Vascular Flashcards
s/p ablation with Numbness along th posteriorlateral aspect of the lower leg and foot. Which nerve?
Sural nerve – bc this surgery was along the small saphenous vein
Absolute Indications for IVC placement
- Contraindication for anticoagulation (intracranial hemorrhage, active bleed, pregnancy, mal HTN, brain/eye/SC surgery)
- recurrent thromboemb despite anticoagulation
- Anticoagulation related complication
s/p endo AAA POD1 with bloody diarrhea and abdominal pain… Next step?
Sigmoidoscopy - eval ischemic colitis caused by coverage of IMA by the endograft
(if free air or HDU, ex lap)
CAD, PAD and Afib with acute diffuse abdominal pain, CT-A with occlusion in the SMA.
location and distribution of the intestinal ischemia
Distal SMA (embolic) Ischemia of mid jejumun through the ascending colon
4 categories of Acute Mesenteric ischemia
- Embolic (distal - usu the middle colic so mid jejunum to ascending colon)
- Thrombotic (proximal)
- Non occ Mes Ischemia (NOMI)
- Mesenteric venous
Thromboxane 2 roles
- platelet aggregation
2. local VC to dec flow to an injured vessel
40 yo w h/o Left leg DVT has swollen extremity and medial mallelous ulcer , U/S of the left venous system shows insufficiency ext from the ileofem segment into the pop… whats the next step in management?
Left lower extremity venogram
Pregnant women with severe abdo pain with HDU and CT showing splenic artery aneurysm with extra… whats the treatment?
IR embolization - high success and low morbity
other options are open or lap surgery
s/p hip surgery with DVT, how long therapy?
Anticoagulation for 3 months
acute Type B dissection from distal to SCA to the Right ext iliac with abdominal tenderness. Tx?
TEVAR - thoracic endovascular aortic repair to cover the entry tear and redirect to the true lumen.
Need a 2.5 cm landing zone
POD4 sleeve now tachy/tachy with PE, how long tx
12 weeks anticoagulation
SVT tx based on location
Usu tx is compression and NSAIDs but if its within 3 cm of the saphenofem Jon ; may benefit from fondaparinux for 45 days
refractory HTN with String of beads on CT scan
Fibromuscular dysplasia
Balloon angioplasty
psuedoaneurysm sp endovasc procedure
When it threatens the overlying skin, immediate operative rapir with proximal and distal control
HDS UGI with h/o AAA repair, what do you think of?
Aortoenteric fistula - Fistula repair, graft excision, aorta overswen, and distal perfusion is restored with extra anatomic bypass
h/o Factor V leiden with left leg massively swollen and cyanotic, tight compartments, nd pedal pulses palpable
Phlegmasia cerulea dolens - Surgical emergency!
Tx pharmacomechanical thrombectomy with locally administered thrombolysis with fasciotomy.
Pregnant + DVT Tx
low molecular weight heparin -
Rutherford classification ; which ones w operative mgmt?
IIB
lower extremity fasciotomy with dec sensation in the skin over the lateral two thirdsof the leg
Superficial Peroneal nerve
forearm compartment measures 35mmHg, what to do?
Compartment syndrome > 30 so fasciotomy via the dorsal and volar incision
contrast induced nephropathy s/p angiogram, treatment
pre-tx w/ NS 1ml/kg/hour for 12 hours prior and after
Dabigatran ( Non Vit K oral anti/direct thrombin inhibitor) PRE OP mgmt depends on
Cr Clearance!
If CrCl>50 then1-2 days before
If < 50 then 3-5 days prior
Restart 1-2 days
Emergent:
Idarucizumab or PCC
Order of AV access operations:
- radiocephalic
- brachiocephalic fistula
3.brachiobasilic fistula - opposite arm
- Brachioaxillary(graft) UE
Graft of LE
Indications for Urgent Dialysis
A - Acidosis<7.1 E- Refractory hyperkalemia I - Intoxication(SLIME) O - volume overload refractorytodiuretics U - Uremia
AAA repair for 5.7 juxtarenal aneurysm –> right foot is cold with nopalpable pulses.. Next step
Right femoral cutdown and embolectomy
Preop Eval for AAAelevtice repair - 4 METS
1 MET - 1 flight of stairs
Access Related HandIschemia (ARHI)
Banding, RUDI (revision using distal inflow),PAI (proximalizaition of arterial inflow, DRIL (distal revs interval ligation), DRAL (distal radial artery ligation)
*DRIL #1 choice
DM with oozing left toe. Tx?
Second toe amp (source control) and then revascularization
gangrene foot with palp popliteal pulse.. sx?
AKA - palpable pulse immediately above the level of amputation predicts successful healing nearly 100% time
Reasons AVF doesn’t mature? 1st step?
Steal, aneurysm, infection, inflow or outflow
1st: US duplex
60F DM s/p AVF. 3 hours after OR, severe pain. Nerve conduction shows axonal damage
Ischemic monomeric neuropathy
NOT steal, as that is associate w loss of pulse
ideal vein for AVF
3mm diameter, no signs of stenosis/thrombus,
Ideal exposure of the femoral artery during vasc procedure is…
is the transverse incision
Calculation ABI
higher pedal pulse/higher brachial pulse
<0.9 inc in CV mortality
Sclerotherapy position?
trendelenberg to prevent refilling
Acute onset of paralysis of both lower extremities and cyanosis of the umbilicus down
occlusion artery of Adamkiewicz
CEA complete, what order do you unclamp the vessels?
External first, then common carotid, then the internal carotid. the internal carotis is reomoved last to avoid cerebral embolization and stroke after carotid
Penetrating injury to the thigh, 50% transection of artery with expanding hematoma. whats the order of reconstruction?
Lateral anteriorrhaphy Lateral suture patch angioplasty Resection and end/end anastomosis Resection and saphenous interposition graft ligation
The decision to start dialysis. in pts w CKD include: ESRD, uremic sis, GFR and rate ofGFR decline… although no set cut off, what is the general rule for initiation?
SYMPTOMATIC pts w GFR 10-15 ml/min/1.3m2
carotid duplex US - peak systolic velocity to measure stenosis, EDV,
ICA PSV
125cm/sec= 50% occlusion
125-230cm/sec = 50-69%
>230cm/sec = >70% stenosis
