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*Surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

Most common cause of arterial stenosis and occlusion

A

atherosclerosis

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2
Q

biggest risk factor for atherosclerosis

A

smoking

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3
Q

cholesterol profile that increases risk for atherosclerosis

A

elevated LDL

low HDL

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4
Q

Treatment for atherosclerosis

A 
stope smoking
exercise, nutrition
antiplatelet
Beta blockers
statins
anithypertensives
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5
Q

Occlusion or stenosis of the arteries in the lower extremities

A

Peripheral Arterial Dz

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6
Q

PAD above the inguinal ligament

A

aortoilliac dz

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7
Q

PAD below the inguinal ligament

A

femoropopliteal dz

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8
Q

PAD below the popiteal trifurcation

A

tibial occlusive disease

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9
Q

presentations of PAD

A 
Asymptomatic 
Intermittent claudication
Ischemic rest pain
Skin ulceration
Gangrene
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10
Q

Sxs of aortoiliac dz

A

buttock pain

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11
Q

sx of femoropopliteal dz

A

thigh pain

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12
Q

sx of tibial occlusive dz

A

calf claudication

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13
Q

Described as an achiness or heaviness in the extremity with exercise and relieved by rest

A

claudication

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14
Q

syndrome caused by aortoiliac disease. have buttock claudication, absence of femoral pulses and erectile dysfunction

A

leriche syndrome

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15
Q

Burning or boring pain in the distal extremity (toes and feet) while supine and may be relieved by dangling foot off side of bed

A

Ischemic rest pain

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16
Q

Mummification without infection

A

dry gangrene

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17
Q

infection w/ cellulitis and purulent discharge

A

wet gangrene

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18
Q

what are the 5 Ps associated w/ PAD

A

pain, pallor, paresthesias, poikilothermia, and pulselessness (6 Ps – add paralysis)

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19
Q

what is a normal ABI?

A

> 0.9

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20
Q

how to calculate ABI

A

BP at brachial and ankles

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21
Q

when is there claudciation w/ ABI

A

<0.8

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22
Q

where is there rest pain or tissue loss with ABI

A

<0.4

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23
Q

what can an ABI>1 indicate

A

calcification

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24
Q

for claudicaton you may have to repeat ABIs after what?

A

walking on the treadmill

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25
Q

normal flow in the artery

A

triphasic

w/ disease- biphasic then monophasic

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26
Q

tx for claudication

A

cessation of smoking
graded exercise (condition muscles)
walk until pain starts and continue until moderate
antiplatelets

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27
Q

how do you describe the claudication

A

onset of pain to a particular walking distance

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28
Q

who requires operative management with PAD

A

moderate to severe claudication that interferes w/ normal activity
rest pain
tissue loss

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29
Q

most minimally invasive tx for PAD

A

angioplasty w/wo stenting

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30
Q

procedure where you take a plaque out of an artery

A

endarterectomy

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31
Q

Characterized by sudden onset of pain

More commonly associated with acute thrombosis in a chronically stenosed vessel in a patient with chronic ischemia

A

acute arterial occlusion

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32
Q

tx for acute arterial occlusion

A

immediate thrombectomy or embolectomy is limb threatening ischemia

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33
Q

PE findings w/ acute arterial occlusion

A

6 Ps (6th ones is paresthesia)

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34
Q

if no limb threatening ischemica present how do you tx a acute areterial occlusions

A

thrombolytic therapy

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35
Q

when can reperfusion injury occur w/ acute arterial occlusions

A

is leg ischemia is >6 hours

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36
Q

what occurs w/ reperfusion injury

A

limb swelling due to increased cpaillary

leakage from dmaged cells can cause acidosis, hyperkalemia, myoglobinemia leading to ATN

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37
Q

carotid artery stenosis presentation

A

asymptomatic
TIA
CVA
amaurosis fugax

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38
Q

caused by hollandhorse plaque, will have blindness like a curtain closing over eye

A

amaurosis fugax

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39
Q

does carotid artery stenosis mean there is a bruit

A

No, but they can

there can be a bruit w/o stenosis

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40
Q

diagnosis for carotid artery stenosis

A

carotid US and MRA

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41
Q

Tx for mild and moderate carotid artery sternosis

A

antiplatelet or anticoagulation

routine surveillance and tx of risk factor

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42
Q

tx for severe or symptomatic dz w/ carotid artery stenosis

A

carotid endarectomy (CEA) or stenting

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43
Q

C/I to CEA

A

Patients with a severe neurologic deficit following a cerebral infarction
Patients with an occluded carotid artery
Concurrent medical illness that would significantly limit the patient’s life expectancy

