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ABSITE Flashcards > Vascular > Flashcards

Vascular Flashcards

1
Q

Collateral path to provide blood flow to lower extremity in setting of complete aortoiliac occlusion?

A

Collaterals of Winslow: subclavian arteries connected to external iliac arteries through the internal mammary (superficial epigastric) and inferior epigastric

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2
Q

How does blood usually reach the foot when SFA is occluded?

A

Profunda collateralizes through the genicular artery to the popliteal artery

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3
Q

What clinical test is performed to evaluate the patency of ulnar and radial arteries?

A

Allen’s test

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4
Q

MC site of UE stenosis?

A

Subclavian artery

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5
Q

Tibioperoneal occlusive disease:

  • -who is at increased disease?
  • -why are these lesions more dangerous?
  • -indications for surgery?
A
  • -diabetes and Bueger’s disease
  • -fewer collaterals
  • -limb salvage and ischemic ulcers only
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6
Q

Surgical options for tibioperoneal disease?

A

Femorotibial or femoropopliteal bypass

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7
Q

Causes of UE occlusive disease?

A 
Embolism
Trauma
Thoracic outlet syndrome
Arteritis (Buerger's and Takayasu's)
Vasospastic disorders (Raynaud's syndrome)
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8
Q

What is the procedure of choice for subclavian artery stenosis in a patient without carotid occlusive disease?

A

Common carotid to subclavian artery bypass with PTFE conduit

OR
Can transect the subclavian artery and transpose the distal end to perform an end-to-side anastomosis

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9
Q

Syme’s amputation

A

Amputation of the foot

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10
Q

Ray amputation

A

Removal of the MT head and digit of foot

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11
Q

Transmetatarsal amputation (TMA)

A

Foot amputation at the level of the metatarsals

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12
Q

Which flap as has the blood supply for a BKA - anterior or posterior?

A

Posterior flap - closer proximity to popliteal artery

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13
Q

Best type of suture for apposing the muscle fascia layer of a BKA or an AKA?

A

Absorbable (such as vicryl)

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14
Q

Best predictor of failure of a BKA to heal?

A

Absence of popliteal arterial pulsation on palpation or Doppler

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15
Q

What toe pressure is though to correlate with the failure of a TMA or toe amputation to heal?

A

Systolic toe pressures <45

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16
Q

How do plaques in carotid disease differ from those in vertebrobasilar disease?

A

Carotid: high incidence of ulcerated plaques
Vertebral: usually a smooth intimal surface

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17
Q

Drop attacks are associated with what disease?

A

Vertebrobasilar disease

Patient suddenly falls to the ground because of bilateral LE motor deficit (+/- LOC with rapid recovery)

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18
Q

Three main mesenteric arteries

A

Celiac: stomach to ampulla of vater (2nd portion of duodenum)
SMA: to the splenic flexure of the colon
IMA: to the rectum

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19
Q

Watershed areas of the colon

A

Splenic flexure

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20
Q

Branches of the celiac artery?

A

L gastric
Splenic
Common hepatic

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21
Q

First two branches of the SMA?

A

Inferior pancreaticoduodenal artery

Middle colic artery

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22
Q

Branches of the IMA?

A

L colic
Sigmoid
Superior rectal

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23
Q

Collateral pathway between celiac and SMA

A

Celiac –> Common hepatic –> GDA –> superior PD artery –> inferior PD artery –> SMA

24
Q

Collateral pathway between SMA and IMA

A

SMA –> middle colic –> arch of Riolan –>left colic –> IMA
SMA –> marginal artery of Drummond –> IMA

Arch of Riolan (meandering mesenteric artery): runs pRoximal to mesenteric root
marginal artery of Drummond: runs Distal to mesenteric root

25
Q

Renal arteries located at what lumbar level?

A

L1 to L2

26
Q

Is the right renal artery anterior or posterior to the IVC?

A

Posterior

27
Q

How is the right renal artery exposed intraoperatively?

A

Cattel and Kocher maneuvers (medial mobilization of the hepatic flexure of the colon and the third portion of the duodenum) +/- retraction of the IVC for exposure of the most proximal portion of the renal artery

28
Q

MC site of visceral embolism causing acute mesenteric ischemia?

A

Proximal SMA
(at the SMA origin or at the takeoff of the middle colic artery)
SMA takeoff is at an acute angle

29
Q

Symptoms of acute mesenteric ischemia?

