vascular Flashcards
1
Q
lateral and medial margins axillary v
A
- lateral=teres major
- medial-bx SCV at 1st rib lateral margin
2
Q
where does cephalic v drain?
A
into SCV
3
Q
how is pelvic venography obtained?
A
- prone from popliteal access
- check IVC rel to spine
4
Q
which renal v is higher
A
left
5
Q
breakdown of ascending aorta
A
- aortic valve annulus
- aortic root (from AV to sinotubular junction)
- sinus of valsalva
- sinotubular junction
6
Q
isthmus
A
segment of aorta btw org L SCA and lig arteriosum
7
Q
ductus bump
A
just distal to isthmus; contour along lesser curvature.
8
Q
aortic variant percentage bd
A
normal 75%
bovine 15%
sep org left vert 5%
9
Q
branches of SMA
A
- inferior pancreaticoduo
- ileocolic
- middle colic
- right colic
10
Q
arc of riolan (meandering mesenteric a)
A
anastomoses btw middle colic and left colic
*not always present
11
Q
how often is traditional celiac anatomy seen? BD of variants
A
60%
- replaced RHA-10%
- accessory LHA 10%
- replaced LHA 7%
12
Q
why care about variant celiac anatomy
A
- partial hepatectomy
- course through Calot’s triangle + short cystic a (lap cholecystectomy)
- pancreatic surgery (replaced RHA)
13
Q
“vessel through straight” sign
A
vess through lig venous
14
Q
Posterior division internal iliac artery
A
I Love Sex
Iliolumbar
Superior gluteal
lateral sacral
15
Q
Ant division int iliac a
A
- umbilical
- sup vesicular
- inferior vesicular
- uterine
- middle rectal
- int pudendal
- inf gluteal
- obturator
I Love Going
Places In My Very Own Underwear!
- Pudendal
- Inf gluteal
- middle rectal
- inf Vescicular
- Obturator
- Uterine/umbilical
16
Q
persistent sciatic a
A
continuation of internal iliac passing pst to femur and anastomose with distal vasculature
- aneurysm, early athero
- “ext iliac occluded but strong pulse in foot”
Internal iliac artery continues as sciatic artery and then as popliteal artery
Hypoplastic external iliac, common femoral, and superficial femoral arteries (SFA)
2 types based on degree of SFA hypoplasia
Aneurysms in 25%, typically under gluteus maximus due to compression of artery by greater trochanter
17
Q
arc of buhler
A
-4% variant collateral pw Celiac – SMA
18
Q
anastomoses SMA-IMA
A
- chr mesenteric isch, treating type 2 endoleak
- arc of riolan-not always present
- marginal of Drummond-always present
19
Q
mc loc penetrating ulcer
A
desc thoracic aorta
-high flow at aortic root prevents formation of athero
20
Q
anastamoses btw IMA and int iliacs
A
- sup rectal (From IMA)
- inf rectal (From int pudendal)
21
Q
Winslow pathway
A
- sup epigastric (from internal thoracic)
- inf epigastric (From EIA)
22
Q
corona mortis/crown of death
A
- variant anastomosis btw obturator and EIA coursing over sup pubic bone–> sev bleed in trauma (6-8% deaths?)
- theoretical cause of type 2 endoleak
23
Q
orientation SCA and SCV
A
- SVA pst to SVC.
- SVA in scalene triangle (w/ brachial plexus), SVC ant to triangle
24
Q
branches of subclavian
A
- vertebral
- internal thoracic
- thyrocervical
- costocervical
- dorsal scapular
25
subclavian --> brachial
- ax at 1st rib
- brachial at lower border tires MAJOR
- radial at radial head
26
ulnar vs radial a on angiogram/cta
- ulnar bigger, gives off common interosseous
- ulnar supplies superficial palmar arch
- radial appear at radial head. supplies deep arch
27
"high org radial a"
from ax or high brachial a
28
anterior interosseous branch (median artery)
upper extremity variant
-persistence of branch supplying deep palmar arch
The anterior interosseous artery is one of the two branches of the short common interosseous artery (from the ulnar artery). The artery courses deep in the anterior compartment of the forearm on the anterior surface of the interosseous membrane along with the anterior interosseous nerve (from the median nerve). It runs between flexor digitorum profundus (medially) and flexor pollicis longus (laterally) muscles supplying both. It gives off several small branches that pierce the interosseous membrane, supplying the deep extensor muscles within the posterior compartment of the forearm. Small nutrient vessels also supply the radius and ulna. At the upper border of pronator quadratus, the artery:
gives off a small branch to anastomose with the palmar carpal arch and,
pierces the interosseous membrane to enter the posterior compartment of the forearm and anastomoses with the posterior interosseous artery which continues distally to join the dorsal carpal arch.
