Vascular

Question 1

What is the spinal cord syndrome assoc with spinal cord ischemia? What functions are lost and preserved?

Answer 1

Anterior cord syndrome–loss of motor, pain + temp

Question 2

What arteries are compromised during TAAA which causes risk for spinal cord ischemia?

Answer 2

lumbar, intercostal, and artery of Adamkiewicz (which reinforces the anterior spinal artery)

Question 3

What is the patency of iliac artery angioplasty at 5 years?

Answer 3

75%–worsens as you move distally down the leg

Question 4

What is Paget-Schroetter syndrome and what is tx?

Answer 4

exercise induced thrombosis of subclavian and axillary veins, common in young athletes. Tx with catheter directed thrombolysis and then first rib resection during same hospitalization.

Question 5

What is better–GSV ligation or stripping?

Answer 5

stripping because it reduces the rate of recurrent varicosities 2/2 recurrent saphenofemoral incompetence

Question 6

What is a common cause of claudication in young, healthy patients?

Answer 6

Popliteal entrapment, caused by entrapment by medial head of gastroc–can lead to popliteal fibrosis and eventual thrombosis.

Question 7

What BP meds do you give for acute tx of aortic dissection, and in what order?

Answer 7

Beta blocker followed by vasodilator

Question 8

What is a characteristic skin finding of venous stasis?

Answer 8

lipodermatosclerosis (fibrosing dermatitis)

Question 9

What % carotid stenosis do you repair in an asymptomatic patient?

Answer 9

80-90%

Question 10

What % carotid stenosis do you repair in a symptomatic patient?

Answer 10

50%

Question 11

Timeframe for carotid intervention after stroke?

Answer 11

Small stroke (<200 g of brain) or TIA: 2 weeks
Medium: 4 weeks
Large or hemorrhagic: 8 weeks

Question 12

Should you recanalize completely occluded carotids?

Answer 12

No, anticoagulate only to prevent propogation. Only exception would be if a trauma patient strokes out in front of you.

Question 13

Tx for carotid body tumors?

Answer 13

Resection, consider embo first if large. Do not bx.

Question 14

What is the anatomy of the thoracic outlet anterior to posterior?

Answer 14

Subclavian vein and phrenic nerve running on top of anterior scalene, then subclavian artery and brachial plexus, then middle scalene then first rib

Question 15

What’s a risk for thoracic outlet syndrome?

Answer 15

extra cervical rib

Question 16

What is the most common type of thoracic outlet syndrome?

Answer 16

Neurogenic–ulnar nerve dist–ring and pinky fingers. Sxs worst with manipulation (hand goes numb when raising arm). Tx: physical therapy first then confirm with nerve conduction studies, then can remove first rib + scalenectomy.

Question 17

What is SC steal syndrome?

Answer 17

Proximal narrowing of SC artery causing reversal of flow through ipsilateral vertebral artery leading to vertebrobasilar sxs (dizziness, weakness, poor coordination)

Question 18

What area of aortic coverage carries highest risk of SCI?

Answer 18

T8-L1

Question 19

What is the tx for popliteal entrapment syndrome?

Answer 19

Resection of medial head of the gastroc

Question 20

Most common site for embolus to lodge in LE?

Answer 20

CFA

Question 21

Most common site for embolus to lodge in UE?

Answer 21

Brachial artery

Question 22

Size at which visceral aneurysms should be repaired?

Answer 22

2 cm

Question 23

Size at which iliac aneurysms should be repaired?

Answer 23

3.5 cm if isolated, 3 cm if in assoc with aortic repair

Question 24

Size at which popliteal aneurysms should be repaired? What is the repair?

Answer 24

2 cm if asymptomatic, any size if symptomatic. Also repair those with mural thrombus or poor runoff. Repair is exclusion and bypass (vein graft).

Question 25

Size at which femoral aneurysms should be repaired and what is the repair?

Answer 25

2.5 cm, resect and place interposition graft

Question 26

What % of patients with popliteal aneurysms also have AAA?

Answer 26

50%

Question 27

“Beads on a string” appearance of renals or carotids =?

Answer 27

fibromuscular dysplasia, tx with balloon angioplasty

Question 28

Where is the most common place for smokers to have arterial stenosis?

Answer 28

SFA

Question 29

How should SFA stenosis be treated?

Answer 29

angioplasty and stent