Vascular

Question 1

Acute limb ischemia: what is the best therapeutic anticoagulation option (and at what rate)?

Answer 1

Heparin Sulfate bolus starting @ 80units/kg

followed by

Heparin sulfate drip at rate of 18 units/kg

Goal for therapy

Question 2

aPTT goal for therapy for acute limb ischemia on a patient with heparin gtt

Answer 2

aPTT 60 - 90 seconds

Question 3

most common cause of ESRD leading to renal transplant?

Answer 3

diabetes mellitus

Question 4

What is the incision of choice for obtaining proximal and distal control for a right subclavian artery repair?

Answer 4

median sternotomy with a supraclavicular extension

Question 5

What is the incision of choice for obtaining proximal and distal control for a left subclavian artery repair?

What other incision can be used to aid in exposure?

What else can you use for distal control?

Answer 5

proximal control = left anterior thoracotomy via 3rd intercostal space

distal control = supraclavicular incision

Can use connection with a median sternotomy (trapdoor incision) to aid in exposure

Can also use intravascular balloon placed through axillary artery

Question 6

What is the incision of choice for obtaining proximal and distal control for an axillary artery injury?

Answer 6

deltopectoral incision

Question 7

What is Leriche syndrome? Symptoms? How to diagnose?

Answer 7

Aortoiliac occlusive disease….

Causes diminished or absent femoral pulse, buttock claudication and impotence

diagnose w/ angiogram

Question 8

What are hard signs of vascular injury?

Answer 8

• pulsatile bleeding
• absent distal pulse
• arterial thrill by manual palpation
• bruit over or near the artery by auscultation
• signs of distal ischemia (pain, pallor, parasthesia… etc)
• visible expanding hematoma

Question 9

What are soft signs of vascular injury?

Answer 9

• stable hematoma
• subjectively decreased pulse
• peripheral nerve deficit
• history of pulsatile or significant hemorrhage at the time of injury
• hypotension
• high-risk orthopedic injury

Question 10

What is CEAP classification for chronic venous disease?

Answer 10

C (clinical class)
E (Etiology)
A (Anatomy)
P (Pathophysiology)

Question 11

What are the 2020 different Clinical (C) CEAP classifications?

Answer 11

C0 = no visible or palpable signs of venous disease
C1 = Telangiectasias or reticular veins
C2 = Varicose veins
C2r = recurrent Varicose veins
C3 = Edema
C4 = Changes in skin and subcutaneous tissue secondary to CVD
C4a = Pigmentation or eczema
C4B = Lipodermatosclerosis or atrophie blanche
C4c = Corona phlebactica
C5 = Healed
C6 = Active venous ulcer
C6r = recurrent active venous ulcer

Question 12

What are the 2020 different Etiologic (E) CEAP classifications?

Answer 12

Ep = primary
Es = secondary 

Esi = Secondary - intravenous
Ese = Secondary - extravenous
Ec = congenital
En = No cause identifieed

Question 13

What are the 2020 different Anatomic (A) CEAP classifications?

Answer 13

As = superficial
Ad = Deep
Ap = Perforator
An = No venous anatomic location identified

Question 14

What are the 2020 different Pathophysiologic (P) CEAP classifications?

Answer 14

Pr = Reflux
Po = Obstruction
Pr,o = reflux and obstruction
Pn = No pathophysiology identified

Question 15

1.6 cm Pseudoaneurysm. Treatment?

Answer 15

Observe + repeat U/S in 4 weeks.

< 2cm pseudoaneurysms will thrombose spontaneously within 4 weeks.

Question 16

B/L lower extremity edema w/ overlying skin not tense, non-erythematous and w/ symmetrical distribution of fat between hips and ankles. Feet no involved. Skin easily pinched nd lifted at base of second toe.

Diagnosis? Treatment?

Answer 16

Dx: Lipedema (NOT lymphedema, which involves feet)

Tx: Weight loss

HINT: Skin easily pinched nd lifted at base of second toe = NEGATIVE Stemmer sign == lipedema