Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery > vascular > Flashcards

vascular Flashcards

1
Q

what is an aneurysm

A

focal dilation/increase in arterial diameter of an artery, generally beyond 50%

fusiform–> bulges out on all sides

saccular–> bulges at one site on one side–> generally more dangerous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

where do aneurysms occur?

A

infrarenal aorta is the most common

other aortic sites–> suprarenal, thoracic, abdominal

peripheral sites–> commonly femoral or popliteal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

who should be screened for a AAA

A

all first degree relatives of AAA patients if above 50

all mean over 65 should have a screening U/S, especially if have risk factors like HTN
—> this is not done in canada because of funding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

who should have their AAA treated?

A

those at risk of rupture (over or equal to 5.5 cm in diameter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how do AAAs present?

A

rupture is almost always fatal–> sudden severe abdo pain and CV collapse

can also be asymptomatic on exam when not ruptures

focal dilation of AA with a major risk of rupture and bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what do you expect to find on the physical exam of someone with a AAA

A

upper abdo pulsatile mass, non tender, pulsatility beside it too

assess presence and estimate size (transverse diameter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what investigations should be done for a AAA

A

U/S

CT from arch to groin if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what causes aneurysms

A

age is a significant risk factor

CV disease–> impacted by smoking, atherosclerosis, hypercholesterolemia, family history

males get them more often

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what determines the risk of rupture for a AAA

A

size related mostly

we fix large aneurysms and leave small ones with monitoring

asymptomatic indications are generalyl for greater than 5-5.5 cm in transverse diameter

surgery for smaller aneurysms does not seem to provide additional survival benefit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

indications for aortic aneurysm repair

A
  1. rupture is most important reason–> most urgent and serious symptom
  2. emboli and thrombosis (microemboli and thrombotic debris can be thrown into smaller vessels, causing ischemia)
  3. pain or tenderness
  4. mass effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the classic triad of ruptured AAA symptoms

A

abdo pain

pulsatile mass

hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ddx for ruptured AAA

A 
pancreatitis
perforated viscus
ischemic bowel
renal colic
MI with abdo pain
pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the two main ways aortic aneurysms are repaired

A
  1. open repair

2. endovascular stent graft repair (more common)–> metal stent framework with fabric sent through the femoral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how do you perform an open aortic aneurysm repair

A

open repair with graft replacement sewn into inside of vessel (dont even have to remove aortic husk)

risks are less than 5% mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how do you manage a ruptured AAA

A
  1. urgent transfer to tertiary center with retroperitoneal containment
  2. poor prognosis–> 50/50 of those who make it to hospital
  3. ABCs
    - -volume resuscitation–> at least two large bore IVs with crystalloid, blood, cross match
    - -limit resus to BP max of about 100-110 (HTN may pop it) and clinical indications until you have definitive control
    - -normal BP in ruptured aneurysm is not a cause for complacency
  4. endovascular repair with aortic balloon occlusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how do popliteal aneurysms present

A

non painful, non tender pulsatile mass behind knee

femoral mass on CT and filated popliteal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

common complications of popliteal aneurysm

A

typically cause microemboli–> blue foot, extremely painful infarction of the toes

knee keeps flexing and extending, squeezing the aneurysm which fragments emboli into the feet

may have limb or tissue loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the indication to treat a popliteal aneurysm

A

just its presence alone–> because of high risk for embolism

bypass or stent graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the main complications of visceral aneurysms

A

rupture/hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the indications for visceral aneurysm repair

A

greater than 2cm because of risk of rupture

not true in young women–> pregnancy weakens arterial walls and can cause rupture so all visceral aneurysms are treated in young women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ddx for TIA/stroke

A

TIA (stroke if weakness beyond 24 hours)

seizure

migraine

hemorrhagic stroke (transient as edema subsides)

tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

define TIA

A

transient focal loss of neurological function–> usually diagnosed based on history, usually due to ischemic events

can be anywhere between the heart and head–> great vessels, carotid bifurcation, lacunae, small vessels

carotids are common site of origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

list the causes of stroke

A
  1. intracranial hemorrhage
  2. TIA
  3. cardiogenic embolus–> afib, MI (causes thrombogenic surfaces in the heart), valvular heart disease
  4. small vessel occlusion in the head
  5. non vascular pathology (ie tumour)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what investigations should be done in stroke patients

