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Absite Behind the Knife > Vascular > Flashcards

Vascular Flashcards

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?

A

MI

24
Q

Pass blood per rectum on POD 1 after AAA repair

A

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

25
Q

If has AAA, must look at…

A

Popliteal

26
Q

Popliteal aneurysms complications

A

Thromboembolic

27
Q

When to treat pop aneurysms

A

> 2 cm

With thrombus inside

28
Q

Iliac aneurysm

A

3.5 cm to 4 cm

29
Q

Tx for popliteal aneurysm

A

Medial approach with exlusion and bypass (saphenous vein) for small
Posterior approach for large (stent graft gore viabond), complication is acute thrombosis

30
Q

Open AAA w/ hematemesis 6 months post repair

A

Herald bleed of aortoenteric fistula

Duodenum lies of incision line

31
Q

Tx of aortoenteric fistula

A

AxFem bypass - same that you do for any infected graft

Debride aorta, remove graft, omentum into dead space

32
Q

Mycotic aneurysm bugs

A

Stapholococcus

Salmonella

33
Q

Infected aortic graft

A

Staph epi

E. Coli

34
Q

Intermittent claudication med tx

A

Statin, ASA, stop smoking, exercise program, cilostazol

35
Q

What % of patients with claudication need amputation

A

5% in 5 years

36
Q

ABIs

A

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
Q

Smoker distribution

A

Proximal disease

Ileofemoral

38
Q

Diabetes distribution

A

Distal

Below the knee

39
Q

Determine level of disease

A

1 level above pain

40
Q

Lariche syndrome

A 
Buttock claudication
No femoral pulses
Impotence
Lesions at aortic bifurcation or above
Tx: Aortobifem graft
41
Q

Where to sew in aortobifem graft

A

Where SFA and profunda take off - distal CFA

42
Q

Finished fem-tib bypass and goes down < 30 days

A

Technical error

43
Q

1-2 yrs intermediate failure

A

intimal hyperplasia

MC occurs @ graft venous anastamosis

44
Q

> 2 yrs late bypass graft failure

A

Progression of atherosclerotic dz Inflow or outflow vessels

45
Q

Fistula access

A 
Vein mapping
3 mm vein for autologous graft
Start distal (radiocephalic, then brachiocephalic)
46
Q

Ensure not at risk for steal pre op

A

Allen test

Ulnar aa is dominant in 80% of people

47
Q

Immediate post op terrible pain after fistula

A

IMN - steal syndrome to nerves
Can develop Volkmann’s contracture
Need to go back to OR

48
Q

Tingling out of OR -> cramping in hand when doing dialysis 6 weeks later

A

Steal syndrome
1st improve arterial inflow with endovascular ballooning etc
DRIL
Too little blood going to hand

49
Q

Rule of 6s

A

6 mm of skin
600 cm/sec
Dilate up to 6 cm
6 weeks post op for maturation

50
Q

Venous insufficiency

A

Medial malleolus ulcer
Edema
Small veins in foot
Tx: Compression therapy, evaluate with duplex us, if reflux in saphenous

51
Q

Buerger Disease

A

Young M smoker with necrosis of fingers
Angiogram -> corkscrew collaterals
Tx: stop smoking

52
Q

Fibromuscular dysplasia

A

Female renal a HTN, beaded vessels

Tx: Angioplasty

53
Q

Marfan’s

A

Defect in fibrillin gene, dissections and aneurysms

54
Q

Ehler’s Danlos

A

Defect in collagen, dissections and aneurysms

55
Q

Kawasaki’s disease

A

Febrile kid, aneurysm in coronary aa.

56
Q

Giant cell arteritis

A

HA, blurred vision

Tx: Steorids

57
Q

Tx for catheter related venous thrombosis

A

Remove catheter and start anticoagulation

Absite Behind the Knife (11 decks)

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