompression of vein (bypass, resection of cervical rib)

Question 17

Nutcracker Syndrome?
What is it?
Workup?
Tx?

Answer 17

1. LEFT renal vv compresion b/t SMA and aorta
2. left flank pain, hematuria, left testicular varicocele –> left gonadal vin into left renal vein
   (women w/ pelvic pain)
3. Venogram
4. Left renal vein transposition and venous stenting

Question 18

May-Thurner Syndrome?
What is it?
Workup?
Tx?

Answer 18

1. Left CI vein between the R CI artery and sacrum
2. Asx, signfiicant phlegmasia
3. AC, compression. Maybe Catheter-thrombolysis w/ stent placement

Question 19

Popliteal vein entrapment?
What is it?
Workup?
Tx?

Answer 19

1. Aberrant course of the medial gastrocnemius mm, pop aneurysm, cyst
2. arterigram, US, venogram
3. compression stockings, AC for DVT, Sx if both artery/vein is involved!