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ABSITE > Vascular > Flashcards

Vascular Flashcards

1
Q

What is the most common site of stenosis in the carotids?

A

At the bifurcation

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2
Q

What is the flow pattern in the external vs internal carotid?

A

Internal -> continuous flow

External -> triphasic flow

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3
Q

What two arteries allow for communication of the ECA and ICA?

A

Ophthalmic and internal maxillary artery

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4
Q

What is the tx for a carotid traumatic injury with fixed deficit?

A

Occluded -> do not repair due to bleeding risk

Not Occluded -> Repair

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5
Q

What are indications for CEA?

A

Symptomatic > 70%, asymptomatic > 80% stenosis

If recent stroke wait 4-6 weeks

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6
Q

What side should be repaired first in bilateral carotid disease?

A

Tightest side first, if equal then repair dominant side first

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7
Q

What is the most common complications from CEA?

A

Vagus injury > hypoglossal > glossopharyngeal

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8
Q

What is the treatment for pseudoaneurysm after CEA?

A

Drape and prep prior to intubation, then intubate and repair

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9
Q

What causes hypertension post-CEA?

A

Damage to carotid body

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10
Q

What are indications for repair of ascending aortic aneurysms?

A

Acutely symptomatic
> 5.5 cm (5.0 with Marfan’s)
>0.5 cm/yr size increase

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11
Q

What are indications for repair of thoracic descending aortic aneurysms?

A

> 5.5 cm for endovascular

>6.5 cm for open repair

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12
Q

What are indications for operative management of thoracic descending dissections?

A

Ischemia or contained rupture

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13
Q

What is the most likely site of rupture for a AAA?

A

Left posterolateral wall, 2-4 cm below renal arteries

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14
Q

What are significant risk factors for rupture?

A

Diastolic HTN

COPD

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15
Q

What are indications for AAA repair?

A

Symptomatic
> 5.5 cm
Growth > 0.5 cm/yr

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16
Q

What are indications for IMA re-implantation?

A

Backpressure < 40 mmHg (poor back-bleeding)
Previous colonic surgery
Stenosis at SMA
Inadequate flow to left colon

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17
Q

Why should you ensure flow to at least one internal iliac when performing aorto-bifemoral repair?

A

To avoid vasculogenic impotence

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18
Q

What is the most common vein injury with aortic crossclamp in AAA repair?

A

Retro-aortic left renal vein

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19
Q

What are causes of death after AAA repair?

A

Acute -> MI

Late -> Renal Failure

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20
Q

What are risk factors for mortality in AAA repair?

A

Cr > 1.8, CHF, ischemia on EKG, COPD, increased age, female sex

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21
Q

What are the types of endoleaks?

A

I: Graft attachment sites (Tx extension cuffs)
II: Collaterals (Observe or embolize)
III: Overlap sites (secondary endograft)
IV: Wall porosity or suture holes (observe)
V: Expansion of aneurysm without evidence of leak (re-do EVAR or open repair)

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22
Q

Where are adhesions found in inflammatory aneurysms?

A 
3rd/4th portions of duodenum
Ureteral entrapment (25%)
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23
Q

What is the most common causes of mycotic aneurysms?

A

Salmonella > Staphylococcus

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24
Q

What are sx/signs of mycotic aneurysm?

A

Pain, fevers

Periaortic fluid, gas, RP soft tissue edema, LAD

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25
Q

What is the tx for mycotic aneurysm?

A

Extra-anatomic bypass and resection of aorta to clear infection

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26
Q

What is the most common cause of aortic graft infection?

A

Staph > E. Coli

Blood cultures often negative

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27
Q

What is the treatment of infected aortic graft?

A

Bypass through non-contaminated field and resection of graft

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28
Q

What are the signs of an aortoenteric fistula?

A

Herald bleed with hematemesis
Then blood per rectum
Usually erode into the duodenum

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29
Q

Where do claudication symptoms occur relative to the lesion?

A

Symptoms occur one level below lesion

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30
Q

What is Leriche syndrome?

A

Occlusion at the aortic bifurcation:

  • No femoral pulses
  • Buttock or thigh claudication
  • Impotence
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31
Q

What is the most common location for lower extremity PAD?

A

Hunter’s Canal (distal SFA exit)

32
Q

What are the ABIs for symptoms?

A

< 0.9 - Claudication
< 0.5 - Rest Pain
< 0.4 - Ulcers
< 0.3 - Gangrene

33
Q

Where should synthetic grafts not be used?

A

Below the knee

34
Q

What must you check for when doing an aorto-bifemoral repair?

A

Flow to at least 1 internal iliac artery (want good back bleeding from at least one artery, or else need to bypass to internal iliac as well)

35
Q

Why are distal lesions more limb threatening?

A

Lack of collaterals

36
Q

What is the 5-year patency for LE bypasses?

A

Fem-pop: 75%

Femoral-Distal: 50%

37
Q

What is a complication of femoral-femoral crossover graft?

