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General Surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

Indications for AAA repair (3)

A

Size (5.5cm in men, 5.0cm in women)
Growth (>0.5cm in 6mo)
Symptomatic

Sizes have not changed in the era of EVAR

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2
Q

Indications for open AAA repair (6, 4 anatomy)

A 
Anatomy: Hostile neck
Anatomy: Neck <1.5cm
Anatomy:Significant angulation of neck (>60 degrees)
Anatomy: Suprarenal aneurysm
Young patient (relative indication)
Endovascular capabilities unavailable
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3
Q

Risk factors for AAA

A 
Increased age
Male
Family history of AAA
Tall
HTN
HLD
CAD
PAD
CVD
Smoker
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4
Q

Risk factors for AAA rupture (5)

A 
Female
HTN
Current smoker
Low FEV1/COPD
Aneurysm size
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5
Q

What three cardiac symptoms in a patient with a AAA requiring repair should prompt evaluation for possible pre-operative intervention?

A

Unstable angina
Aortic stenosis
Severe left ventricular dysfunction

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6
Q

What is the most effective measure to decrease rate of aneurysm growth?

A

Smoking cessation

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7
Q

Type I endoleak

A

Inadequate sealing at either proximal or distal attachment sites

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8
Q

Type II endoleak

A

Flow into the aneurysm sac from patent branch vessels (IMA, lumbar artery)

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9
Q

Type III endoleak

A

Defect in graft fabric or seal failure between graft components

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10
Q

Type IV endoleak

A

Leaking of blood between the interstices of the graft fabric

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11
Q

Type V endoleak

A

Endotension - the sac remains pressurized despite lack of visible endoleak

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12
Q

Which two endoleaks are due to inadequate sealing?

A

Type I (inadequate proximal or distal seal) and Type III (seal failure between graft components)

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13
Q

Which two endoleaks are due to flow directly from a vessel?

A

Type I (inadequate proximal or distal seal) and Type II (flow into sac from patent branch vessel)

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14
Q

Which is the most common type of endoleak?

A

Type II (patent branch vessel feeding sac). Spontaneous resolution in 30-90% of cases.

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15
Q

What structure can be identified on a pre-operative CT abdomen for a ruptured AAA and will help avoid injury during cross-clamping?

A

Retroaortic L renal vein

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16
Q

What is the blood pressure goal in the pre-operative resuscitation of a ruptured AAA?

A

SBP 50-70mmHg

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17
Q

Indications for repair of TAAA (2)

A

Size >6cm
Growth >10mm/y

In Marfan’s patients or those with a chronic dissection, size criterion is 5cm

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18
Q

What two risk factors change the size criterion for repair of TAAA?

A

In Marfan’s patients or those with a chronic dissection, size criterion is 5cm rather than 6cm

19
Q

What is the time frame that differentiates between an acute and a chronic aortic dissection?

A

14 days

20
Q

What makes a Stanford Type B aortic dissection complicated (5)?

A 
Rupture
Impending rupture
Malperfusion
Refractory pain
Refractory hypertension

Urgent endovascular or open surgical therapy is recommended

21
Q

Patients with Stanford type A dissections and a new diastolic murmur or evidence of aortic regurgitation should not be managed with which class of drugs?

A

Beta blockers because of the risk of exacerbating congestive heart failure

22
Q

What percent stenosis is an indication for CEA in an Asymptomatic patient?

A

60% or more

23
Q

What percent stenosis is an indication for CEA in a Symptomatic patient?

A

50% or more

24
Q

Why is a cranial extension of a CEA incision angled to the posterior of the earlobe?

A

To avoid the parotid gland

25
Q

What vein is a marker for the carotid bifurcation?

A

The facial vein

26
Q

What can following the ansa cervicalis superiorly lead you to?

A

The hypoglossal nerve

27
Q

What are the EEG criteria for carotid shunting? (3)

A

50% decrease in fast background activity
Increase in delta wave activity
Complete loss of EEG signals

28
Q

What are the criteria for non-selective carotid shunting?

A

Recent stroke
TIA
Amaurosis

Shunt to avoid cerebral hypoperfusion of at-risk regions

29
Q

What is a contraindication for the eversion technique of CEA?

A

Need for shunt

30
Q

If one must divide the digastric in order to gain more cephalad exposure during a CEA, what structure must be identified first?

A

The hypoglossal nerve, as it frequently runs posterior to the digastric muscle

31
Q

What is the usefulness of D-dimer in a perioperative surgical inpatient undergoing workup for DVT?

A

A normal D-dimer in this population definitively rules out DVT.

32
Q

What are the recommendations for anticoagulation in
A) provoked DVT
B) spontaneous DVT
C) DVT in high-risk patients (recurrent, cancer, hypercoagulable states)

A

A) 3mo
B) 3-6mo
C) indefinite

33
Q

What are absolute contraindications to anticoagulation in patients with massive PEs? (2)

A 
Intracranial hemorrhage (trauma or CVA)
Active, uncontrolled internal hemorrhage
34
Q

How is a PE classified as massive or submassive? (3)

A

Hypotension (SBP<90, >40mmHg drop)
Shock/tissue hypoperfusion
RV dysfunction or pHTN

35
Q

What are the recommendations for anticoagulation in
A) provoked PE
B) spontaneous PE
C) PE in high-risk patients (recurrent, cancer, hypercoagulable states)

A

A) 3mo
B) 3-6mo
C) indefinite

These are EXACTLY the same as timeframes for DVTs

36
Q

What are absolute indications for IVC filter placement? (5)

A

Recurrent VTE on adequate anticoagulation
Absolute contraindication to anticoagulation
Complications from anticoagulation
Pulmonary hypertension in the setting of chronic PE
Immobile trauma patients with ICH

37
Q

What are the prophylactic indications for IVC filter placement? (3)

A

Multitrauma patients with long bone fractures and contraindication to Rx prophylaxis other than ICH (ie solid organ injury)
Patients with cancer undergoing extensive resection with high risk for VTE and post-operative hemorrhage
Other surgical patients or those with medical conditions with high risk for VTE

38
Q

T/F: A patient with an acute, isolated distal DVT of the leg without risk factors for extension or severe symptoms may be treated with compression therapy and repeat imaging in two weeks.

A

True. If the DVT propagates in the two weeks, anticoagulation is instituted.

39
Q

Repair isolated iliac aneurysms at what size?

A

3.5cm. Repair at 3cm if in conjunction with aortic aneurysms.

40
Q

Repair femoral aneurysms at what size?

A

2.5cm. Resect and place interposition graft.

41
Q

What is the next study if a popliteal aneurysm is found?

A

Abdominal imaging to look for AAA.

42
Q

What is the procedure of choice for popliteal aneurysm?

A

Exclusion and bypass with vein graft.

43
Q

What is treatment for a lesion known as “beads on a string” on angiogram?

A

Balloon angioplasty for fibromuscular dysplasia, either in ICA or renals.

44
Q

Two most common organisms in mycotic aneurysms

A

Salmonella, Staph

General Surgery (12 decks)

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