A

CT

vascular imaging/angiogram

maybe cardiac imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
how should you manage a TIA/stroke patient
1. treat right away and investigate for a cause right away--> risk of further stroke is highest immediately following TIA or initial minor stroke --> hard to predict what the next event will be 2. immediately people get ASPIRIN when come in the door (antiplatelet to prevent furhter emboli) or CLOPIDOGREL 3. statin drugs immediately to lower lipids and stabilize plaque 4. some BP control indicated but want to avoid excessive BP lowering (may extend ischemia) 5. anticoagulation with heparin NOT normally indicated if its an ischemic stroke 6. thrombolysis--> tPA only if the patient is seen in the first 3 hours, if there is still deficit present, if the CT is negative for intracranial hemorrhage and there are no contraindications 7. intracranial clot suction if visualized in a tertiary location
26
what is the most common location of a TIA or stroke etiology
extracranial carotid artery
27
how do you perform carotid enderarterectomy
open artery extract intimal layer and its debris partch artery leave artery with smooth intraluminal surface small but serious surgery
28
what are the risks associated with carotid enderarterectomy surgery
1-2% risk of stroke associated with surgery but without surgery and only medical therapy, the risk of stroke is usually much higher
29
indications for carotid enderarterectomy
simple and stenosis based 1. in symptomatic carotid stenosis--> greater than 50% stenosis following TIA or minor stroke ipsilateral to the carotid stenosis lesion with recovery 2. in asymptomatic stenosis--> 80% occlusion in low surgical risk patients found accidentally on imaging but havent had a TIA--> still benefits from enderarterectomy as not all strokes are preceeded by a TIA or a TIA isnt recognized
30
what are the long term outcomes of stroke patients
about 25% recover about 25% die about 25% have some form of permanent disability
31
what is the initial management of MVA leg trauma
1. ABCs--stabilize BP 2. DE 3. xray etc...
32
how do embolism and thrombosis differ with regard to the following characteristic: onset
embolism--sudden thrombosis--less dramatic
33
how do embolism and thrombosis differ with regard to the following characteristic: prior claudication
embolism--rare thrombosis--common
34
how do embolism and thrombosis differ with regard to the following characteristic: source (afib/AAA)
embolism--yes thrombosis--no
35
how do embolism and thrombosis differ with regard to the following characteristic: arrhythmia
embolism--common thrombosis--possible
36
how do embolism and thrombosis differ with regard to the following characteristic: other leg
embolism--usually normal thrombosis--usually abnormal
37
how do embolism and thrombosis differ with regard to the following characteristic: angiogram
embolism--sharp cutoff thrombosis--diffuse disease
38
what are the 6 Ps of limb ischemia
Paralysis--most important; if you have paralysis you have 6 hours to revacsularize before necrosis begins Pain Pallor Poikilothermia Pulselessness Paresthesia
39
what is the simple treatment of fracture
reduce the fracture quickly before muscle spasm sets it if ischemia persists, need to call for help (as an MSI)
40
what is compartment syndrome
reperfusion of the revascularized limb--leads to disruption of cellular membranes, swelling and pressure in the muscular compartments, then pain and numbness you need to do a surgical FASCIOTOMY down to the muscle to relieve the muscle of swelling (medial and lateral incision down to the muscle bellies)
41
what are causes of acute arterial ischemia
thrombosis EMBOLUS dissection
42
how do you manage a patient with peripheral ischemia due to a cardiac embolus
HEPARIN is of vital important (unfractionated) in acute ischemic conditions can do CT/angio now because is fast enough that it doesnt unnecessarily delay surgery surgery should be done ASAP especially if paralysis present
43
what are the 4 stages of progression of peripheral vascular disease
stage 1--non specific symptoms stage 2--intermittent claudication; benign, and doesnt necessarily require intervention stage 3--rest pain; especially in people who smoke/have diabetes; skin can break pen and cause holes or wounds or sores, especially over bony prominences, that can lead to gangrene stage 4--ulceration, gangrene
44
ddx of claudication
1. neurogenic claudication - -immediate pain upon standing or sitting, usually predictable during exercise that doesnt go away right after stopping exercise 2. arthritis - -this typically is pain in joints 3. excessive lactic acidosis from over activity or inadequate training 4. rare causes - -myositis - -cellulitis
45
define claudication
leg pain during walking most claudicants should be managed with risk factor modification initially (while still benign) only 1% of patients progress to limb loss
46
what is the most useful exam for those with claudication
measurement of resting and exercise ankle pressures--> ankle-brachial index measured at the pedal pulse an A-B index of above 1 or equal to 1 is considered normal
47
what is the number one risk factor for claudication and PVD
smoking
48
treatment for claudication
NO SMOKING exercise primarily by walking until the pain occurs, but then push yourself (isnt harmful to muscles) and over time this will help collateral vessels walk twice daily or join a club for team behavioural modification meds-->most target CVD because there is so much overlap - -statins - -antiplatelets (ASA or plavix) - -other medical condition treatments (for DM, HTN etc)
49
how do you manage diabetic foot