29
when does EIA bc CFA?
-once it gives off inf epigastric at ing ligament
30
course of deep femoral artery
lateral, pst.
31
course SFA
anterior, medial into flexor m compartment (adductor/hunter's canal)
-popliteal once emerge from canal
32
popliteal branches
- ant tib (1st branch)
- tibioperoneal trunk
* at level of distal popliteus m
33
adductor/hunters canal
The adductor canal extends from the apex of the femoral triangle to the adductor hiatus. It is an intermuscular cleft situated on the medial aspect of the middle third of the anterior compartment of the thigh, and has the following boundaries:
Anteromedial wall - sartorius.
Posterior wall - adductor longus and adductor magnus.
Laterally - vastus medialis.
34
course of ant tibialis
anterolat through interosseous membrane
| -dorsalis pedis at angkle
35
most medial a in leg?
-pst tibial (felt at medial malleolus)
36
isolated gastric varies-cause and drainage
- splenic v thrombus
| - --> inf phrenic v --> renal v --> gastrorenal shunt
37
splenorenal shunt
- collateral btw splenic and renal v
* not ass w/ GI bleed!!!
- but is ass w/ hepatic encephalopathy
38
left SVC ass
- ASD (mc)
| - unroofed coronary sinus
39
duplicated IVC ass
* renal stuff
- horseshoe
- cross fused ectopic kidneys
- circumaortic renal collars
40
circumaortic venous collar/renal vein-when it matters and loc of limbs
- renal tx, ivc filter
| - ant=sup, pst=inf
41
azygos continuation of ivc ass
- duplicated IVC
- polysplenia
* dilated azygos in chest
42
MC cong venous anomaly in chest
left SVC
43
sac like aneurysm above vs below diaph
- above=penetrating ulcer
| - below=mycotic aneurysm
44
path of penetrating ulcer
atherosclerotic --> erosion of intimal --> hematoma in media --> pseudoaneursym, rupture
45
mcc acute aortic syndrome
dissection 70%
46
who's at risk of dissection
- htn #1
- CT do
- preg
- cocaine
47
ascending aorta Ca
takayasu
syphilis
*matters during clamping for CABG
48
acute dissection by week
<2wks
49
contents of true vs false lumens
true: celiac trunk, SMA, right renal
| false= left renal
50
aneurysm with mural thrombus vs thromboses dissection
diss should spiral and displace intimal calcs
51
predictors of shitty outcome in intramural hematoma
- >2 cm thickness
- 5cm+ aneurysm
- +diss/penetrating ulcer (PU worse than diss)
52
true vs false aneurysms shape
- true=fusiform
| - false=saccular
53
causes of aortic pseudoaneurysm
```
trauma
iatrogneic
inf
pancreatitis
vasculitides
```
54
sinus of valsalva aneurysm-who, which sinus, causes, ass, compl, mx
- asian men
- R sinus
- cong or acquired (inf)
- VSD
- cardiac tamp
- bentall procedure
55
MCC ascending aortic aneurysm
medial degeneration
56
sgx's of impending aortic aneurysm rupture
- draped aorta
- growth 10mm+/yr
- focal discon't in circumferential wall calcs
- hyperdense crescent sax-hemorrhage. One of most spec manifestations of impending rupture
- periarotic stranding
- pain
57
MC img finding of aortic rupture
RP hematoma
58
embolic vs thrombotic colitis/enteritis
- embolic=branch points
| - thromboic=otsteium
59
what protects against aneurysm rupture?
circumferential mural thrombus
60
mycotic aneurysm-how, app, where, mx
- seeding from endocarditis
- SACCULAR, PA, inflamm, gas. Expand faster than athero
- thoracic or suprarenal abd
- small, asyx and enruptured.
61
where are most atherosclerotic AAA
infrarenal
62
joeys Dietz syndrome-triad
hypertelorism
bifid uvula or cleft palate
-aortic aneurysm with tortuosity
*shitty version of marfans
63
pathophy marfans vs ehlers danlos
- marfans=fibrillin gene.
| - ehlers-danlos-collagen
64
marfans systemic findings
- ectopic lens
- tall
- pectus deformity
- scoliosis
- long fingers
- vascular-aneurysm, diss, pulm a dilation
65
Ehlers danlos systemic findings
- many subtypes
- stretchy skin, hypermobile joints, bv fragility w/ bleeding diatheses
- vascular issues-aortic root, abd visceral a's
66
who should you avoid precut on?
