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ORAL BOARDS > VASCULAR > Flashcards

VASCULAR Flashcards

1
Q

AAA - OR

A 
A line, foley
Midline incision
RP exposure
Dissect up to renals, clamp infrarenal 
Get control of iliacs
Heparin 100U/kg
Open aneurysm, evacuate thrombus, suture ligate lumbars, place graft (size it)
Close peritoneum over top of graft
PALPATE DISTAL PULSES 
Return to ICU
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2
Q

Screening and confirmatory for HIT

A

PF4 antibody

Serotonin Release Assay

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3
Q

Suspicion for acute limb ischemia - first step

A

Evaluate pt for risk of hemorrhage

If no contraindication, START HEPARIN GTT

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4
Q

Exposure of below knee pop

A

bump under distal thigh

medial incision about 1 fingerbreadth behind tibia to access popliteal artery by retracting gastroc posteriorly

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5
Q

if no saphenous vein available for conduit

A

arm vein mapping

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6
Q

if forced to do prosthetic conduit

A

6 mm ringed PTFE with saphenous vein patch on artery

sew ptfe to patch of vein, hope to prevent intimal hyperplasia distally

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7
Q

once you have your saphenous vein and proximal/distal exposure, next steps for SFA –> below knee bypass

A

tunnel in anatomic plane and leave tunneler in position
sew vein in reverse orientation and start this by beveling end of it
ensure adequate heparinization
clamp cfa proximally and distally
make arteriotomy and sew anastomosis with 5-0 prolene
pressurize vein and look for any bleeders, ID correct orientation of vein
Bring vein through tunnel and sew to below knee pop using 5-0 prolene
Consider fasciotomy

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8
Q

signal in foot marginally improved since prior to bypass - next steps?

A

listen to signal in foot with bypass clamped and unclamped

angiogram on table

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9
Q

angiogram shows “string sign” at distal anastomosis with limited flow to foot

A

re-perform anastomosis

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10
Q

H&P/first steps for carotid stenosis

A 
Review EKG
Detailed neuro exam
medical and surgical history
order echo 
obtain carotid duplex
dual antiplatelet therapy + statin
check a1c and ensure DM well controlled
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11
Q

symptomatic carotid stenosis - when to perform cea

A

at least 2 days after but within 2 weeks

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12
Q

CEA - OR

A

shoulder roll + extend neck
make incision along anterior border of SCM
take down through platysma, ID facial vein and ligate
retract IJ laterally and ID common carotid prox with care to ID vagus nerve
dissect CCA distally and loop out CCA, ICA, and ECA
heparinize patient with 100U/kg
clamp in ICE order
longitudinal arteriotomy
place argyle shunt using clamps to hold in place
perform endarterectomy and then patch angioplasty with bovine pericardium and sew in place with 5-0 prolene
remove shunt, flush carotid
confirm good repair with intraoperative US and assess for intimal flaps

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13
Q

CVA s/p CEA - US shows patch is patent, carotid a is patent - next steps?

A

CTA

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14
Q

CVA s/p CEA - US shows patch is thrombosed

A

Embolectomies
If no technical defect, assume platelet aggregation issue
Use saph vein instead of bovine patch, apixiban gtt following case

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15
Q

Lymphatic leak s/p bypass - OR

A

Groin exploration
Ligation of lymphatics
Washout
Close skin with wound vac

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16
Q

Saphenous vein ablation

A

US guidance to access GSV just below knee and use micropuncture needle and wire
Then place 7 fr sheath and place ablation catheter through this and follow it up to saphenofemoral junction
Inject tumescence around GSV throughout course in leg
Pull cath back 2 cm distal to SFJ and begin ablating down extent of vein
Remove catheter + sheath, eval SFJ to ensure no evidence of DVT in common femoral vein

17
Q

Treatment of post-ablation VTE

A

2 weeks of anticoagulation and repeat imaging

18
Q

Saddle embolus + evidence of R heart strain

A

Consult PE team

IR/vasc for catheter directed thrombolysis

19
Q

Basilic vein access - important to remember

A

Need to be brought up more superficially for access
2 stages
1. connect basilic v to brachial a, wait for maturation
2. transposition (free up throughout course and make superficial tunnel in arm to make it more easily accessable)

20
Q

Brachiocephalic access

A

Mark a and v with duplex
make oblique incision incorporating both above antecubital crease
Dissect adequate vein proximally and distally
Open brachial sheath and isolate brachial artery for 4 cm segment
Heparinize with 3000U
Clamp proximally, distally, make arteriotomy and sew in vein end to side fashion using 6-0 prolene
Feel for thrill in vein, ensure no kinks or restrictive tissue
Feel pulses in hand
Close after hemostasis

21
Q

Follow-up after autologous fistula

A

US at one month

Then qmonth until mature

22
Q

Rule of 6s

A

6 mm diameter
6 mm deep to skin
flow velocities 600 mm/sec

23
Q

Extreme pain in hand immediately in PACU but good pulse

A

Ischemic monolelic neuropathy

Ligate fistula

24
Q

Extreme pain in hand immediately in PACU but weak pulse

A

Steal

Ligate fistula

25
Q

Difficulty using dialysis - “high pressure alerts” and prolonged bleeding - where is problem, what can you do to help

A

Order duplex esp look for outflow stenosis

If identified, fistulagram and balloon angioplasty of stenosis

26
Q

Bleeding ulcer @ site of fistula

A

Ligate fistula

Establish access elsewhere

27
Q

Chronic steal syndrome - tx options

A

Banding of outflow tract

DRIL - distal revascularization, interval ligation

28
Q

Supraceliac aorta control

A

Transperitoneal approach
Retract left lobe of liver to the right
Open gastrohepatic omentum and enter lesser sac
Retract stomach and esophagus to the left
Clamp aorta as exists the crura (may need to divide)

29
Q

Preoperative imaging and labs in acute limb ischemia

A

CTA, duplex US
2D echo
Coags, CPK, Cr, lactate

30
Q

Acute limb ischemia - absent bilateral femoral pulses

A

explore bilateral groins for saddle embolus

prepare infraclavicular area for possible extra-anatomic bypass

31
Q

May Thurner

A

R CIA compresses L CIV

32
Q

Basic history taking for vascular pt

A 
HTN
HLD
Smoking
DM II
Family hx 
Heart dz
33
Q

Prior to compression/unna boot for venous stasis, make sure to check …

A

arterial pulses

34
Q

SMA exposure

A

Elevate transverse colon
Follow middle colic down to the root at its base
Isolate with silastic loops

35
Q

If vessel is soft, what sort of arteriotomy in embolectomy?

A

Transverse

36
Q

If vessel is hard and crunchy, what sort of arteriotomy in embolectomy?

A

Longitudinal (may need patch)

37
Q

How to fix aortocaval blowout

A

From inside the aorta

38
Q

Repair of aortoenteric fistula

A

extranaatomic bypass
excise graft
oversew stump with double layer prolene suture
piece of omentum to buttress

ORAL BOARDS (11 decks)

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