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ABSITE Flash Cards > Vascular > Flashcards

Vascular Flashcards

1
Q

Location of superficial peroneal nerve

A

lies within the septum of anterior and lateral compartment of lower leg

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2
Q

function of superficial peroneal nerve

A

sensation to dorsum of foot, except for first web space

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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

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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)

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5
Q

location of great saphenous vein compared to common femoral vein

A

superficial and medial on US

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6
Q

Recommendation for AAA screening per vascular surgery guidelines

A

one time US for men 65-75 with history of smoking

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7
Q

landmarks used to place a subclavian line

A

sternal notch
deltopectoral groove
at midclavicular line

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8
Q

most likely artery to remain patent in diabetic vasculopath, lower leg

A

Peroneal artery

  • secondary to deep anatomic location
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9
Q

when planning a bypass to a peroneal artery, what must you ensure

A

The tibioperitoneal trunk is patent

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10
Q

Initial treatment for venous mesenteric ischemia, in a stable patient without peritonitis

A

anticoagulation

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11
Q

what ABI would be considered a contraindication to compression therapy for venous hypertension?

A

< 0.7

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12
Q

what constitutes telangiectasisas

A

venous structures with diameter < 3 mm

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13
Q

treatment for telangiectasias

A

sclerotherapy injection into feeding vein (reticular vein)

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14
Q

what kind of block would you do for an upper extremity AVF

A
  • supraclavicular block into brachial plexus
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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

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16
Q

what symptoms would warrant surgical repair of AAA

A
  • back or abdominal pain, not explained by another cause
  • embolic phenomenon
  • rupture
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17
Q

what is the classic pattern of injury secondary to acute mesenteric ischemia?

A
  • ischemic bowel from distal jejunum to transverse colon
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18
Q

most common site of peripheral arterial emboli

A

at bifurcations

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19
Q

How do you test for popliteal arterial entrapment

A
  • active ankle plantar flexion
  • passive ankle dorsiflexion
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20
Q

what is the preferred approach for fibromuscular dysplasia of the carotid artery

A

balloon angioplasty

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21
Q

Grade 1 blunt aortic injury

A

intimal tear

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22
Q

Grade II blunt aortic injury

A

intramural hematoma

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23
Q

Grade III blunt aortic injury

A

pseudo-aneurysm

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24
Q

Grade IV blunt aortic injury

A

rupture

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25
Q

Which blunt aortic injuries can be safely observed with proper pharmacotherapy

A

Grades I and II

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26
Q

smokers develop PDA in what artery preferentially

A

Superficial femoral artery

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27
Q

diabetic patients develop PAD in what artery preferentially

A

infrapopliteal arteries

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28
Q

what is a fundamental principle of popliteal artery aneurysm repair

A

typically treated with a bypass to a patent runoff vessel identified with angiography

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29
Q

for a patient in ESRD what kind of long term anti-coagulation should you use?

A

Warfarin

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30
Q

first sign of compartment syndrome?

A

pain

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31
Q

what study would you use to confirm the presence of a pseudo aneurysm

A

arterial duplex

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32
Q

when performing decompression of the thigh, which compartment can be omitted?

A

medial compartment

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33
Q

where can the below-knee popliteal artery be found on cut down?

A
  • 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
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34
Q

you are performing a cut down on the below-knee popliteal artery, how would you expose the proximal tibioperoneal trunk?

A

divide the soleus muscle

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35
Q

what nerve do you need to ligate during an above-the-knee amputation?

A

sciatic nerve

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36
Q

why do you ligate nerves during amputations

A
  • prevent neuroma formation
  • prevent neuropathic pain post-op
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37
Q

which renal artery is more amenable to a retroperitoneal approach when repairing in conjunction with a AAA

A

left renal artery

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38
Q

why isn’t the right renal artery easily accessible from a retroperitoneal approach

A

IVC is on top of it

39
Q

what is required for all blunt cerebrovascular injuries

A

anticoagulation to reduce risk of embolic events

40
Q

man s/p AAA repair now with leukocytosis, lower abdominal pain, and some bloody stools. What is likely going on

A

possible colonic ischemia
patient should get a sigmoidoscopy to check

41
Q

at what size would you electively repair a popliteal aneurysm

A

2 cm

42
Q

how do you treat a popliteal aneurysm

A

its treated with a bypass, ideally an autograft from the contralateral saphenous vein

43
Q

what nerve is located posterior to the common carotid artery

A

Vagus nerve

44
Q

what does injury of the Vagus nerve, during a CEA, lead to?

A

ipsilateral vocal cord paralysis

45
Q

what is the surgical approach for a left subclavian artery injury

A

left anterolateral thoracotomy

avoid a trap door incision because of the morbidity associated with that surgical approach

46
Q

what US characteristic reliably distinguishes the internal jugular vein from the carotid artery

A

Waveform with respiratory variation on spectral analysis

47
Q

indications for repairing an SFA aneurysm

A
  • size > 3 cm
  • sxs (pain, ischemia)
  • intraluminal thrombus
  • saccular morphology
48
Q

what it the main reason autogenous AVFs don’t mature

A

venous outflow obstruction, usually from stenosis

49
Q

what is the treatment of choice for fibromuscular dysplasia

A

angioplasty is typically sufficient

50
Q

At what size would you intervene on a hepatic artery aneurysm

A

2 cm or larger

51
Q

what 3 US findings would suggest renal artery stenosis?