multidisciplinary (vascular, podiatry, endo etc) swab for C and S, broad spectrum abx, management of infection and possible sepsis etc wound care and surgical debridement and specialized dressings xray to look for bone infection or gas gangrene (requires urgent surgery ABI index with or without imaging to assess ischemia stage revascularize and debride or amputate as needed remove pressure (special shoes etc)
50
how does critical limb ischemia present
1. rest pain 2. ischemic ulcer (toe or heel) 3. gangrene (toe or heel)
51
management of critical limb ischemia
1. high risk for amputation (20% per year) 2. need referral 3. imaging and revascularization (endovascular approach or open/surgical approach)
52
what is the rate of DVT in north america
1/1000 increases with age
53
what is virchows triad
etiology of DVT-- 1. stasis 2. hypercoagulability 3. vessel wall damage
54
symptoms of DVT
may have minimal sx pain swelling erythema clinical diagnosis is thus unreliable
55
what test is usually used to diagnose DVT
U/S--90% accuracy
56
risk factors for DVT
``` immobility obesity malignancy pregnancy CHF age hypercoagulable state trauma/surgery previous DVT ```
57
investigations for DVT
``` blood work including: INR PTT platelets Hbg Hct ``` ``` coagulation workup to assess for thrombophilia protein C and S antithrombin III factor V leiden lupus antocoagulant ```
58
treatment for DVT
anticoagulation, initially with UNFRACTIONATED HEPARIN or LMW heparin then oral therapy with coumadin for 3-6 months side effects: bleeding, HIT, osteoporosis coumadin can cause bleeding, skin necrosis and teratogenicity can also use compressive treament (i.e elastic stockings) of the legs
59
what are the wells criteria for PE
symptoms of DVT no alternative better diagnosis tachy with pulse above 100 immobilization more than 3 days or surgery in previous 4 weeks prior history of DVT or PE presence of hemoptysis presence of malignancy
60
list complications of DVT
1. PE--up to 50% 2. venous valvular incompetence--up to 100% (late) 3. recurrent thrombosis--most common early but continues long term, up to 10% 4. post phlebetic syndrome--months to many years, 50% but greater with follow up exceeding 5 years 5. paradoxial embolus--imemdiate, low frequency
61
how do you classify DVT
based on location in leg class I--> isolated to calf; low incidence of post thrombotic or post phlebitis syndrome class II--> popliteal area from the level of the common femoral vein (Class III) and up, there are fewer collaterals and less valves
62
how is fem-pop DVT best managed
mostly recanalizes, with last post phlebetic syndrome due to valvular reflux..... best managed by anticoagulation
63
how is iliofemoral DVT best managed
few valves has little recanalization and postphlebetic syndrome occurs immediately due to obstruction from venous thrombosis---best managed by thrombolysis with or without stent if iliac vein is narrowed
64
what might be helpful in patients with high risk of DVT who are taking a long plane ride
single dose of LMWH
65
in which patients is an IVC filter indicated
in patients with DVT and PE that are recurrent on anticoagulation or are contraindicated with anticoagulants (they are inserted to catch potential pulmonary emboli) prevents potentially fatal PE but does not treat the DVT as soon as the patient can be anticoagulated, they should be give symptomatic leg treatment with compression stockings
66
list the types of chronic venous disease
varicose veins ededma skin changes venous ulcers
67
what is the CEAP classification for chronic venous disease
C0--no signs C1--telangiectasia C2--varicose veins C3--peripheral edema C4--skin pigmentation and lipodermatosclerosis C5--healed ulcer C6--active venous ulcer
68
symptoms of varicose veins
pain with standing, specifically in the veins heaviness increased warmth (from blood) itchiness (blood and histamine) leg cramps (etiology unsure) usually NOT foot pain
69
causes of varicose veins
valvular incompetence more common in women family history, age, ethnicity (more in latinos), pregnancy, obesity, prior deep vein clot all increase the risk and incidence
70
pathophysiology of varicose veins
reflux in saphenous vein causes venous hypertension in superficial veins of the leg normal valve function in deep veins and perforating veins (though they can be involved) venous recirculation and congestion in lower leg
71
treatment/management of varicose veins
thorough diagnosis followed up by U/S to ID the highest level of competence and where the problem starts, then treat in a top-down way remove truncal reflux first--in the greater or lesser saphenous veins, then address the residual reflux in smaller branches surgery (ligation or stripping of saphenous veins)--> removal of saphenous vein endothermal treatment (destruction of the vein by lasers or radiofrequency) foam sclerotherapy compression stockings
72
how do you treat non-truncal varicosities
phlebotomy (can be outpatient with micropunctures) sclerotherapy (foam or liquid) compression stockings
73
list complications of chronic venous disease
thrombosis bleedings dermatitis ulcers
74
describe how thrombosis can result from chronic venous disease and how it can present
superficial thrombosis is usually related to the size of the varicosities initiated by stasis or trauma presents acutely with pain, heat, erythema, and rarely embolize to PE treat with symptomatic relief, but watch for propagation to saphenofemoral junction assess with U/S and again if pain continues or migrates to saphenofemoral junction--treatt with ICE not with warm compresses abx NOT helpful consider LMWH for large thromboses resistant to conservative treatment
75
how should you manage ulcers caused by chronic venous disease
rule out arterial ischemia dont culture unless significant pain, pus or drainage use specialized dressings (Profore) that are very tight (only if ABI above 7) and then stockings after ulcer heals and refer to vascular specialist for long term management of reflux in the veins

Surgery (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions