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ABSITE > Vascular > Flashcards

Vascular Flashcards

1
Q

MC congenital hypercoagulable disorder

A

Resistance to activated factor C (Leiden factor)

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2
Q

MC acquired hypercoagulable disorder

A

Smoking

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3
Q

Stage of Atherosclerosis

A

1st: Foam cells: Macrophages that have absorbed fat and lipids in the vessel wall
2nd: Sm muscle proliferation (wall injury)
3rd: Intimal disruption (sm muscle cell proliferation); leads to exposure of collagen in vessel wall and thrombus formation –> fibrous plaques

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4
Q

Most important risk factor for stroke

A

HTN

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5
Q

Carotids supply what % blood flow to brain

A

85%

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6
Q

T/F Normal ICA has continuous forward flow

A

True

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7
Q

First branch of ICA

A

Opthalmic artery

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8
Q

T/F Normal ECA has triphasic flow

A

True: Antegrade, retrograde, then antegrade

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9
Q

First branch of ECA

A

Superior thyroid a.

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10
Q

Communication between ICA and ECA

A

Opthalmic/internal maxillary artery

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11
Q

Most commonly diseased intracranial artery

A

MCA

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12
Q

Cerebral ischemic events most commonly from ICA embolization or thrombus

A

Embolization; or low flow state from stenotic lesion

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13
Q

Second most common source of cerebral emboli to the ICA

A

Heart

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14
Q

ACA vs. MCA vs. PCA symptoms

A

ACA: AMS, release, slowing
MCA: contralateral motor/speech, contalateral facial droop
PCA: vertigo, tinnitus, drop attachs, incoordination

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15
Q

Amaurosis fugax

A

Occlusion of the opthalmic branch of the ICA (visual changes –> shade coming down over eyes); visual changes are transient

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16
Q

What do you see on retinal examination of amurosis fugax?

A

Hollenhorst plaques

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17
Q

Carotid traumatic injury with major fixed deficit. Management if occluded vs. not occluded

A

Occluded: Do not repair (can exacerbate bleeding)

Not occluded: repair with carotid stent or open

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18
Q

Indications for carotid endarterectomy (symptomatic, asymptomatic)

A

Symptomatic: >50% stenosis
Asymptomatic: >70% stenosis

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19
Q

When is an emergent CEA indicated?

A

Fluctuating neurologic symptoms or crescnedo/evolving TIA’s

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20
Q

Which side to repair first if patient has bilateral stenosis?

A

Tightest side first

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21
Q

Which side to repair if patient has equally tight carotid stenosis bilaterally?

A

Dominant side first

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22
Q

Which of the 3 layers are removed during a CEA?

A

Intima, and part of the media

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23
Q

When to shunt during a CEA?

A

Back pressure is <50 mm Hg orif contralateral side is tight or occulded

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24
Q

If ICA is occluded, should you repair it?