Ehlers danlos-excessive risk arterial dissection
67
syphilitic leutic aneruysm
untreated tertiary syph
- saccular, asc aorta and arch + root branches
- heavily "tree bark" intimal ca
- 30% CA ostium narrowing
- AV insufficiency
68
aortoenteric fistula-types, where
- 1˚ and 2˚ (mc)
| - 3rd, 4th pts duo
69
inflammatory aneurysms
- young men
- often syx. rupture risk ind of size
- RF= smoking-smoking cessation; periarotic RP fibrosis, AI (SLE, GC, RA)
- 1/3 hydro/renal fx
- ESR+
- sparing pst wall (diff from vasculitis)
70
how to differentiate inflamm aneurysm from vasculitis
-sparing pst wall
71
leriche syndrome
-compl occlusion aorta distal to renal a's (MC at aortic bifurcation.) 2/2 athero
+ collateral
-triad: impotence, claudication, ø femoral pulse
72
mid aortic syndrome (CoA of abd aorta)-how, triad
- absolute zebra off children/young adults 2/2 intrauterine insult w/ fragmentation of elastic media
- narrowed long segm aorta w/o arteritis or atherosclerosis
Triad:
- htn-mc presenting sx and cause of death
- weak/ø fem pulse
- claudation
- renal fx
73
CoA vs pseudocoA
-pseudo=no P gradient, collateral formation, rib notching
74
what a supplies 1st and 2nd rib
costocervical trunk
75
thoracic outlet syndrome-how, order of spectrum, causes, mx, img
- cong or acquired compression SC vess and brachial plexus passing through inlet
- spectrum (N 95% >>>>>>>> SCV > SVA)
causes:
- compression by ant scalene (MC)
- cervical rib
- muscular HTr
- firous bands
- pagets
- tumors, etc
mx:
sx removal rib/m
img:
occlusion w/ arms up on angiogram
76
paget schroetter
- TOS + venous thrombus in SCV
- athletes
- mx: lysis + sx removal offending agent
77
pulm a aneurysm
- swan ganz
- behcets
- chronic PE
- rasmussen
- TOF repair gone wrong
- Hughes-stovin syndrome
78
splenic artery aneurysm-high risk rupture
- liver tx
- portal htn
- pregnancy
- ct do
- alpha 1 antitrypsin def
79
spelnic a aneurysm-rx
->2cm
pseduoanerusym
woman planning to get pregnant
80
splenic a aneurysm mimic
-islet cell pancreatic tumor-ie: don't bx an aneurysm
81
causes splenic a aneurysm
- portal htn
- mult pregn
- pancreatitis (false aneurysms)
82
MC loc splenic a aneurysm
distal
83
SMA aneurysm-mx, ass
```
treat all (high rate of rupture)
-ass w/ mes ischemia
```
84
hepatic a aneurysm-mx
- syx or >2cm
| - FMD, PAN-treat regardless of size.
85
median arcuate lig syndrome (dunbar syndrome)
- compression celiac a by medical arcuate lig
- worse on expiration
- 20-40 yo
- "hooked appearance"
- --> pancreaticoduonenal collaterals and aneurysm
- sx
86
griffith's point
SMA-IMA watershed.
| MC loc for ischemia
87
Sudeck's point
IMA-iliac watershet
| -highly susceptible to ischemia
88
mcc death HHT
-stroke, brain abscess
89
problem with HHT in liver
-shunting --> biliary necrosis --> bile leak
90
uterine avm vs RPOC
myometrial
91
renal artery stenosis causes
- athero 75%
- FMD- 2nd MCC
- PAN, takayasu, NF1, radiation
92
next step: CTA+ or high susp FMD
1) angio w/ P measurements
AND
2) CTA head to toe (look for occult aneurysms)
93
FMD locs
renal-mc
- carotid 2nd mc
- vertebral 3md
- lower extrem=EIA (BL and MF)
94
FMD types and classification
- 3 histo types (medial mc (95%))
| - classification=angiographic (focal vs MF)
95
Segmental arterial mediolysis
abN medial layer --> aneurysms (mult, saccular, diss, occlusion). Spon't intraabdominal hemorrhage.
- splanchnic in elderly
- coronaries in young
96
FMD ass
- spon't dissection
| - spon't coronary artery dissection (SCAD)
97
FMD mx
-mx but if pressure gradient: angio (no stent)
98
nutcracker syndrome vs SMA syndrome
- nutcracker=renal v compressed by sma
| - SMA syndrome= duo compressed by SMA
99
nutcracker syndrome-who, syx
- health female 30s-40s
| - left flank pain, hematuria, llc pain/testicular pain if gonad v involved
100
splanchnic a's
Celiac, SMA, IMA
101
pelvic congestion syndrome
chronic pelvis pain via venous obstruction at left renal v (nutcracker) or income ovarian vein
- mul dilateer parauterine v's
- mx: ovarian v embo
102
branches of IMA
Left colic
Sigmoid
Superior rectal arteries
103
testicular varicocele-which are bad
- non decompressible
| - right sided
104
uterine AVM causes
- cong
| - acquired (D&C, abortion, mult pregs
105
mx uterine AVM
-embo
106
May Thurner
compression left common iliac v by right common iliac a
107
popliteal aneurysm ass, main concern, bilaterality
* mc peripheral arterial aneurysm (2nd to aorta)
- BL 50-70%
ass:
- AAA (30-50%)
- 10% AAA have popliteal aneurysm
concern: acute limb from thromb/distal embo
108
popliteal entrapment
symptomatic compression/occlusion popliteal a via medial head gastrocnemius (less commonly popliteus)
- men <30 yo
- normal pulse that decrease w/ doors/plantar flexion of foot
- dx: medial deviation of pop a
109
cystic adventitial dx
- multiple mucoid-filled cysts in outer media and adventitia of popliteal a --> compr popliteal arter
- uncommon disorder
- young men
110
who's more likely to dev VTE: paraplegic or tetraplegic?