A

Vascular steal in the donor leg

38
Q

What are the #1 causes of saphenous vein graft failures?

A

Early - Technical problem

Late - Atherosclerosis

39
Q

What is a Mal Perforans ulcer?

A

Ulcer at metatarsal heads (2nd MTP most common)

40
Q

When is re-perfusion/compratment syndrome more likely to occur?

A

With ischemia times > 4-6 hours

41
Q

What is the most common site in the leg for compartment syndrome?

A

Anterior compartment (results in foot drop)

42
Q

What are the symptoms of popliteal entrapment syndrome?

A

Loss of pulses with plantar flexion.

Cause is medial aviation of artery around medial head of gastroc

43
Q

What is adventitial cystic disease?

A

Men in 40s. Bilateral ganglia originate from joint capsule causing compression in popliteal fossa (most common). Symptoms change with knee flexion/extension

44
Q

What is the most common site of peripheral obstruction from emboli?

A

Common femoral artery

45
Q

What is atheroma embolism?

A

Cholesterol clefts that lodge in small arteries. Renals most common site

46
Q

What is the most common source of Blue Toe Syndrome?

A

Aortoiliac disease that keeps embolizing

47
Q

What is the treatment of acute arterial thrombosis?

A

Threatened limb -> heparin and OR

Non-threatened -> angiography and thrombolytics

48
Q

What is the most common site of renal atherosclerosis?

A

Proximal left artery

49
Q

What are indications for nephrectomy with renal HTN?

A

Atrophic kidney < 6 cm with persistently elevated renin levels

50
Q

What is the most common site of upper extremity occlusive disease?

A

Subclavian artery

51
Q

What is the most common symptom of TOS?

A

Neurologic involvement with ulnar nerve involvement (triceps weakness and intrinsic hand muscles)

52
Q

What is the common cause of subclavian artery TOS?

A

Anterior scalene hypertrophy (weight lifters) causing hand pain from ischemia

53
Q

What is Adson’s test?

A

Absent radial pulse with head turn to ipsilateral side

54
Q

Why can you have motor function in digits after prolonged hand ischemia?

A

Motor groups for digits are in proximal forearm

55
Q

What history elements might distinguish SMA embolism from thrombosis?

A

Thrombosis has more chronic history of food fear, weight loss

56
Q

What are the symptoms of mesenteric venous thrombosis?

A

Bloody diarrhea, cramps pain

Hx of: vasculitis, hyper coagulable, portal HTN

57
Q

What are Griffith’s and Sudan’s areas?

A

Watershed areas in colon, splenic flexure and upper rectum respectively

58
Q

What is median arcuate ligament syndrome?

A

Celiac artery compression causing bruit near epigastrum

59
Q

What is the arc of Riolan?

A

important collateral between SMA and IMA

60
Q

What are the common complications of aneurysms above and below the inguinal ligament?

A

Above -> Rupture

Below -> Thrombosis

61
Q

When should splanchnic artery aneurysms be repaired?

A

> 2 cm EXCEPT splenic

62
Q

When should splenic artery aneurysms be repaired?

A

Symptomatic
Pregnant
Childbearing Age
>3-4 cm

63
Q

What is the treatment for splanchnic artery aneurysms?

A 
Covered Stent (bypass if fails)
Splenic -> Ligate aneurysm
64
Q

When should renal artery aneurysms be treated?

A

> 1.5 cm -> covered stent

65
Q

When should iliac and femoral artery aneurysms be treated?

A

Iliac > 3 cm

Femoral > 2.5 cm

66
Q

What are surgical indications for a popliteal aneurysm?

A

> 2 cm
Mycotic
Symptomatic

67
Q

What is the treatment of choice for popliteal aneurysms?

A

Exclusion and bypass NOT covered stent

68
Q

What is implied by a pseudyaneurysm at a suture line months to years after surgery?

A

Graft infection

69
Q

What is the classic imaging finding of Breuger’s disease?

A

Corkscrew collaterals

70
Q

What are the timelines of radiation arteritis?

A

Early -> Sloughing/thrombosis
Late (1-10 years) -> scar, fibrosis, stenosis
Very late (3-30 years) -> atherosclerosis

71
Q

What is the most common cause of dialysis graft failure?

A

Venous obstruction due to intimal hyperplasia

72
Q

What is Phlegmasia Alba Dolens?

A

Tenderness + Pallor + edema

Tx: Heparin

73
Q

What is Phlegmasia Cerulia Dolens?

A

Tenderness + cyanosis + massive edema

Tx: Heparin (rarely surgery)

74
Q

What is the source of a PE with an IVC filter in place?

A

Ovarian veins, IVC superior to filter, SVC/upper extremities

75
Q

What is the most common organism causing cellulitis and lymphangitis?

A

Strep

76
Q

What is Stewart-Treves syndrome?

A

Lymphangiosarcoma from chronic lymphedema 2/2 breast axillary dissection

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