A

No

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25
Can you routinely divide the facial vein?
Yes
26
The MC cranial nerve injured during CEA
Vagus nerve 2/2 vascular clamping --> hoarseness (RLN comes off vagus)
27
If there is a hypoglossal nerve injury during a CEA, what are the symptoms?
Tongue deviates towards the side of the injury (speech and mastication difficulty)
28
If there is a glossopharyngeal injury during CEA, what are the symptoms?
Difficulty swallowing (during a high dissection)
29
The brachiocephalic artery is also called...
Innominate artery (R subclavian, R common carotid)
30
Some symptoms of ascending aortic aneurysms
Often asymptomatic | - Compression of vertebra (back pain), RLN (voice changes), bronchi (SOB/PNA), esophagus (dysphagia)
31
Indications for ascending aortic aneurysm repair
Acutely symptomatic, >5.5 cm, (> 5 cm for Marfan's), rapid increase in size (> 0.5 cm/yr)
32
Another name for a descending aortic aneurysm
Thoracoabdominal aneurysm
33
Indications for TAAA repair
Endovascular: >5.5cm Open: >6.5 cm
34
Endo vs. Open TAAA risks
Endo: 2-3% Open: 20% (mortality, paraplegia) *Reimplant intercostalarteries below T8 to help prevent paraplegia with open repair
35
Sanford vs. DeBakey classification of aortic dissections
Stanford A- any ascending involvement Stanford B- descending only Debakey I - asc/desc Debakey II - asc only Debakey III - desc only
36
Where do most aortic dissections start?
Ascending aorta; can mimic an MI
37
Classic symptoms of ascending aortic dissection
Tearing chest pain, unequal pulses/BP in upper extremities
38
Management of deep venous thrombosis resulting from upper extremity central venous lines
Removal of line, heparin, bridge to Coumadin for 3-6 months
39
Clinical distinctions between acute arterial embolism and acute arterial thrombosis
Embolism: Arrhythmia, no prior claudication/rest pain; normal contra-lateral pulses; no physical findings of chronic limb ischemia Thrombosis: No arrhythmia, history of claudication/rest pain; absent contra-lateral pulses; physical findings of chronic limb ischemia
40
MCC of acute arterial embolism
A fib, MI with thrombus, myxoma, aorto-iliac disease
41
Most common site of peripheral obstruction from emboli
Common femoral artery
42
When do you do a fasciotomy following an embolectomy?
>4-6 hours of ischemia
43
Aorto-iliac emboli is treated with... (loss of both femoral pulses)
Bilateral femoral artery cutdowns and bilateral embolectomies
44
MC site of atheroma embolism
Renals
45
What is blue toe syndrome
Flaking atherosclerotic emboli off abdominal aorta or branches
46
Most common source of emboli in blue toe syndrome
Aortoiliac disease
47
Diagnosis for atheroma embolism
CT C/A/P to look for aneurysm, and Echo -- clot or myxoma in heart
48
Treatment for acute arterial thrombosis (with an without limb threat)
For a threatened limb -- loss of sensation/motor --> give heparin and go to OR for thrombectomy If not threatened: angiography for thrombolytics
49
Thrombosis of PTFE graft
Thrombolytics and anti-coagulation; if limb is threatened go to OR for thrombectomy
50
Which renal artery runs posterior to IVC
Right
51
Examples of reno-vascular HTN
RAS: bruits, DBP > 115, HTN in children/pre-menopausal, HTN resistant to drug therapy
52
Which side: atherosclrosis vs. FMD for
FMD: R -- PTA without stent Athero: L -- gets stent
53
Indications for nephrectomy with renal HTN
Atrophic kidney < 6 cm with persistently high renin
54
MC peripheral aneurysm
Popliteal
55
MCC popliteal aneurysm
Atherosclerosis
56
What % popliteal aneruysm are bilateral?
1/2
57
What % of patients have aneurysm other than popliteal?
50% -- AAA, femoral, etc.
58
Diagnosis of popliteal aneurysm
Ultrasound
59
Surgical indications of popliteal artery aneurysm
Symptomatic, >2cm, mycotic
60
Surgical treatment of popliteal aneurysm
Exclusion & bypass; 25% have a complication that requires amputation if not treated
61
What is a pseudoanurysm?
Collection of blood in continuity with arterial system but not enclosed by all 3 layers of arterial wall
62
Treatment of pseudo-aneurysm after perc intervention
US guided compression with thrombin injuection (surgical repair if flow remains in PSA after thrombin injection)
63
If a pseudo-aneurysm occurs a suture line early after surgery
Needs surgical repair
64
PSA that occur at suture line late after surgery (months to years) --> suggests what?
graft infection
65
MC variant of FMD; MC treatment
Medial fibro-dysplasia; PTA best bypass if fails
66
Stewart-Treves Syndrome
Lymphangioarcoma a/w breast axillary dissection and chronic lymphedema
67
Lymphangioarcoma often mets to...
Lung
68
How can you identify lymphatic channels supplying a lymphocele?
Isosulfan blue dye to inject
69
First line treatment of lymphocele
Perc drainage
70
Do lymphatics contain a basement membrane?
No
71
Do deep lymphatics have valves?
Yes
72
What causes lymphedema?
Obstructed lymphatics, too few in number, non-functional
73
MC infection in lymphedema
Strep
74
Congenital lymphedema is more common L or R
L

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