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44
Q

Seen mostly in younger (<40) smokers who smoke more than 25 to 30 cigarettes a day
A progressive inflammatory disease of small vessels caused by smoking causing obliteration of the vessels

A

Buerger’s Dz

Thromboangiitis Obliterans

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45
Q

what is Buerger’s dz often associated w/

A

Raynaud’s phenomenon

superficial thrombophlebitis of the hands and feet

46
Q

only tx for Buerger’s Dz

A

stop smoking

47
Q

Characterized by hypertension that is difficult to control, of acute onset or sudden progression despite having been stable

A

Renal Artery Stenosis

48
Q

cause of renal artery stenosis

A

Caused by stenosis of one or both renal arteries most commonly by atherosclerosis (older patients) and less commonly by fibromuscular dysplasia (young women)

49
Q

Diagnosis of renal artery stenosis

A

renal artery US

50
Q

Tx of renal artery stenosis

A

angioplasty w/ stenting of the affected vessel or endarterectomy

51
Q

Focal dilation > 1.5 times it’s regular size

A

aneurysms

52
Q

what are most true aneurysms associated w/?

A

atherosclerosis

53
Q

what are false aneurysms associated w/?

A

injury or infection

54
Q

what type of aneurysms rupture?

A

AAA and iliac

55
Q

what type or aneurysms rarely rupture but thrombus can dislodge and embolize arteries of the calf and foot

A

popliteal and femoral

56
Q

if elective surgery for an aneurysms is planned what do you need before

A

CTA or arteriogram

57
Q

most non-ruptures AAAs are what?

A

asymptomatic

58
Q

AAA rupture causes what

A

acute back pain
HPOTN
hemodynamic collapse

59
Q

classic triad of a AAA

A

back pain
HPOTN
pulsatile abdominal mass

60
Q

tx for non-ruptured AAA

A

> 5 cm to 5.5 cm in men and
4.5 cm in women (transverse diameter) OR
rapidly enlarging OR
symptomatic

61
Q

Tx for ruptured AAA

A

NO CT scan

call vascular surgeon- need immediate surgery

62
Q

traditional repair for AAA

A

Abdominal incision
Aorta clamped
Prosthetic graft sewn in place

63
Q

endovascular repair w/ AAA

A

Placing prosthetic grafts with wire supports through femoral or iliac arteries

64
Q

immediate risks of AAA reapir

A

MI, renal failure, colonic ischemia, distal emboli, hemorrhage

65
Q

long term risks of AAA repair

A

– graft infection, aortic-enteric fistula, graft thrombosis, pseudoaneurysm

66
Q

endovascular risk w/ AAA remair

A

endoleak

67
Q

Usually with AAA
Most asymptomatic
May be felt on PE but most found incidentally
Risk is rupture

A

iliac aneurysm (true)

68
Q

when do you repair an iliac aneurysm

A

> 4 cm

69
Q

Usually asymptomatic
Don’t rupture
Thrombose and embolize (blue toe syndrome)
Acute ischemia

A

popliteal aneurysms (true)

70
Q

when is repair w/ a popliteal aneursyms done?

A

at 2 cm of any size if lined w/ thrombus or emboli

71
Q

Uncommon

Most are psuedo-aneurysms (False) – after arteriogram

A

femoral aneursyms

72
Q

Tx for a true femoral aneurysm

A

> 2 cm or throwing emboli

73
Q

risk factors for DVTs

A 
older age
obesity
cancer
surgery
trauma
immobilization
HRT< OCP
preggo
neurologic dz
varicose veins
chemo
history/ FH of DVT
74
Q

genetic hypercoagulable states

A

Deficiencies of antithrombin III, protein C or S
Factor V Leiden
Elevated homocysteine levels
Elevated factor VIII

75
Q

present w/ Dull ache in calf or leg with mild edema to severe pain and massive swelling

