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QUESTION NOTES > VASCULAR > Flashcards

VASCULAR Flashcards

1
Q

Best options for SMA bypass for chronic mesenteric ischemia

A
  • suprarenal aorta (infrarenal typically has high degree atherosclerotic burden)
  • right iliac artery
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2
Q

Sxs of chronic mesenteric ischemia

A

postprandial abdominal pain, fear of food, unintentional weight loss (not typically N/V)

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3
Q

To remember for traumatic isolated LE vascular injuries…

A
  • death MC injuries to CFA/SFA than to pop/tib arteries
  • death MC penetrating injuries than blunt
  • amputation MC injuries to pop/tib than CFA/SFA
  • amputation MC blunt injuries than penetrating
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4
Q

Mgmt for penetrating wound close to major vascular structure, but wo hard signs of vascular injury…?

A

arterial pressure index (API) - doppler arterial pressure distal to site of injury/doppler pressure in uninvolved contralateral extremity

  • if <0.9 -> need angiography
  • if >0.9 -> unlikely to have vascular injury
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5
Q

Surgical approach for repair of popliteal artery? Exposure gives view of what structures?

A

medial incision of popliteal space w/ division of medial head gastrocnemius and semimembranosus and semitendinosus muscles - exposure gives complete view of poplliteal artery/vein and tibial nerve

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6
Q

Mgmt ileofemoral DVT

A

cath-directed pharmacologic thrombolysis or pharmacomechanical thrombectomy

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7
Q

Criteria for early thrombus removal of first episode acute iliofemoral DVT

A
  1. symptom duration <14d
  2. low risk bleeding
  3. ambulatory
  4. good functional capacity
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8
Q

Why iliofemoral DVT worse prognosis than femoropopliteal DVT?

A
  • associated with long-term postthrombotic syndrome, which is related to residual venous obstruction and valvular reflux
  • associated with higher risk recurrent VTE
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9
Q

What is “nonocclusive” mesenteric ischemia due to?

A

typically low-flow states - dehydration, sepsis, cardiac failure, vasopressor use

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10
Q

Presentation of nonocclusive ischemic colitis

A

acute onset abdominal pain, cramping, bloody diarrhea (2/2 mucosal injury)

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11
Q

Mgmt ischemic colitis

A

bowel rest + IV fluids

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12
Q

Tx DVT (including iliofemoral, unless life-threatening) during pregnancy

A

SQH for duration of pregnancy + 6-wk post-partum

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13
Q

Can repair of thoracic aorta be done endovascularly in pediatrics?

A

NO - bc growing.

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14
Q

Blockage of left subclavian artery during TEVAR may result in…

A
  • paraplegia: blood supply to upper spinal cord through vertebral artery connection to anterior spinal artery
  • left arm ischemia
  • vertebrobasilar ischemia: covering flow to left vertebral artery results in reversal of blood flow in left vertebral, stealing flow from posterior circulation
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15
Q

Sxs of vertebrobasiliar ischemia

A

syncope, diplopia, vertigo

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16
Q

Is angiography good way to dx colonic ischemia?

A

NO - bc colonic ischemia (unlike midgut mesenteric ischemia) is usually associated with small vessels

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17
Q

Mesenteric venous thrombosis typically associated with…?

A

hypercoagulable state

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18
Q

Presentation of mesenteric venous thrombosis

A

slow onset abdominal pain, made worse by meals, +/- abdominal distention - hx hypercoag state

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19
Q

Postthrombotic syndrome (PTS)

A

occurs after DVT destroys compentency of deep venous valvular system -> reflux and HTN of venous system -> swollen, heavy, and painful leg that is worse with standing/walking

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20
Q

Mgmt postthrombotic syndrome

A

anticoag 6-mo + compression stockings for at least 24-mo

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21
Q

Surgical approach to access origin/proximal/distal subclavian artery

A

@origin - partial or complete sternotomy
@prox left - anterolateral
@distal or right side - supraclavicular

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22
Q

Can pts receiving thrombolytic therapy also receive heparin?

