Vascular Flashcards
Atherosclerosis stages
1st – foam cells → macrophages that have absorbed fat and lipids in the vessel wall
2nd – smooth muscle cell proliferation → caused by growth factors released from macrophages; results in wall injury
3rd – intimal disruption (from smooth muscle cell proliferation) → leads to exposure of collagen in vessel wall and eventual thrombus formation → fibrous plaques then form in these areas with underlying atheromas
Risk factors: smoking, HTN, hypercholesterolemia, DM, hereditary factors
Which site is the most common site of carotid stenosis?
How is the flow in the eca vs ica?
How does the ICA and ECA communicate?
Which intracerebral artery is most commonly affected?
Cerebral ischemic events occur most commonly from arterial embolization from which artery?
How do anterior, middle cerebral artery events present? How posterior?
What is amaurosis fugax?
How do you fix carotid traumatic injury with major fixed deficit?
What are the indication for a CEA? What do you do in b/l carotid stenosis?
Amaurosis fugax – occlusion of the ophthalmic branch of the ICA (visual changes → shade coming down over eyes); visual changes are transient
• See Hollenhorst plaques on ophthalmologic exam
How do you perform a CEA? What is the most importan technical concern? When do you have to use a shunt?
What are typical complications from repair and what would you do in each case?
When would you consider a carotid stenting?
For high-risk patients (eg patients with previous CEA and restenosis, multiple medical comorbidities, previous neck XRT)
Vertebral basillary artery disease and Carotid body tumors?
How do ascending aortic aneurysms present and what are the indications for surgery?
What are indication for thoracoabdominal aneurysm repair, endo vs. open, what’s the diff? How do you prevent paraplegia with open repair?
What are the different categories of aortic dissections?
Where do most dissections start?
Sy? RF? Cxr? Dx?
Where does the dissection occur?
When does AI occur?
What are some of the aortic dissection associated complications?
Aortic insufficiency occurs in 70%, caused by annular dilatation or when aortic valve cusp is sheared off.
How do you manage AD, when do you operate on ascending vs descending dissection?
How do you follow these patients?
What are the common postop complications?
AAA MC, RF
What is the leading cause of death without an operation? What would be the Dx to confirm your suscpicion? Where? Rf?
What are the repair indications? EVAR vs open?
What are some important technical aspects?
What are some of the complications and how do they present?
What are the ideal criteria for AAA endovascular repair?
What are the various different endoleak types?
Inflammatory aneurysm?
Mycotic aneurysms
Aortic graft infection?
Aortoenteric fistula?
What are the various different leg compartments and signs of PAD?
What is the #1 preventive agent for atherosclerosis?
Rx and Symptoms of claudication of the various different levels? How about lumbar stenosis? Diabetic neuropathy? Leriche syndrom?
What is the most common atherosclerotic occlusion in lower extremities?
What are the various different types of collateral circulation? What is postnatal angiogenesis? ABI? What’s normal?
PVR vs arteriogram?
What are the various different indications for PAD? How about: - PTFE - Dacron - What is the best predictor of longterm patency? Best technique for graft surveillance? ASA?
What do you do in aortoiliac occlusive disease, what do you need to be careful about? How about isolated iliac disease?
How about femoropopliteal grafts? / femoro-distal grafts? extra-anatomic grafts? femoral to femoral crossover graft?
How about swelling after lower extremity bypass?
What are reperfusion complications?
What is the #1 cause of late vs early failure reversed saphenous vein grafts?
How about dry vs. wet gangrene, how about diabetic foot ulcer, how do you manage this?
• Tx: non-weightbearing, debridement of metatarsal head (need to remove cartilage), antibiotics; assess need for revascularization
PTA?
Compartment syndrom?
Popliteal entrapment syndrom?
Adventitial cystic disease?
Arterial autografts?
BKA vs. AKA?
Embolism vs. thrombus?
Acute arterial emboli vs acute arterial thrombosis?
Renovascular disease, symptoms, pathology, diagnosis, therapy, what are the indications for nephrectomy with renal HTN?
UE - occlusive disease/subclavian steal syndrome/thoracic outlet syndrom
Ulnar nerve distribution (C8–T1) most common (inferior portion of brachial plexus) → weakness of intrinsic muscles of hand, weak wrist flexion Tx: cervical rib and 1st rib resection, divide anterior scalene muscle
Subclavian veins/artery pathologies/ Sy/Dx/Rx?
What are the most common causes of mesenteric ischemia?
SMA embolism/thrombosis/
mesenteric vein thrombosis/
NOMI/
median arcuate ligament syndrome/ chronic mesenteric angina/
Arc of riolan?
Visceral and peripheral aneurysms?
Rupture/Emboli/Visceral artery aneurysms/Renal artery aneurysm/ Iliac/femoral aneurysm/ popliteal artery aneurysm/ Pseudoaneurysm?
How about FMD, Buerger’s disease, cystic medial necrosis, immune arteritis, radiation arteritis, raynaud’s disease?
Venous disease:
greater saphenous veins?
dialsys access grafts?
acquired A/V fistula?
Varicose veins? Venous ulcers? Venous insufficiency?
Sy, Dx, Rx for each?
Superficial thrombophlebitis - suppurative thrombophlebitis - migrating thromboplebitis - normal venous doppler u/s - Squential compression devices -
DVT where which symptom, clinical picture?
How about venous thrombosis in the central line?
What are the contraindications to vein stripping?
What are the features of lymphedema?
Lymphangiosarcoma? Lymphocele?