A
  • flow velocity ratio > 3.5 (renal artery/aorta)
  • flow > 180 m/s
  • narrowing > 50%
52
Q

how should you treat greater saphenous vein thrombosis

A

Fondaparinux (ppx dose of 2.5 mg/day)

  • trying to prevent a DVT from developing
53
Q

if you have embolic ischemia in a leg, where does the emboli usually lodge itself

A

at bifurcation sites

aortic bifurcation
femoral bifurcation
popliteal bifurcation

54
Q

What differentiates Class IIa from Class IIb ischemia? (Rutherford classification)

A
  • 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
Q

acute limb ischemia with sensory loss at toes and no motor dysfunction = what class of acute limb ischemia?

A

Class IIa

56
Q

acute limb ischemia with sensory loss above toes and mild motor dysfunction = what class of acute limb ischemia?

A

Class IIb

57
Q

what is the increase in energy requirement after a BKA

A

increase of 10-40% percent to ambulate

58
Q

what are the two agents approved by the FDA for sclerotherapy in vascular surgery

A
  • Polidocanol
  • Sodium tetradecyl sulfate
59
Q

after a right sided carotid endarterectomy patient presents in follow up clinic with right tongue deviation, what nerve was injured?

A

ipsilateral hypoglossal nerve

60
Q

you are dissecting down to the profunda artery and notice dark blood. What have you hit?

A

lateral femoral circumflex vein

61
Q

chronic wounds are arrested at what phase of wound healing

A

inflammatory

62
Q

When performing extra-anatomical bypass to the femoral arteries, which vessel is preferred as the inflow vessel and why?

A
  • Right axillary artery

keeps away from left flank to allow for retroperitoneal approach in the future

63
Q

laterally located venous ulcers are connected to what larger drainage vessel

A

small saphenous vein

64
Q

medially located venous ulcers are connected to what larger drainage vessel

A

great saphenous vein

65
Q

Segment V1 of vertebral artery

A

origin to foramen of C6

66
Q

Segment V2 of vertebral artery

A

transverse foramen of C6 to transverse foramen of C2

67
Q

Segment V3 of vertebral artery

A

Transverse foramen of C2 to dura

68
Q

Segment V4 of vertebral artery

A

Dura to confluence at basilar artery

69
Q

When performing an Above-knee amputation, which nerve should you identify and ligate

A

Sciatic nerve (within the posterior thigh)

70
Q

what is the current minimum diameter of the iliac artery to accommodate a fenestrated device for a AAA repair?

A

7.5 mm

71
Q

which vascular graft material has been associated with degenerative pseudoaneursym

A

Dacron grafts

72
Q

Argatroban

A

synthetic direct thrombin inhibitor

73
Q

mechanism of action for Argatroban

A

binds reversibly to activation site of thrombin

74
Q

Mechanism of action for heparin

A

binds to antithrombin and inhibits the effects of downstream enzymes of the clotting cascade

75
Q

Main Targets of antithrombin

A

Factor IIa (thrombin)
Factor Xa

76
Q

Another name for enoxaparin

A

low molecular weight heparin
AKA: lovenox

77
Q

how does enoxaparin differ from heparin mechanistically

A

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
Q

Mechanism of action of Apixaban

A

direct Factor Xa inhibitor

79
Q

Pradaxa is what drug?

A

dabigatran

80
Q

eliquis is what drug?

A

apixaban

81
Q

Protamine use

A

reversal of unfractionated heparin

82
Q

how does protamine work

A

forms a salt aggregate with unfractionated heparin

83
Q

What is the technical name for the colloquial “heparin”

A

unfractionated heparin

84
Q

what muscle is involved in popliteal artery entrapment

A

gastrocnemius

85
Q

You identify a patient with popliteal aneurysm thrombosis and lack of flow distally, what Rutherford class is this?

A

IIA - limb marginally threatened can be salvaged

86
Q

Next step - patient with pain for 3 hours found to have popliteal aneurysm thrombosis and no distal flow

A

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
Q

most common reason AVFs fail to mature

A

venous outflow stenosis or obstruction from previous IV sites

88
Q

Land marks delineating superior and inferior borders of CFA

A

superior: take off of superficial epigastric and circumflex iliac arteries

inferior: bifurcation into SFA and profunda

89
Q

When would you do an emergent TEVAR for a type B aortic dissection?

A

Free rupture or malperfusion of end organs

90
Q

minimum size for AVF of artery and vein

A

artery - 2 mm
vein - 3 mm

91
Q

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

A

Intercostobrachial nerv e (T1-T2)

innervates inner upper arm and is not targeted by brachial plexus nerve block

92
Q

what is more taxing Aorta-to-SMA bypass or an Iliac artery-to-SMA bypass, and why

A

Aorta-to-SMA, because you have to clamp the Aorta to do your bypass

93
Q

What is the 30-day mortality rate for critical limb ischemia if no intervention is undertaken

A

60%

94
Q

Why are autogenous fistulas preferred over non-autogenous grafts for HD

A
  • lower complication rate
  • better cumulative patency rates

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