A

YES.

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23
Q

Association of thrombolytic therapy and stroke?

A

Thrombolytic therapy associated with 3x increase risk of periprocedural stroke

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24
Q

Anatomical relationship between right vs. left external iliac vein and artery

A

Right: vein posterior and lateral to artery
Left: vein posterior and medial to artery

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25
Q

MC acute thoracic aortic pathology

A

aortic dissection

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26
Q

If have flank/abdominal pain with known aortic dissection, think…?

A

progression of intimal tear -> occlusion renal or mesenteric vessels -> ischemia

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27
Q

MC occurring visceral aneurysm (#1, #2)

A

splenic (#1), hepatic artery (#2)

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28
Q

MC location of aneurysm along splenic artery

A

75% occur in distal third

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29
Q

“Saturday night palsy”

A

compressive brachial plexopathy and ischemia of UE -> may need compartment release

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30
Q

Pts with popliteal artery entrapment syndrome will usually c/o…?

A

calf pain with walking

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31
Q

Dx imaging for popliteal artery entrapment syndrome

A

angiography or MRI w/ pt’s feet in both dorsiflexion and plantar flexion (provocative studies)

32
Q

Sxs chronic exertional compartment syndrome

A

pain or tightness, cramping, burning, or aching over affected compartment with exercise; may also have weakness

33
Q

Dx chronic exertional compartment syndrome

A

measuring pre- and post-exercise compartment syndrome

34
Q

Risk factors with immediate score of 5 on Caprini model = highest risk

A
  • stroke within past month
  • elective major LE arthroplasty
  • hip, pelvis or leg fx within past month
  • acute spinal cord injury (paralysis) within past month
  • multiple trauma within past month
35
Q

Effected bowel in acute embolic vs. thrombotic mesenteric ischemia

A

Embolic (occludes SMA distal to middle colic): sparing of proximal jejunum + transverse colon
Thrombotic (occludes at proximal SMA): all SMA effected

36
Q

Prevention of post-thrombotic syndrome after acute DVT involves…?

A

wearing 30-40mmHg compression stockings from time of dx for up to 2 years

37
Q

What is post-thrombotic syndrome?

A

development of chronic pain, swelling, ulceration, and discoloration after DVT - may develop ulceration 2/2 venous stasis

38
Q

RF post-thrombotic syndrome

A
  • older age
  • proximal DVT
  • recurrent DVT in same limb
  • morbid obesity
  • persistent sxs despite AC
39
Q

Mgmt: penetrating injury w/o hard signs vascular injury

A

ABI - if <0.9, need to further evaluate with CT angio

40
Q

Fistula stenosis physical exam finding (what type of flow?)

A

pulsatile flow compared to palpable thrill

41
Q

May-Thurner syndrome

A

(Iliac vein compression syndrome)

2/2 compression of common venous outflow tract of LLE that may cause swelling and DVT in iliofemoral veins

42
Q

MC nerve damaged during LE fasciotomy

A

Superficial peroneal nerve

43
Q

Location of artery of Adamkiewics

A

Between T7 and L1

44
Q

MC location which cardiac emboli lodge in LE

A

Common femoral artery

45
Q

What does monophonic signal suggest about flow?

A

Proximal occlusion with patent distal vessels

46
Q

Most significant RF for stroke

A

HTN

47
Q

MCC ischemic stroke

A

Cardioembolic disease

48
Q

Which PSA not likely to spontaneously thrombose (aka. Need intervention) after angio puncture?

A
  • > 3cm size

- presence of anticoagulation

49
Q

Steps of thrombin injection for Tx of PSA

A
  • Duplex US: characteristic “swirling” flow within cavity
  • US-guided needle injection of thrombin
  • 1000U/cc thrombin injected SLOWLY over 15s - once thrombosis achieved, must stop injection to avoid thrombin reaching circulation
  • bed rest for 1hr
  • repeat duplex US in 24hrs to confirm thrombosis
50
Q

Patho of arterial wall thickening (HTN) 2/2 atherosclerosis

A

Artery wall thickens due to invasion and accumulation of WBC and proliferation of intimacy smooth muscle cells

51
Q

Patho fibromuscular dysplasia (on micro vasculature level)

A

Multi-focal fibroplasia -> thickening of media and collagen formation

52
Q

Visceral aneurysms listed from descending order of incidence

A

spleen > hepatic

53
Q

Pt w/ recent exposure to heparin, who presents with acute thrombosis… suspect?

