Vascular 1 Flashcards
From smallest to largest what is the order for the following surgical clamps:
Jake
Hemostat/Snap
Mosquito
Kelly
Jake
Mosquito
Hemostat/Snap
Kelly
What are the 4 etiologies of PAD?
- atherosclerosis
- arterial embolism
- vasculitis
- fibromuscular dysplasia (FMD)
What are the 5 modifiable risk factors for PAD?
- smoking
- hypertension
- diabetes
- hyperlipidemia
- metabolic syndrome
Pain in the lower extremity with walking or physical activity that is relieved with rest is defined as?
intermittent claudication
What physical exam test can distinguish PAD from cellulitis?
Buerger test
- red discoloration that goes away with leg elevation is consistent with PAD
- this does not happen with cellultis!
What type of ulcer is this?
very painful ulcer located on the foot, toes, lateral boarders of the foot, or heel that is pale, yellow, or brown and has sharply defined or “punched out” boarders.
arterial
What type of ulcer is this?
ulcer can be asymptomatic and can occur at any of the pressure points. The color is variable and the borders are punched out with surrounding calloused skin.
neuropathic
What type of ulcer is this?
painful ulcer that is commonly found above medial or lateral malleoli. It is edematous with yellow fibrinous tissue and possible discharge. The borders are irregular with surrounding edema.
venous
Which of the gangrene types can result in auto-amputation?
dry gangrene
wet gangrene needs to go to the OR
T/F: You only need one of the tibial arteries to maintain blood flow to the foot.
True
What is the first line and easiest diagnostic study to do for PAD?
ankle-brachial index (ABI)
higher ankle SBP/higher arm SBP
What ankle-brachial index (ABI) score is diagnostic for PAD?
< 0.9
What ankle-brachial index (ABI) score is considered normal?
0.91-1.30
What ankle-brachial index (ABI) score is considered severe?
< 0.4
What does a ABI score of >1.3 mean?
vessel is non compressible d/t occlusion
need to use another test = toe pressure
PAD diagnosis consists of these 3 criteria.
- symptoms of critical limb ischemia
- ABI < 0.90
- Post-exercise ABI decrease by >20%
If a patient presents complaining of difficulty sleeping d/t lower limb pain that is only relieved when they dangle their leg from the edge of the bed what is this called?
rest pain
For patients with diabetes or ESRD who may have falsely elevated ABIs d/t calcifications what test is more accurate for PAD?
toe pressures or TBI
What are the 3 indications for measuring ABI in asymptomatic patients?
- abnormal or absent pedal pulses
- age > 70 years
- age 50-69 and history of smoking or diabetes
What do the 3 Rutherford Grades correlate with?
- Grade 1 = claudication
- Grade 2 = rest pain
- Grade 3 = tissue loss
What does the AHA Life’s simple 7 consist of?
- not smoking
- being physically active
- having normal BP
- having normal glucose level
- having normal total cholesterol level
- eating a healthy diet
Medical management for PAD always include these 2 medications.
- Aspirin
- Statin
What is cilostazole (Pletal) used for?
improve walking distance during exercise
What are the 4 indications for surgical intervention for PAD?
- disabling claudication
- ischemic rest pain
- ulcerations
- gangrene
What surgical procedure is particularly helpful for fibromuscular dysplasia (FMD)?
- balloon angioplasty
In patients with intermittent claudication what % of patients will have an MI or stroke within 5 years?
20%
What are the 4 signs and symptoms consistent with subclavian steal syndrome?
- unequal UE BP
- arm claudication
- arm or hand ischemia
- neurologic symptoms (e.g. dizziness, visual changes, syncope)
What are the 2 reasons for intervention for subclavian steal syndrome?
- severe symptoms
- maintain LIMA bypass
What are the 4 etiologies of acute limb ischemia/arterial occlusion?
- progression of PAD
- arterial emboli
- arterial thrombus
- arterial trauma
What is the most common site of an arterial thromboemboli?
- femoral
Dislocation of this joint is associated with arterial occlusion.
knee joint
The main risk factor associated with arterial occlusion is what cardiac arrhythmia?
atrial fibrillation
What are the 6 P’s of limb ischemia d/t arterial occlusion?
- pulselessness
- pain
- poikilothermia
- pallor
- paresthesia
- paralysis
In acute limb ischemia there is irreversible damage after ___ hours.
6 hours
What is the treatment for arterial occlusion?
emergent/urgent revascularization via thrombectomy OR embolectomy
What classification of acute extremity ischemia is this? What is the treatment?
pain is mild capillary refill is intact motor innervation is intact sensory innervation is intact arterial doppler is audible venous doppler is audible
- classified as VIABLE
- treatment = urgent work-up
What classification of acute extremity ischemia is this? What is the treatment?
pain is severe capillary refill is delayed motor innervation is partially intact sensory innervation is partially intact arterial doppler is inaudible venous doppler is audible
- classified as THREATENED
- treatment = emergency surgery
What classification of acute extremity ischemia is this? What is the treatment?
pain is variable capillary refill is absent motor innervation is absent sensory innervation is absent arterial doppler is inaudible venous doppler is inaudible
- classified as NONVIABLE
- treatment = amputation
What hypercoagulable disease is associated with arterial embolic events?
anti phospholipid antibodies
this syndrome is characterized by scattered petechiae or cyanosis of soles of foot or toes that is caused by small vessel occlusions.
blue toe syndrome
This disease is characterized by severe ischemia and tissue loss of the distal extremities and is primarily seen in CIGARETTE SMOKERS.
thromboangitis obliterans (Buerger Disease)
What findings on angiogram are consistent with thromboangitis obliterans (Buerger Disease)?
- corkscrew appearance of arteries
