Vascular Flashcards
what is hyperperfusion syndrome after a CEA? pathophysiology? treatment?
impaired autoregulation of cerebral blood flow – typically occurs POD#5, management = control BP (beta blocker), avoid vasodilators, and anti-seizure meds
young female with dizziness, syncope, upper extremity claudication, elevated ESR, absent radial and carotid pulses. dx / tx?
Takayasu arteritis - inflammatory disease, involves branches of aorta and coronary/pulmonary arteries, tx w/ steroids and cytotoxic agents – carotidynia (pain along the inflamed arteries) pathognomonic for Takayasu arteritis
features and management of blunt carotid injury
Horner syndrome is common with this injury - anticoagulation (heparin) or antiplatelet is the treatment of choice for small dissection
indication for screening for blunt carotid injury
severe cervical hyperextension/hyperflexion, closed head injury w/ DAI, near hanging and resulting anoxic brain injury, seat belt abrasion to anterior neck, basilar skull fracture involving carotid canal, cervical vertebral body fx
causes of re-stenosis – within 1 month? 1 month to 2 years? greater htan 2 years?
within 1 month = technical, within 1 month - 2 years myointimal hyperplasia, greater than 2 years usually due to atherosclerosis
sudden ICA occlusion in a young patient - dx, tx?
spontaneous dissection. tx w/ anticoagulation
characteristics of thromboangiitis obliterans?
non-atherosclerotic inflammation of small-medium sized arteries, veins, nerves of upper and lower extremities, 20-50 yrs old, men who smoke, extensive collateralization / corkscrew collaterals – spares aortoiliac segments / coronary arteries
conditions that falsely elevate ABIs?
ESRD and diabetes
categories of acute limb ischemia
class 1 (non-threatened) normal motor and sensory function, class 2 (threatened) - 2a sensory deficit only, 2b (immediately threatened) both motor and sensory deficit, class 3 irreversible complete motor and sensory loss
management of class 2b ischemia
2b threat of limb loss more immediate, thrombolytics often take more than 24-48 hrs to restore flow, thrombolysis contraindicated, shoudl be taken to OR
management of class 3 ischemia
class 3 ischemia w/ irreversible complete motor/sensory loss, proceed w/ amputation
causes of acute mesenteric ischemia
embolization (30-50%), arterial thrombosis (mesenteric atherosclerosis), venous thrombosis (hypercoag state), non-occlusive mesenteric ischemia
most common area of mesenteric embolization
SMA just distal to the middle colic artery – ischemia spares proximal jejunum and transverse colon
management of acute mesenteric ischemia without evidence of peritonitis
heparin drip – if embolic -> open SMA embolectomy, if thrombotic / mesenteric atherosclerosis -> arteriography and possible arterial bypass or stent, if mesenteric vein thrombus -> heparin alone; if NOMI -> correct underlying shock, consider catheter directed papaverine
medication for claudication? mechanism?
cilostazol (pletal) – causes inhibition fo platelet aggregation, increases vasodilation more effective than pentoxifylline
most common cause of leg edema after fem-pop bypass?
dysruption of lymphatics
pt who had CABG who presents with recurrent chest pain / angina – BP R arm > L arm: dx, pathophys, tx?
after cabg w/ LIMA to LAD graft – in setting of subclavian stenosis or occlusion proximal to takeoff of IMA, arm exercise leads to vasodilation of arm vessels and lower resistance (giving flow pref to arm instead of heart -> angina) – either stent subclavian artery or carotid to subclavian bypass
how do you obtain operative exposure of the SMA for embolectomy?
1) rotating small bowel to the right, sharply dissecting the ligament of Treitz, 2) SMA will be found at the root of the mesentery 3) transverse arteriotomy (longitudinal will cause stenosis upon closure) and embolectomy w/ Fogarty 4) non-viable bowel resected, borderline viable bowel left in place for second look
5 year risk of major amputation in a pt w/ claudication? 5 year survival rate? MCC of death?
1-3.3% risk of major amputation; 70% survival rate (40-60% of deaths caused by coronary artery disease)
mesenteric ischemia that spares the proximal jejunum is most likely due to….
embolus – usually lodges just past the SMA origin beyond 1st jejunal branch, often have sparing of proximal jejunum and transverse colon because middle colic artery patent – if thrombosis, usually involves SMA origin and would not spare proximal jejunum
most common visceral artery aneurysms? #1, #2
splenic (60%), hepatic (20%)
mortality rates of AAA open vs endo? ruptured? elective?
ruptured similar mortality rates, in elective setting endo w/ lower mortality rates
popliteal aneurysms and AAA relationship? most common symptom of popliteal aneurysm?
30% of pt w/ pop aneurysm also have AAA – 50% w/ thrombosis causing acute/chronic ischemia, 2nd most common is distal embolization, rupture is rare
indications for repair of popliteal aneurysm, surgical approach
large aneurysm (>2 cm), presence of intraluminal thrombus (regardless of size), or symptomatic – can eigher do a medial or posterior approach, typically proceed w/ bypass w/ saphenous vein and ligation of pop artery; also endoaneurysmorraphy – in acute thrombosis, lytics are treatment of choice
