Vascular Flashcards
what is a superficial venous thrombosis?
thrombosis that affects the axial veins (great and saphenous veins)
which is more common, superficial or deep vein thrombosis?
superficial
what is the management of superficial venous thrombosis
anticoagulation, especially near the saphenofemoral junction
what is a SVT after endogenous laser ablation called?
EHIT (endovenous heat induced thrombosis)
how is EHIT managed?
NOT anticoagulation, conservative management and surveillance
is the risk of PE high or low with EHIT?
low
when would you anticoagulate for EHIT?
Class 3 (thrombus extending 75% into the lumen of common femoral vein) or 4 (thrombus completely occluding the common femoral vein)
what is the treatment for superficial thrombophlebitis?
antibiotics and excision of the superficial vein (curative)
what is the treatment of deep or central vein thrombophlebitis?
intensive antibiotics and heparin anticoagulation for 2-3 weeks, if not successful then can do venous thrombectomy and vein excision
What kind of endoleak is this?
Type II retrograde flow from side branches of the aorta
what kind of endoleak is this?
Type IV Porosity of the graft wall
What kind of endoleak is this?
Type III Defect in the graft, usually d/t inadequate overlap between the stent-graft components
What kind of endoleak is this?
Type I Inadequate sealing at the proximal (type Ia) or distal (type Ib) attachment sites
what kind of endoleak is this?
Type V Increase in the size of aneurysm with no identifiable leak
what is the MC type of endoleak?
Type II (70-75%) retrograde flow from branches of the aorta
How do you treat Type II endoleaks?
observation and appropriate surveillance - typically resolve on their own
if aneurysm gets bigger at follow up CTA at 1 month or q6 months, transarterial embolization of the responsible branch is recommended
which types of endoleaks do you have to fix right away?
Types I and III
How do you treat a type I endoleak?
angioplasty to increase the radial force on the graft to improve the seal, if this fails can do a cuff (short stent graft)
When are stent grafts used for endoleaks?
Type 1 - extend the seal zone
Type 3 - help bridge the disconnected stent graft components
when would you do surgical repair for a pseudo aneurysm?
complicated PsA - infected Psa, HD instability, active bleeding, skin necrosis, cellulitis, distal limb ischemia, neurologic deficit, failure of US treatment, large aneurysm (>5 cm) with wide neck
What is the treatment for a PsA that is uncomplicated and <3 cm
observation, serial US
What is the treatment for a PsA that is uncomplicated <3 cm and does not resolve after 6 weeks or increases in size?
US guided thrombin injection
What is the treatment for a PsA that is uncomplicated and 3 cm or bigger?
US guided thrombin injection
what are absolute indications for dialysis?
Uremic pericarditis, pleurites, or encephalopathy
In the setting of HIT and liver failure, what anticoagulant should you switch to?
Bivalirudin - has hepatic metabolism and metabolism by proteolysis. Excreted by both liver and kidneys which is better than argatroban (liver only)
What is the order of central venous access in a patient that has an upper extremity AV fistula?
contralateral IJV, ipsilateral IJV, contralateral subclavian, ipsilateral subclavian vein
What is the treatment for grade I blunt traumatic aortic injury?
admission and aggressive pulse rate (<100 beats/min) and blood pressure control (<100 mmHg) (impulse control) before TEVAR
What is a Grade II BTAI (blunt traumatic aortic injury)
intramural hematoma
what is a Grade I BTAI (brunet traumatic aortic injury)
intimal tears
What is a grade III BTAi
pseudoaneurysm
what is a grade IV BTAI
rupture
what is the next treatment for grade II-IV BTAI?
TEVAR
