Vascular Flashcards
1
Q
Location of superficial peroneal nerve
A
lies within the septum of anterior and lateral compartment of lower leg
2
Q
function of superficial peroneal nerve
A
sensation to dorsum of foot, except for first web space
3
Q
Young female patient presents with unilateral lower extremity swelling, discoloration and paresthesias. What does she have
A
Phlegmasia Cerulean Dolens, likely has extensive DVT
4
Q
when can you use catheter directed thrombolysis in limb ischemia?
A
when it is chronic or sub-acute (i.e. without limb threatening ischemic symptoms)
5
Q
location of great saphenous vein compared to common femoral vein
A
superficial and medial on US
6
Q
Recommendation for AAA screening per vascular surgery guidelines
A
one time US for men 65-75 with history of smoking
7
Q
landmarks used to place a subclavian line
A
sternal notch
deltopectoral groove
at midclavicular line
8
Q
most likely artery to remain patent in diabetic vasculopath, lower leg
A
Peroneal artery
- secondary to deep anatomic location
9
Q
when planning a bypass to a peroneal artery, what must you ensure
A
The tibioperitoneal trunk is patent
10
Q
Initial treatment for venous mesenteric ischemia, in a stable patient without peritonitis
A
anticoagulation
11
Q
what ABI would be considered a contraindication to compression therapy for venous hypertension?
A
< 0.7
12
Q
what constitutes telangiectasisas
A
venous structures with diameter < 3 mm
13
Q
treatment for telangiectasias
A
sclerotherapy injection into feeding vein (reticular vein)
14
Q
what kind of block would you do for an upper extremity AVF
A
- supraclavicular block into brachial plexus
15
Q
what growth rate would warrant surgical intervention on a AAA
A
0.5 cm of growth in 6 months
OR
1 cm of growth in 1 year
16
Q
what symptoms would warrant surgical repair of AAA
A
- back or abdominal pain, not explained by another cause
- embolic phenomenon
- rupture
17
Q
what is the classic pattern of injury secondary to acute mesenteric ischemia?
A
- ischemic bowel from distal jejunum to transverse colon
18
Q
most common site of peripheral arterial emboli
A
at bifurcations
19
Q
How do you test for popliteal arterial entrapment
A
- active ankle plantar flexion
- passive ankle dorsiflexion
20
Q
what is the preferred approach for fibromuscular dysplasia of the carotid artery
A
balloon angioplasty
21
Q
Grade 1 blunt aortic injury
A
intimal tear
22
Q
Grade II blunt aortic injury
A
intramural hematoma
23
Q
Grade III blunt aortic injury
A
pseudo-aneurysm
24
Q
Grade IV blunt aortic injury
A
rupture
25
Which blunt aortic injuries can be safely observed with proper pharmacotherapy
Grades I and II
26
smokers develop PDA in what artery preferentially
Superficial femoral artery
27
diabetic patients develop PAD in what artery preferentially
infrapopliteal arteries
28
what is a fundamental principle of popliteal artery aneurysm repair
typically treated with a bypass to a patent runoff vessel identified with angiography
29
for a patient in ESRD what kind of long term anti-coagulation should you use?
Warfarin
30
first sign of compartment syndrome?
pain
31
what study would you use to confirm the presence of a pseudo aneurysm
arterial duplex
32
when performing decompression of the thigh, which compartment can be omitted?
medial compartment
33
where can the below-knee popliteal artery be found on cut down?
- cut down on medial lower leg
- expose medial head of gastroc and retract posteriorly
- popliteal artery will be located in deep posterior compartment posterior to tibia
34
you are performing a cut down on the below-knee popliteal artery, how would you expose the proximal tibioperoneal trunk?
divide the soleus muscle
35
what nerve do you need to ligate during an above-the-knee amputation?
sciatic nerve
36
why do you ligate nerves during amputations
- prevent neuroma formation
- prevent neuropathic pain post-op
37
which renal artery is more amenable to a retroperitoneal approach when repairing in conjunction with a AAA
left renal artery
38
why isn't the right renal artery easily accessible from a retroperitoneal approach
IVC is on top of it
39
what is required for all blunt cerebrovascular injuries
anticoagulation to reduce risk of embolic events
40
man s/p AAA repair now with leukocytosis, lower abdominal pain, and some bloody stools. What is likely going on
possible colonic ischemia
patient should get a sigmoidoscopy to check
41
at what size would you electively repair a popliteal aneurysm
2 cm
42
how do you treat a popliteal aneurysm
its treated with a bypass, ideally an autograft from the contralateral saphenous vein
43
what nerve is located posterior to the common carotid artery
Vagus nerve
44
what does injury of the Vagus nerve, during a CEA, lead to?
ipsilateral vocal cord paralysis
45
what is the surgical approach for a left subclavian artery injury
left anterolateral thoracotomy
avoid a trap door incision because of the morbidity associated with that surgical approach
46
what US characteristic reliably distinguishes the internal jugular vein from the carotid artery
Waveform with respiratory variation on spectral analysis
47
indications for repairing an SFA aneurysm
- size > 3 cm
- sxs (pain, ischemia)
- intraluminal thrombus
- saccular morphology
48
what it the main reason autogenous AVFs don't mature
venous outflow obstruction, usually from stenosis
49
what is the treatment of choice for fibromuscular dysplasia
angioplasty is typically sufficient
50
At what size would you intervene on a hepatic artery aneurysm
2 cm or larger
51
what 3 US findings would suggest renal artery stenosis?