A

severe abd pain, pain out of proportion to the signs on physical exam

30
Q

When is bowel nonviability determined?

A

After the revascularization procedure

31
Q

How is bowel viability assessed intraoperatively?

A

Gross exam: palpable pulses, pink color, visible peristalsis
Wood’s lamp inspection after IV fluorescein
Doppler US of mesenteric artery adjacent to the bowel in question

32
Q

Classic angiographic findings for embolus/thrombosis/nonocclusive etiologies?

A

Embolus: abrupt occlusion with a meniscus sign, usually 5-8 cm from origin of SMA

33
Q

Revascularization options/treatment for acute mesenteric ischemia

A

SMA thrombosis: mesenteric bypass or reimplantation of SMA to aorta

SMA embolism: embolectomy +/- SMA patch angioplasty

Non-occlusive mesenteric ischemia: correct underlying condition, consider catheter directed intraarterial infusion of vasodilator

34
Q

Mesenteric bypass retrograde vs antegrade

A

Retrograde: from iliac artery or infrarenal aorta to SMA

Antegrade: from supraceliac aorta to SMA

35
Q

What do the terms antegrade and retrograde refer to in describing aortovisceral bypass?

A

Site of aortic anastomosis with respect to the origin of the mesenteric vessel being bypassed
Antegrade - proximal to origin
Retrograde - distal to origin

36
Q

Why is antegrade bypass preferred?

A

Longer-term patency

but retrograde is faster/easier

37
Q

Why is mortality rate so high for acute mesenteric ischemia?

A

Delayed diagnosis

38
Q

1 peripheral aneurysm

A

popliteal aneurysm
50% are bilateral
1/3 have AAA

39
Q

1 visceral aneurysm

A

splenic aneurysm

Tx if >2 cm, child bearing age or planning pregnancy, or symptomatic

40
Q

Bloody diarrhea first few days s/p AAA repair

A

Needs flex sig/colonoscopy to evaluate for ischemic colon (due to loss of IMA)

41
Q

1 CN injury with CEA

A

vagus nerve –> hoarseness

42
Q

fibromuscular dysplasia typical pt

A

young woman with HTN
usually R renal a.
tx: angioplasty

43
Q

MC bacteria that cause mycotic AAA?

A

S. epidermidis
S. aureus
Salmonella

44
Q

Classic physical exam finding of ruptured AAA?

A

Ecchymosis in the inguinal and groin region

45
Q

What is graft material of choice for AAA?

A

Dacron (woven or knitted, +/- collagen impregnation)

2nd choice - PTFE

46
Q

What are two surgical approaches for AAA repair?

A

Midline laparotomy

RP approach through L flank incision

47
Q

In a patient with a ruptured AAA, what is first step after midline laparotomy?

What are the next steps?

A

Immediate compression of the supraceliac aorta against the vertebral bodies through the lesser sac

L crus of the diaphragm is divided, the supraceliac aorta is clamped, the neck of the AAA (usually infrarenal) is exposed and clamped, the supraceliac clamp is removed, and the graft is placed

48
Q

What frequently obstructs access to the neck of the AAA in the transabdominal approach?

A

L renal vein

49
Q

What is the presentation of aortocaval fistula?

A

High output CHF, hypotension, cyanosis, venous distension of the LE, abdominal bruit, and palpable abdominal thrill

50
Q

What is the treatment of aortocaval fistula?

A

The fistula is closed:

  • -Achieve proximal and distal control of the aorta and IVC
  • -make and incision in the aortic graft
  • -repair the fistula from within graft with large suture bites
  • -close the aortic graft
51
Q

What is excluded in the setting of pseudoaneurysm?

A

Graft infection

52
Q

ACAS trial

A

asymptomatic, >60% stenosis

CEA reduces 5 year stroke rate from 11 to 5%

53
Q

NASCET trial

A

symptomatic, >70% stenosis CEA reduces 5 year stroke rate from 26 to 9%

54
Q

1 CN injury with CEA

A

Vagus nerve -> hoarseness

55
Q

Atherosclerosis pathology

A

type I foam cells (lipids in macrophages; II fibrointimal lesion = smooth muscle proliferation due to mac’s growth factors; III: disruption exposes collagen -> thrombosis

ABSITE Flashcards (19 decks)

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