A

DVT

76
Q

massive swelling, cyanosis, may have low grade fever and tachycardia

A

proximal DVT

77
Q

severe form of DVT with leg pulseless, pale and cool

A

Phlegmasia alba dolens

78
Q

DVT w/ cyanosis and gangrene

A

Phlegmasia cerulea dolens

79
Q

Do if positive D-dimer and in all patients with a moderate-to-high risk of DVT

A

Duplex US

80
Q

what is the prediction criterion for DVT

A

Wells Clinical Prediction Rule

81
Q

if DVT was unprovoked or recurrent what should you do

A

Evaluate for hypercoagulability

82
Q

pharm tx for DVT prophylaxis

A

SQ heparin, LMWH or warfarin

83
Q

Tx for DVT

A

LMWH (at home)
IV heparin (hospital)
transition to warfarin

84
Q

if high suspicion of a DVT when should you treat ?

A

initiate tx before results of diagnostics

85
Q

if you have an intermediate suspicion of a DVT when should you start tx

A

treat before results if not available for >4 hours

86
Q

what type DVT have low risk of PE

A

calf DVTs

87
Q

Obstructions of large pulmonary arteries results in increase PA pressure and acute right ventricular failure

A

Pulmonary Embolism

88
Q

presentation of PE (triad)

A

Dyspnea
pleuritic chest pain
hemoptysis

89
Q

standard for dx of PE

A

pulmonary angiography

but CTA initial imaging of choice

90
Q

TX for PE

A

anticoagultion to prevent further emboli
thrombolytic therapy- if stable but compromised
IVC filter
embelectomy- really high mortality

91
Q

See in patients with VV, pregnancy or postpartum, or from trauma, like an IV
Erythema, induration and tenderness along a superficial vein
Palpable cord

A

Superficial thrombophlebitis

92
Q

tx for superficial thrombophlebitis

A 
NSAIDs
heat
elevation
compression and walking 
excision if persistence or spread of process
93
Q

if superficial thrombophlebitis is in the greater saphenous and progressing to the SFJ what needs to be done?

A

full anticoagulation

94
Q

tx for septic thrombophlebitis

A

broad spectrum abx and excision

95
Q

The superficial, perforating and deep veins connect
Blood flows from superficial to deep
Dilated, tortuous superficial veins in the LE

A

varicose veins

96
Q

Symptoms of varicose veins

A

Sxs-heaviness and fatigue with standing, swelling, night cramps, itching, venous stasis ulcers, superficial thrombophlebitis and bleeding

97
Q

what is primary varicose veins

A

incompetent valves at the SFJ

98
Q

tx for varicose veins

A

elastic stockings
periodic elevation
regular exercise

99
Q

indications for surgery for varicose veins

A

Persistent or disabling pain despite non-operative measures
Recurrent superficial thrombophlebitis
Erosion of overlying skin with bleeding
Ulceration

100
Q

surgery tx for varicose veins

A

stripping- remove saphenous veins
saphenous ligation- high recurrence
endovenous laser tx or RF ablation
branch vein excision

101
Q

what causes chronic venous insufficiency

A

venous HTN

102
Q

presentation of CVI

A

swollen legs
hyperpigmentation at the ankles
venous stasis ulceration- medial/ lateral malleoli

103
Q

Tx of CVI

A

compression and wound care
leg elevation and exercise
surgery in rare cases

104
Q

diagnosis of CVI

A

US

105
Q

painless edema of mostly LE- including feet and toes

A

lymphedema

106
Q

diagnostics for lymphedema

A

venous duplex (r/o venous insufficiency) or DVT

107
Q

tx for lymphedema

A

compression
massage
sequential pneumatic compression devices
good skin care w/ lotion

108
Q

Vasospastic disorder of the hands and feet most commonly seen in young women
Classic history is cold stimulus followed by tricolor changes of the digits
White(pallor)  blue(cyanosis)  red(hyperemia)

A

Raynaud Syndrome

109
Q

Due to spasm
Common and benign
Characterized by hyperresponsiveness of normal vasospasm to cold or emotional stimuli

A

Raynaud Disease (primary)

110
Q

Older women
Associated with connective tissue disorders
Scleroderma, SLE
Generally more severe with occasional tissue loss or gangrene
↑ sed rate and ANA

A

Raynaud phenomenon (secondary)

111
Q

Tx of Raynaud syndrome

A

avoid triggers
no smoking, OCP or meds that decrease CO or cause vasospasm
CCB or angiotensin receptor blockers

*Surgery (5 decks)

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