Vascular Flashcards
Carotid Triangle
Posterior belly of digastric m.
Anterior belly of omohyoid m.
Sternocleidomastoid m.
Internal jugular vein
Lateral to internal carotid artery then lateral to common carotid artery. Facial vein enters IJ at level of carotid bifurcation.
Joins the subclavian vein to form brachiocephalic (innominate) vein.
Paget-von-Schroetter syndrome
Venous thoracic outlet syndrome. Effort thrombosis.
thrombosis or severe narrowing of subclavian-axillary vein 2/2 chronic extrinsic mechanical compression w/in thoracic outlet (from cervical rib or muscular tissue b/w head of clavicle and 1st rib)
repetitive injury to subclavian vein at level of costoclavicular space (medial thoracic outlet)
1st rib, clavicle, subclavius muscle, costocoracoid ligament, anterior scalene muscle
Cocaine-induced mesenteric ischemia
inhibition of Norepi reuptake at presynaptic terminal –> more NE at postsynaptic rec –> tachycardia, HTN, vasoconstriction
NOMI
cocaine, hypovolemia, heart failure
CT: bowel wall thickness, target-like appearance
Arterial occlusion MI
Hx PVD, cardiac arrhythmia, valvular disease
CT: bowel wall thickness, filling defect within mesenteric vessels (MC SMA)
Venous occlusion MI
Portal HTN, R heart failure, hyper coagulable
CT: wall thickening, decreased attenuation of bowel wall, mesenteric fluid/ascites
Mechanical strangulation/MI
Acute onset, malrotation/volvulus, previous abdominal surgery
CT: “whirl sign”, hazy mesentery, bowel dilation, air-fluid levels, venous engorgement (outflow obstruction)
Misc causes of MI
Hx vasculitis, trauma, cytotoxic drugs (chemo, radioembolization)
CT: wall thickening, contrast extra or mesentery stranding
Mesenteric venous thrombosis tx
resection of non-viable intestine, large vessel venous thrombectomy, admin of anticoagulation
if bowel is dusky -> 2nd look operation to evaluate viability of any marginally perfused bowel
AVF maturation failure
Technical failure Dialysis-associated steal syndrome aneurysm formation infection excess flow -> heart failure arterial inflow or venous outflow stenosis
AVF with poor pulse augmentation
inflow problem
AVF without a pulse/thrill
thrombosed or stenotic lesion
outflow problem
VTE treatment (provoked vs unprovoked)
Provoked -> RFs: surgery, travel, prolonged immobility, pregnancy, OCPs. Tx: systemic anticoagulation for 12 weeks
Provoked in atypical patients -> RFs: persistent immobility, other persistent reversible RFs, phlegmasia cerulean dolens. Tx: Anticoag for 6-12 months
Unprovoked -> malignancy, inherited thrombophilia. Tx: indefinite anticoagulation
IVC filer - indicated if systemic anticoagulation is contraindicated d/t high bleeding risk (intracranial surgery, spine surgery) or ongoing postop bleeding.
Distal DVTs can be surveilled with serial US.
Large PSA distal to L SCA takeoff. CIs to endovascular repair with stent coverage?
Aberrant L vertebral artery
Dominant L vertebral artery
Previous CABG w/ LIMA usage
Functioning AVF in LUE
Amaurosis fugax
Emboli to retinal or ophthalmic arteries (branch of ICA) d/t atherosclerotic disease
TIA, “pulling down shade” intermittent vision changes
Degree of ICA stenosis by PSV and ICA/CCA PSV ratio
Normal - <50%: <125 cm/s, <2.0
50-69%: 125-230 cm/s, 2.0-4.0
>70%: >230 cm/s, >4.0
Indications for CEA
+sxs w/ >50% ICA stenosis
asxs w/ >60% stenosis (if perioperative stroke or death rate <3%)
Aortic Dissections
Type A: ascending aorta
Type B: descending aorta
Type B -> uncomplicated vs complicated
Complicated: impending rupture, rupture, malperfusion of aortic branch artery, refractory pain/HTN. Tx: EVAR
Uncomplicated tx: aggressive medical therapy w/ Beta-blocker
Activated clotting time (ACT)
Measures intrinsic pathway
Monitors heparin therapy and determines amount of protamine needed to reverse the effects
More accurate for high doses (for CABG cases)
Activated Partial Thromboplastin Time
Measures intrinsic pathway
Monitors heparin therapy
Not accurate for high doses of heparin
Bleeding Time
Measures effectiveness of platelets
Outdated and time-consuming
Prothrombin Time
Measures extrinsic pathway
Fibromuscular dysplasia
noninflammatory nonatherosclerotic disorder –> arterial stenosis, aneurysm, dissection, arterial tortuosity
MC involved arteries: renal, ICA, vertebral, iliac, visceral
String of beads = pathognomonic
Tx: balloon angioplasty
W/u of deep venous insufficiency from post-thrombotic syndrome
extremity venogram - determine if venous system is chronically occluded or diseased.
tx: recanalization with stenting
Classification of peripheral arterial disease (Rutherford)
Class I - viable, intact cap return, MSI, +signals, urgent vascular eval required
Class IIa - threatened (salvageable), slow cap refill, intact or minimal loss of motor and sensation, inaudible signals, urgent revascularization vs thrombolysis
Class IIb - threatened (salvageable w/ immediate recon), slow/absent cap refill, partial paralysis, partial sensory loss + rest pain, absent signals, surgical revascularization
Class III - irreversible, absent cap refill, profound M/S loss, absent signals, amputation
Critical limb ischemia
Multi-segment occlusive disease
ABIs <0.4
Blue toe syndrome
atheroemboli, originate from aortic plaque, occlude small vessels
P/w: 6 Ps (pallor, pulseless, poikilothermia, paresthesia, paralysis, pain). + strong pedal pulses
50% occlusion of ICA correlates to what PSV?
125 cm/sec
50-69% occlusion of ICA correlates to what PSV?
125-230 cm/sec
> 70% occlusion of ICA correlates to what PSV?
> 230 cm/sec
Ischemic monomeric neuropathy
MC in W & +DM
Complication after access surgery
Due to shunting of blood away from nerves of distal upper extremity
Signs/sxs: pain out of proportion, acute sensory and motor deficits after creation of AVF
Dx: clinical, nerve conduction studies show axonal damage
Tx: immediate ligation of AVF, restoration of blood flow to hand
Venous hypertension at dialysis access site
Signs/sxs: extremity edema, varicosities, dermatosclerosis, venous ulceration, prolonged bleeding, difficulty with dialysis against high pressure (constant beeping of dialysis machine)
MCC: stenosis, thrombosis of central venous system 2/2 previous catheterization
dx: venogram/fistulogram
tx: end-vascular recanalization of stenotic or occluded veins, or bypass