A

HIT

54
Q

Approach for LE open embolectomy

A
  • CFA preferred site of cutdown
  • once exposed, vessel loops to gain control of artery
  • transverse arteriotomy preferred incision to avoid narrowing of vessel upon closure
  • embolectomy cath passed both prox and distal until back bleeding achieved
  • completion angiogram
55
Q

Appropriate diameter of vein and artery for HD access

A

Vein >3mm without evidence signif stenosis

Artery >2mm

56
Q

MCC (#1 and #2) of peripheral arterial embolic occlusion

A 
#1 = atrial fibrillation
#2 = proximal atherosclerosis
57
Q

Which mesenteric artery cannot be ligated even in trauma? (Bc incompatible with life if ligated)

A

SMA

58
Q

Renal artery stenosis causing HTN in young females typically caused by…?

A

fibromuscular dysplasia

59
Q

Pathophys: fibromuscular dysplasia

A

thickening of media and collagen formation

60
Q

s/p TEVAR, with bloody diarrhea that improves with fluids and IV Abx… next step to evaluate?

A

sigmoidoscopy - black mucosa signifies transmural necrosis and needs OR
(NOT CT angio A/P bc cannot evaluate severity)

61
Q

MC organism non-aneurysmal aortic infection

A

salmonella

62
Q

MC organism aortic infections (both aneurysmal and non)

A

S.aureus - associated with aneurysmal degeneration

63
Q

on US, acute DVT vs. chronic DVT appears how?

A 
acute = echolucent (black)
chronic = echogenic (white)
64
Q

Tx septic thrombophlebitis superficial vs. deep veins?

A

Abx and excision of superficial vein (entire lenght) - if deep/central veins, then only IV Abx + hep gtt for 2-3wk (cannot excise)

65
Q

Paget-Schroetter syndrome

A

venous thoracic outlet syndrome; exercise-induced thrombosis of subclavian and axillary veins

66
Q

Sxs and Tx Paget-Schroetter syndrome

A

Sxs: short hx pain/swelling arm
Tx: cath-directed thrombolysis

67
Q

Vessel lumen is not compromised until >?% stenosis occurs

A

> 40%

68
Q

Nerves that may be damaged during CEA and their deficits

A
  • vagus nerve (long recurrent laryngeal): hoarseness
  • superior laryngeal (br off vagus): loss high-pitches
  • marginal mandibular: drooping of ipsilateral lip
  • hypoglossal: ipsilateral deviation of tongue
69
Q

Which LE artery has longest patency after angioplasty?

A

iliac arteries - proximal has better patency

70
Q

Dx compartment syndrome via pressure transducer

A

pt’s compartment pressure - pt’s DBP <30mmHg, then Dx supported

71
Q

Presentation of porto-mesenteric vein thrombosis (PMVT)

A

abrupt onset abdominal pain >10d after discharge (s/p bypass)

72
Q

Thickness of vein wall for acute vs. chronic DVT

A 
Acute = thin, smooth
Chronic = thick, contracted (2/2 inflammation)
73
Q

Rule of 6s criteria for cannulation of dialysis access

A
  • vein diameter 6mm
  • access depth of 6mm
  • access flow of 600 cc/min
74
Q

30d mortality for endovascular vs. open repair of infrarenal AAA

A

endo: 1.6%
open: 4.8%
* no long-term benefit shown with EVAR vs. open

75
Q

90d mortality for open thoracoabdominal aneurysm repair

A

8-10%

76
Q

% mortality endo vs. open repair of ruptured AAA

A

endo: 25%
open: 50%

QUESTION NOTES (28 decks)

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