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Surgery Job Study > Vascular > Flashcards

Vascular Flashcards

1
Q

What are the common sites for plaque formation in arteries

A

Branch points (carotid bifurcation) Tethered sites (SFA)

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2
Q

What are the three layers of artery?

A
  1. Intima 2. Media 3. Adventitia
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3
Q

What is a true aneurysm?

A

Dilation (>2xnL diam) of all three layers of vessel

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4
Q
A

1 Aorta

2 Internal iliac (hypogastric)

  1. External iliac
  2. common femoral
  3. Profundi femoral artery
  4. Superficial femoral artery (SFA)
  5. Popliteal
  6. Trifurcation

9 Anterior tibial artery

10 Peroneal artery

  1. Posterior tibial artery
  2. Dorsalis pedis artery
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5
Q

How can you remember the orientation of the lower exterior arteries below the knee on A-gram?

A

LAMP

Lateral Anterior tibial

Medial Posterior tibial

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6
Q

What is the most common site of arterial atherosclerotic occlusion in the lower extremities?

A

SFA in hunters canal

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7
Q

What are the sx of PVD?

A

Intermittent claudication, rest pain, erectile dysfunction, sensorimotor impairment, tissue loss

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8
Q

What is Intermittent claudication

A

Pain and cramping (usually in calf) after walking a specific distance, resolves when stop walking for a certain amount of time.

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9
Q

What is rest pain

A

pain in LE (usually top of foot) arising at rest, usually when sleeping

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10
Q

SIGNS of PVD

A

absent pulses, bruit, muscular atrophy, decreased ahair growth, thick toenails tissue necrosis/ulcers/infusions

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11
Q

ABI’s associated with normals, claudicators and rest pain

A

Normal ABI->/= 1.0

Claudicator-<0.6

Rest pain - <0.4

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12
Q

Why would a pt get a false ABI reading

A

Completely calcified arteries (esp. pt’s with DM)

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13
Q

Indications for surgical tx of PVD

A

STIR

Severed claudication refractory to tx

Tissue necrosis

Infection

Rest pain

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14
Q

What is risk of limb loss w/ claudication

A

5% in 5 years

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15
Q

What is the risk of limb loss w/ rest pain

A

>50% of these pts will lose a limb at some point

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16
Q

in pt with PVD what is the main post op concern?

A

CARDIAC!!! - Most pt’s with PVD have coronary artery dz as well.

MI is most common cause of post op death after a PVD operation

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17
Q

What are the classic signs/symptoms of acute arterial occlusion?

A

the 6 p’s

Pain

paresthesias

paralysis

pallor

Poikilothermia

Pulselessness

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18
Q

What is the immediate preoperative management of acute arterial occlusion

A
  1. Anticoagulate wit hIV heparin (bolus w/ cont infusion)
  2. A-gram
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19
Q

What is the most common cause of embolus from the heart?

A

afib

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20
Q

What is the most common site of arterial occlusion by an embolus

A

carotid artery

(SFA mc site of arterial occlusion from atherosclerosis)

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21
Q

What is the tx for acute arterial occlusion?

A

surgical embolectomy with cutdown

fogarty balloon

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22
Q

What is the most common site for AAA

A

Infrarenal

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23
Q

What are sx of AAA?

A

Most commonly asymptomatic

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24
Q

Signs of ruptured AAA?

A

1 abd pain

  1. pulsatile mass

3 hypotension

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25
Q

Laplace’s Law

A

Wall tension = pressure x diameter

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26
Q

What are indications for AAA surgery?

A

AAA >5.5cm diameter

rupture of AAA

Any size AAA with rapid growth

symptoms/embolization of plaque

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27
Q

What is the mortality rate for elective rx of AAA

A

4%

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28
Q

What is the mortality rate for AAA that is ruptured?

A

~50% operative mortality

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29
Q

What is the leadign cause of post op death in pt undergoing elective AAA tx

A

MI

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30
Q

What is mean normal aortic diameter

A

2cm

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31
Q

Why is colonic ischemia a concern with AAA rx?

A

often the IMA is sacrificed during surgery. if collaterals are not adequate pt will have colonic ischemia

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32
Q

Operative complications of AAA rx?

A

MI

Atheroembolism

declamping hypotension

acute renal failure

uretal injury

hemorrhage

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33
Q

sx of colonic ischemia

A

Heme positive stool

Bright red blood per rectum

diarrhea

abdominal pain

34
Q

What is the possible long term complication that oftn presents with both upper and lower GI bleeding?

A

Aortoenteric fistula

35
Q

What are sx of anterior cord syndrome (complication of AAA repair)

A
  1. Paraplegia
  2. Loss of bladder/bowel control
  3. Loss of pain/temp sensation below level of involvement
  4. SPARING OF PROPRIOCEPTION
36
Q

How is a graft infection with an aortoenteric fistula tx?

A

xtra-anatomic bypass (ax-bifem)

37
Q

Which vein crosses the neck of athe AAA proximally?

A

L renal vein

38
Q

What part of the small bowel crosses in front of the AAA

A

Duodenum

39
Q

Which artery comes off the middle of the AAA and runs to the left?

