Vascular

Question 1

Hypothenar-Hammer syndrome

Answer 1

Repetitive blunt trauma to the hypothenar eminence leads to thrombosis or aneurysm formation of the ulnar artery at Guyon’s canal; typically occupational

± distal embolization

Predisposed patients may have underlying fibromuscular dysplasia

Treatment is surgical bypass

Question 2

Findings of chronic venous thrombosis vs acute

Answer 2

Venographic features that stronglysuggest a chronic process include the lack of significantdilation of the occluded veins, the somewhat taperedaspect of the occlusion, the lack of globular filling defectsor
a meniscus sign, and the presence of abundantcollaterals.

Question 3

How to provoke thoracic outlet compression syndrome

Answer 3

worsen with arm abduction. Reduction or obliterationof the radial pulse during clinical maneuvers such aspassive arm hyperabduction or Adson’s maneuver (deepinspiration with hyperextension of the neck while thehead is rotated to the symptomatic side) are highly sug-gestive of the diagnosis. A systolic bruit can sometimesbe heard at the site of compression.

Question 4

Gi bleed, if superselective cannot be achieved what is the tx?

Answer 4

Vasopressin infusion

Question 5

How do you setup vasopressin infusion? Contraindications ?

Answer 5

Only in lower GI bleed, would be located inthe proximal superior mesenteric artery. Vasopressininfusion is started at 0.2 U/min. Follow-up arteriographyis performed in 20 to 30 minutes to assess response. If Active extravasation is still present, the infusion is increased to 0.4 U/min, and arteriography is repeated in 20 to 30 minutes. If active extravasation isstill observed, alternative therapies (such as emboliza-tion) should be pursued. If vasopressin infusion doesresult in cessation of bleeding, the infusion is continuedfor 12 to 24 hours and the patient is closely monitoredin an intensive care unit.

Contraind: Severe coronary artery disease, dysrhythmia,
cerebrovascular disease, severe hypertension.

Question 6

What happens to hepatic arterial flow with cirrhosis

Answer 6

Early liver diseaseoften
results
in
hepatic
swelling
and
enlargement,which can give a stretched appearance to the small arte-rial branches. As cirrhosis worsens and portal hyper-tension
develops,
portal
venous
return
to
the
liverdecreases. To compensate for this, hepatic arterial flowincreases. This increased flowis the likely cause of theseintrahepatic
arterial
changes.
Ultimately,
as
fibrosisdevelops and worsens, the peripheral branches exhibita characteristic corkscrew configuration. Occasionally,telangiectasias,
aneurysms,
or
arterioportal
venousshunting can be demonstrated.

Question 7

Hepatic pressures

Answer 7

The normal corrected hepatic sinusoidal pres-sure is less than 5 mm Hg; a gradient greater than6 mm Hg represents indirect evidence of portal hyper-tension, and a gradient of greater than 12 mm Hg isthought to correlate with an increased risk of varicealbleeding.

Question 8

Hepatic embolization for trauma, who gets superselective

Answer 8

Gelfoam can be used to embolize an entirehepatic lobe rather than attempting to coil embolizeeach individual branch. However, patients with portalvenous thrombosis and those with portal hypertensionare at increased risk for hepatic ischemia, and emboliza-tion in these patients should be performed judiciously(portal hypertension patients) or not at all (portal veinthrombosis patients).

Question 9

is the minimum desired diameter for a stent placed in a renal artery?

Answer 9

6 mm

Question 10

3. If percutaneous and surgical revascularization are not possible owing to the small vessel size, what procedurecan be used to ameliorate renovascular hypertension?

Answer 10

artery supplying only a small amount of

parenchyma may be embolized and that parenchymasacrificed to treat renovascular hypertension.

Question 11

Papvr connects :

Answer 11

most common is an anomalous connection between theright upper-lobe pulmonary vein and the SVC. PAPVRfrom the right lower-lobe pulmonary vein to the inferiorvena cava is called scimitar syn

Question 12

claudication of the buttocks and thighs
absent or decreased femoral pulses
erectile dysfunction

Answer 12

Liriche syndrome or aortoiliac occlusion, tx is bypass

Question 13

Lerichi syndrome

Answer 13

claudication of the buttocks and thighs
absent or decreased femoral pulses
erectile dysfunction

Question 14

What is the outer diameter of a 5F sheath

Answer 14

7fr, sheath is alway 2 bigger ok the outside

Question 15

Sfa to pop transition occurs at

Answer 15

Medial cortex of the femur

Question 16

Rutherford classification

Answer 16

0 no symptoms 
1 mild
2 moderate
3 severe
4 rest pain
5 minor tissue loss
6 major tissue loss

Question 17

most common peripheral aneurysm and size treatment

Answer 17

pop, 2 cm

Question 18

Abi claudication

Answer 18

0.5-0.8, <0.3 gangrene