para (doesn't make sense)
111
Klippel Trenaunay Syndrome (KTS)-what, ass, dx
low flow (venous) AV malformations
- port wine nevi
- bony/soft tissue HTr (gigantism)
- venous malform
- ass: -peristent sciatic v
- gi involvement/bleed 20%
- margincal v of servelle=pathognomonic. superficial v in lateral calf and thigh. ie: great saphenous on wrong side
think of this when you see MRA/MRV of leg w/ bunch of superficial vessels (and no deep drainage)
*often linked with Parkes-weber (high flow arterial AVM)
112
ABI for claudication?
- 0.75-0.9=mild
0. 5-0.75-claudication
0. 3-0.5=severe
113
ABI for rest pain?
<0.3
114
intimal HP
- recurr stenosis after revascularization
| - can grow through stent (if fenestrated) or at tips (if covered)
115
hypothenar hammer
blunt trauma to ulnar a and superficial palmar arch
- aneurysm +/- thrombosis
- corkscrew or pseudoaneurysm app
116
takayasu types
-5 total, #3 MC (involving aortic arch and abd aorta
117
takayasu vessel involvement
-aorta and branches, pulm a's ("pruning")
118
MC primary system vasculitis?
Giant cell
119
GCA ass
polymyalgia rheumatica (morning stillness in shoulders/arms)
120
location strategy: central chest, mid clay, armpit
central=takayasu
-mid clavicle=thoracic syndrome
=armpit=gca
121
cogan syndrom
-kid with eye and ear syx's + aortitis
122
vasculitides based on vessel size
- large-takayasu, GCA, Cogan
- medium-PAN, Kawasaki
- small, ANCA+: granulomatosis w/ polyangiitis, churg-strauss, microscopic polyangiitis
- small ANCA-: HSP, Behcets, Beurgers
123
PAN- involved organs, app, ass
- renal (90%), cardiac (70%), GI (50-70%)
- microaneurysm (typically at branch points) --> infarction (wedge shaped)
- hep B
124
which vasculitides are MC in men?
- PAN (MAN)
| - beurgers
125
when is a CA aneurysm ass with Kawasaki not good?
>8mm (risk MI) (smaller may regress)
126
clinical sequelae of kawasaki
- 5 day fever
- strawberry tongue
- neck LAD
- sore throat/diarrhea
- palm/sole feet
127
ways of showing henoch schonlein purpura
intuss
| massive scrotal edema
128
behcets
mouth/genical ulcers
| aortic thickening, pulm artery aneurysm
129
beugers
smokers
- legs> hand, more than one limb
- BW: "auto amputation"
130
mc vasculitis in children
-henoch schonlein purpura
131
corkscrew angiogram of hand
ulnar=hhs
| finger=buergers
132
what's considered narrow neck in pseudo aneurysm?
-neck:PA <1/2
133
where do superior & inferior epigastric anastomose?
umbilicus
134
how common is the 3 vessel L aortic arch?
-70-80%
135
most common arch variation and how common?
common trunk of brachiocephalic and L common carotid (21-27%)
136
congenital vascular anomolies ass w/ aberrant right subclavian?
PDA
ACoA
VSD
carotid/vertebral anomolies
137
Complications of a kommerell diverticulum?
dissection, rupture
138
"significant carotid stenosis"
PSV > 230 cm/s in ICA
OR
ICA/CCA ratio > 4
*suggest 70% stenosis --> intervention required
139
Aortic arch types
1-3 based on degree of elongation (origin brachiocephalic to cephalic portion of arch)
140
HU normal bf
40-50
141
Monckenberg calcification-what, vs atheromatous Ca
- calcification within media of vessels
- diabetes, elderly
- no luminal narrowing
- vs: atheromatous plaque: intermittent, nonuniform calcification of atheromatous plaques, which is associated with luminal narrowing, ischemic symptoms, and aneurysmal development.
