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Vascular Flashcards

(57 cards)

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1
Q

Carotid Screening?

A 
Age > 70 w/ atherosclerotic RF:
Cardiac disease
Smoker
PVD
TIA/Stroke - only 20% of all strokes
Bruit on exam - get duplex US
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2
Q

How to screen

A

Duplex US

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3
Q

Duplex US criteria

A

> 50-60% symptomatic dz
80% asymptomatic dz
PSV in ICA > 230

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4
Q

Medical mgmt for carotid dz

A

ASA + Statin + stop smoking
Beta blocker
Control DM

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5
Q

Transient monocular visual loss

A

Amaurosis Fugax

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6
Q

Tx for Carotid Stenosis

A

CEA

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7
Q

Structures worried about injuring

A

Vagus - Carotid sheath (btw IJ and Carotid) - hoarseness
Hypoglossal - just sup to carotid bifurcation, ipsilateral tongue deviation
Glossopharyngeal - oropharygeal dysfunction
Marginal mandibular branch of facial - mouth drooping, traction stunning - usually see in higher dz around angle of manible (retract on digastric muscle instead)

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8
Q

BP dropping during CEA

A

Hitting carotid body - Parasympathetic fibers ->

inject 1% lidocaine to fix

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9
Q

Clamping, non shunting

A

Stump pressures > 40
EEG - selective shunting
Keep awake - most sensitive indicator of cerebral perfusion

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10
Q

External carotid flows

A

Similar to peripheral artery - Triphasic flow

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11
Q

Internal carotid flows

A

Uninteruppted, continual flow - biphasic flow (diastolic)

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12
Q

Aortic Dissection

A

Class A - Ascending Aorta
Class B - Descending Aorta (post L subclavian)
Marfan’s
Dissections in medial layer

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13
Q

Type A dissection

A

CT surgery reconstruction of aortic arch

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14
Q

Type B dissection

A

Medical if no end organ problems
Meds:
BP - esmolol drip, nipride (reduce afterload)

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15
Q

Complications of TEVAR

A

Paraplegia
MI
Renal failure

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16
Q

Minimize risk of paraplegia

A

Permissive HTN

Lumbar drain

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17
Q

Most dangerous area to overlay (what artery)

A

Artery of adamkiewicz aroudn T8 - L1

Supplies blood from aorta to spine

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18
Q

RF for AAA formation

A

HLD, HTN, Smoking, Age

FmHx is the most potent risk factor

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19
Q

Repair of AAA?

A

Asymptomatic > 5.5 cm for M, > 5 F

Growth > 1 cm / year

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20
Q

AAA is a disease of what part of the artery

A

Media

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21
Q

AAA Tx

A 
EVAR
Must have adequate neck length (15 mm landing zone)
- Below renals and before hypogastrics
Neck diameter infrarenal must be < 30 mm
Not too much angulation < 60 Deg
Iliacs > 8 mm but < 18 mm
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22
Q

Types of endoleak

A

Type 1a: Leak at proximal
Type 1b: Leak at distal
Type 2: Retrograde flow from lumbar or intercostals
Type 3: Structural failure of graft, leakage btw components of graft
Type 4: Leakage through graft due to porosity
Type 5: Endotension
Must Fix 1/3 prior to leaving OR
Small type 2 endoleaks can be observed

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23
Q

1 reason AAA and CEA patients die in hospital?

24
Q

Pass blood per rectum on POD 1 after AAA repair

Study These Flashcards
A

Colonic ischemia
Sigmoidoscopy, fluid resuscitation, abx if not crashing
Colectomy if crashing

25
If has AAA, must look at...
Popliteal
26
Popliteal aneurysms complications
Thromboembolic
27
When to treat pop aneurysms
> 2 cm | With thrombus inside
28
Iliac aneurysm
3.5 cm to 4 cm
29
Tx for popliteal aneurysm
Medial approach with exlusion and bypass (saphenous vein) for small Posterior approach for large (stent graft gore viabond), complication is acute thrombosis
30
Open AAA w/ hematemesis 6 months post repair
Herald bleed of aortoenteric fistula | Duodenum lies of incision line
31
Tx of aortoenteric fistula
AxFem bypass - same that you do for any infected graft | Debride aorta, remove graft, omentum into dead space
32
Mycotic aneurysm bugs
Stapholococcus | Salmonella
33
Infected aortic graft
Staph epi | E. Coli
34
Intermittent claudication med tx
Statin, ASA, stop smoking, exercise program, cilostazol
35
What % of patients with claudication need amputation
5% in 5 years
36
ABIs
Not reliable in DM, CKD (calcification of arteries), Obese people Get Toe pressures on them (<30 is critical limb ischemia) < 0.4 for critical limb ischemia < 0.9 for intermittent claudication
37
Smoker distribution
Proximal disease | Ileofemoral
38
Diabetes distribution
Distal | Below the knee
39
Determine level of disease
1 level above pain
40
Lariche syndrome
``` Buttock claudication No femoral pulses Impotence Lesions at aortic bifurcation or above Tx: Aortobifem graft ```
41
Where to sew in aortobifem graft
Where SFA and profunda take off - distal CFA
42
Finished fem-tib bypass and goes down < 30 days
Technical error
43
1-2 yrs intermediate failure
intimal hyperplasia | MC occurs @ graft venous anastamosis
44
> 2 yrs late bypass graft failure
Progression of atherosclerotic dz Inflow or outflow vessels
45
Fistula access
``` Vein mapping 3 mm vein for autologous graft Start distal (radiocephalic, then brachiocephalic) ```
46
Ensure not at risk for steal pre op
Allen test | Ulnar aa is dominant in 80% of people
47
Immediate post op terrible pain after fistula
IMN - steal syndrome to nerves Can develop Volkmann's contracture Need to go back to OR
48
Tingling out of OR -> cramping in hand when doing dialysis 6 weeks later
Steal syndrome 1st improve arterial inflow with endovascular ballooning etc DRIL Too little blood going to hand
49
Rule of 6s
6 mm of skin 600 cm/sec Dilate up to 6 cm 6 weeks post op for maturation
50
Venous insufficiency
Medial malleolus ulcer Edema Small veins in foot Tx: Compression therapy, evaluate with duplex us, if reflux in saphenous
51
Buerger Disease
Young M smoker with necrosis of fingers Angiogram -> corkscrew collaterals Tx: stop smoking
52
Fibromuscular dysplasia
Female renal a HTN, beaded vessels | Tx: Angioplasty
53
Marfan's
Defect in fibrillin gene, dissections and aneurysms
54
Ehler's Danlos
Defect in collagen, dissections and aneurysms
55
Kawasaki's disease
Febrile kid, aneurysm in coronary aa.
56
Giant cell arteritis
HA, blurred vision | Tx: Steorids
57
Tx for catheter related venous thrombosis
Remove catheter and start anticoagulation

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