A

Inferior mescenteric artery

40
Q

Which vein runs behind the R common iliac artery?

A

L common iliac vein

41
Q

which renal vein is longer?

A

L

42
Q

sx and sg of carotid vascular dz

A

Amaurosis fugax

TIA

Reversible ischemic neurologic deficit

CVA

43
Q

Indications for CEA in Asymptomatic patient?

A

Carotid Stenosis >60% (greates tbenefit is probably in pt’s with >80%)

44
Q

Indications for CEA in SYMPTOMATIC patient

A

Carotid stenosis >50%

45
Q

Post operative complications for CEA

A

CVA

MI

hematoma

wound infection

hemorrhage

hypiotension/hypertension thrombosis

vagus nerve injury (change in voice)

Hypoglossal injury (ipselateral tongue deviation)

46
Q

Mortality rate of CEA

A

~1%

47
Q

Most common cause of death during early postop period for vascular surgery

A

MI

48
Q

What thin muscle is cutright under the skin in the neck?

A

Platysma

49
Q

What are the branches of the ICA?

A

NONE

50
Q

Which vein crosses the carotid bifurcation?

A

facial vein

51
Q

What is the first branch of the external carotid

A

Superior thyroid

52
Q

What muscle crosses the common carotid proximally

A

Omohyoid

53
Q

Which muscle crosses the carotid artery distally?

A

Posterior belly of the digastric (D=Distal, D=digastric)

54
Q

Which nerve crosses approximately 1cm distal to the carotid bifurcation

A

Hypoglossal

55
Q

Which nerve crosses the interal carotid near the ear

A

facial nerve

56
Q

What is in the carotid sheath

A
  1. Carotid artery
  2. internal Jugular vein
  3. vagus nerve
  4. Deep cervical lymph nodes
57
Q

what should be examined in a pt with politeal artery aneurysm

A

contralateral side - 50% of pt’s with pop artery aneurysm have one on contralateral side

rest of arterial tree (especially aorta) - 75% of all patients with popliteal aneurysm have additional aneurysms elsewhere (50% are located in aorta/iliac)

58
Q

What are indications for elective surgical rx of a pop aneurysm?

A
  1. >/= 2cm in diameter
  2. Intraluminal thrombus
  3. artery deformation
59
Q

Indications for surgical rx of following aneurysm?

Thoracic aorta

A

>6.5%

60
Q

Indications for surgical rx of following aneurysm?

Abdominal aorta

A

>5.5cm

61
Q

Indications for surgical rx of following aneurysm?

Iliac artery?

A

>4cm

62
Q

Indications for surgical rx of following aneurysm?

Femoral artery

A

>2.5cm

63
Q

Indications for surgical rx of following aneurysm?

Popliteal artery

A

>2cm

64
Q

what are the branches of the ECA

A

Superior thyroid

Ascending pharyngeal

Lingual

Facial

occipital

posterior auricular

maxillary

superficial temporal

65
Q

What order are the clamps put on in CEA

A

I C E

Internal

Common

External

66
Q

What order are the vessels unclamped in CEA?

A

E C I

External

Common

Internal

67
Q

What is median arcuate ligament syndrome

A

mesenteric ischemia from narrowing of the celiac axis vessels by extrinsic compression by the median arcuate ligament

68
Q

What is the median arcuate ligament comprised of?

A

Diaphragm hiatus fibers

69
Q

What are symptoms of median arcuate ligament syndrome?

A

Postprandial pain, weight loss

70
Q

What are SIGNS of median arcuate ligament syndrome?

A

Abd bruit in almost all pateints

71
Q

Tx: of median arcuate ligament syndrome?

A

Release arcuate ligament surgically

72
Q

What are associated risks/clues of renal artery stenosis

A

Fam hx

early onset HTN

HTN refractory to medical tx.

73
Q

sx/sg of renal artery stenosis

A

Most are asx but may have HA

DIASTOLIC HTN

Flank bruit

Dec renal fxn

74
Q

What are dx tests of renal artery stenosis

A

Agram (GOLD STANDARD)

IVP

Renal vein renin ratio

75
Q

What is surgical tx for renal artery stenosis?

Invasive but non-surgical tx for renal artery stenosis?

A

Surgical - Resection, bypass, vein/graft interposition, or endarterectomy

Non-surgical - PRTA/stenting

76
Q

What anti-hypertensive med is CONTRAINDICATED in pt w/ hypertension from renovascular stenosis

A

ACE - I

77
Q

Define “Milk leg”

A

AKA plegmasia alba dolens;

Often seen in pregnant women w/ occlusion of iliac vein resulting from xt. compression by uterus

78
Q

Phlegmasia cerulea dolens

A

2nd to severe venous outflow obstruction and results in cyanotic leg: extensive venous thrombosis results in arterial inflow impairment

79
Q

Takayasu’s arteritis

A

arteritis of the aorta and aortic branches, resulting in stenosis/occlusion/aneurysms

80
Q

Buerger’s disease

A

thromboangitis obliterans; seen in young men who smoke

Digital gangrene –> amputations

81
Q

Tx for beurger’s disease

A

smoking cessation

+/- sympathectomy

82
Q
A

Surgery Job Study (11 decks)

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