- flow velocity ratio > 3.5 (renal artery/aorta)
- flow > 180 m/s
- narrowing > 50%
52
how should you treat greater saphenous vein thrombosis
Fondaparinux (ppx dose of 2.5 mg/day)
- trying to prevent a DVT from developing
53
if you have embolic ischemia in a leg, where does the emboli usually lodge itself
at bifurcation sites
aortic bifurcation
femoral bifurcation
popliteal bifurcation
54
What differentiates Class IIa from Class IIb ischemia? (Rutherford classification)
- Class IIa: threatened limb with minimal sensory loss (toes) NO motor loss
- Class IIb: threatened limb with BOTH sensory loss (more than toes) and motor dysfunction (but not profound)
55
acute limb ischemia with sensory loss at toes and no motor dysfunction = what class of acute limb ischemia?
Class IIa
56
acute limb ischemia with sensory loss above toes and mild motor dysfunction = what class of acute limb ischemia?
Class IIb
57
what is the increase in energy requirement after a BKA
increase of 10-40% percent to ambulate
58
what are the two agents approved by the FDA for sclerotherapy in vascular surgery
- Polidocanol
- Sodium tetradecyl sulfate
59
after a right sided carotid endarterectomy patient presents in follow up clinic with right tongue deviation, what nerve was injured?
ipsilateral hypoglossal nerve
60
you are dissecting down to the profunda artery and notice dark blood. What have you hit?
lateral femoral circumflex vein
61
chronic wounds are arrested at what phase of wound healing
inflammatory
62
When performing extra-anatomical bypass to the femoral arteries, which vessel is preferred as the inflow vessel and why?
- Right axillary artery
keeps away from left flank to allow for retroperitoneal approach in the future
63
laterally located venous ulcers are connected to what larger drainage vessel
small saphenous vein
64
medially located venous ulcers are connected to what larger drainage vessel
great saphenous vein
65
Segment V1 of vertebral artery
origin to foramen of C6
66
Segment V2 of vertebral artery
transverse foramen of C6 to transverse foramen of C2
67
Segment V3 of vertebral artery
Transverse foramen of C2 to dura
68
Segment V4 of vertebral artery
Dura to confluence at basilar artery
69
When performing an Above-knee amputation, which nerve should you identify and ligate
Sciatic nerve (within the posterior thigh)
70
what is the current minimum diameter of the iliac artery to accommodate a fenestrated device for a AAA repair?
7.5 mm
71
which vascular graft material has been associated with degenerative pseudoaneursym
Dacron grafts
72
Argatroban
synthetic direct thrombin inhibitor
73
mechanism of action for Argatroban
binds reversibly to activation site of thrombin
74
Mechanism of action for heparin
binds to antithrombin and inhibits the effects of downstream enzymes of the clotting cascade
75
Main Targets of antithrombin
Factor IIa (thrombin)
Factor Xa
76
Another name for enoxaparin
low molecular weight heparin
AKA: lovenox
77
how does enoxaparin differ from heparin mechanistically
it is a smaller molecule and therefore when it binds to antithrombin it cannot also bind to thrombin as effectively as heparin can
enoxaparin has a greater inhibitory effect on Factor Xa than thrombin
78
Mechanism of action of Apixaban
direct Factor Xa inhibitor
79
Pradaxa is what drug?
dabigatran
80
eliquis is what drug?
apixaban
81
Protamine use
reversal of unfractionated heparin
82
how does protamine work
forms a salt aggregate with unfractionated heparin
83
What is the technical name for the colloquial "heparin"
unfractionated heparin
84
what muscle is involved in popliteal artery entrapment
gastrocnemius
85
You identify a patient with popliteal aneurysm thrombosis and lack of flow distally, what Rutherford class is this?
IIA - limb marginally threatened can be salvaged
86
Next step - patient with pain for 3 hours found to have popliteal aneurysm thrombosis and no distal flow
Heparinize and angiography
- patient will ultimately need a bypass of the thrombosed aneurysm but you’re trying to prevent progression of disease and also (with Angio) find a distal target for your bypass
87
most common reason AVFs fail to mature
venous outflow stenosis or obstruction from previous IV sites
88
Land marks delineating superior and inferior borders of CFA
superior: take off of superficial epigastric and circumflex iliac arteries
inferior: bifurcation into SFA and profunda
89
When would you do an emergent TEVAR for a type B aortic dissection?
Free rupture or malperfusion of end organs
90
minimum size for AVF of artery and vein
artery - 2 mm
vein - 3 mm
91
patient gets a brachial plexus nerve block prior to UE vascular surgery with tourniquet. He starts to complain of pain at the tourniquet...what nerve did we not account for
Intercostobrachial nerv e (T1-T2)
innervates inner upper arm and is not targeted by brachial plexus nerve block
92
what is more taxing Aorta-to-SMA bypass or an Iliac artery-to-SMA bypass, and why
Aorta-to-SMA, because you have to clamp the Aorta to do your bypass
93
What is the 30-day mortality rate for critical limb ischemia if no intervention is undertaken
60%
94
Why are autogenous fistulas preferred over non-autogenous grafts for HD
- lower complication rate
- better cumulative patency rates
