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SURG > Vascular > Flashcards

Vascular Flashcards

1
Q

Most common congenital hypercoagulable disorder

A

Leiden factor- resistance to activated protein C

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2
Q

Most common acquired hypercoagulable disorder

A

Smoking

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3
Q

Most important risk factor for stroke and cerebrovascular disease

A

HTN

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4
Q

Most common site of stenosis in carotids

A

carotid bifurcation

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5
Q

Normal flow in internal carotid artery

A

continuous forward flow

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6
Q

Normal flow in external carotid artery

A

Triphasic flow (antegrade, retrograde, antegrade)

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7
Q

1st branch of external carotid artery

A

Superior thyroid artery

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8
Q

Communication between ICA and ECA occurs via which arteries?

A

Ophthalmic artery (off ICA) and internal maxillary artery (off ECA)

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9
Q

Most commonly diseased intracranial artery

A

Middle cerebral artery

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10
Q

S&S of ACA events

A

mental status change, release, slowing

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11
Q

S&S of MCA events

A

contralateral motor and speech, contralateral facial droop

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12
Q

S&S of PCA events

A

vertigo, tinnitus, drop attacks, incoordination

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13
Q

occlusion of ophthalmic branch of ICA causes

A

Amaurosis fugax (visual changes; shade coming down over eye)

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14
Q

Indications for CEA

A

symptomatic > 50% stenosis

asymptomatic > 70% stenosis

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15
Q

Indications for emergent CEA

A

fluctuating neurologic symptoms

crescendo/evolving TIAs

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16
Q

If bilateral carotid stenosis, which side should be repaired first?

A

Repair tightest side first if patient has bilateral stenosis
Repair dominant side first if patient has equal stenosis

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17
Q

When to use a shunt in CEA?

A

if back pressure is <50 mm Hg or if contralateral side is tight or occluded

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18
Q

When should you repair an occluded ICA?

A

You shouldn’t. NO benefit

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19
Q

What is the most common cranial nerve injury with CEA?

A

Vagus nerve injury secondary to vascular clamping. Patients get hoarseness because recurrent laryngeal nerve comes off of vagus.

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20
Q

What other cranial nerve is at risk during CEA?

A

Hypoglossal nerve; tongue deviates TOWARDS side of injury (speech and mastication difficult).

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21
Q

Pseudoaneurysm after CEA

A

pulsatile, bleeding mass

Drape and prep before intubation, intubate, repair

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22
Q

Restenosis rate after CEA

A

15%

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23
Q

Symptoms of ascending aortic aneurysms

A

back pain (compression of vertebra)
voice changes (RLN)
dyspnea/PNA (bronchi)
dysphagia (esophagus)

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24
Q

Indications for repair of Ascending aortic aneurysms

A

acutely symptomatic
> 5.5 cm
> 5 cm w/ Marfans
rapid increase in size (> 0.5 cm year)

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25
Q

Indications for repair of descending aortic repair

A

Endovascular repair >5.5 cm

Open repair > 6.5 cm

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26
Q

Stanford classification of aortic dissections

A

Class A- any ascending aortic involvement

Class B- descending aortic involvement ONLY

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27
Q

DeBakey Classification of aortic dissections

A

Type I- ascending and descending
Type II- ascending only
Type III- descending only

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28
Q

Most dissections start _____.

A

in ascending aorta

29
Q

Symptoms of aortic dissection:

A

tearing-like chest pain

unequal pulses in upper extremities

30
Q

RF for aortic dissection

A

sever HTN, Marfan’s, previous aneurysm, atherosclerosis

31
Q

Dx of aortic dissection

A

chest CT w contrast

32
Q

Dissection occurs in ______ layer of blood vessel wall.

A

medial

33
Q

Aortic insufficiency occurs in ___% of cases and is caused by ______.

A

70%

annular dilation or when aortic valve cusp is sheared off

34
Q

Medical Tx of aortic dissection

A

control BP with IV beta-blockers (esmolol) and nipride

35
Q

When to operate on ascending aortic dissections?

A

operate on all ascending aortic dissections; need open repair, graft is placed to eliminate flow to false lumen

36
Q

When to operate on descending aortic dissections?

A

visceral or extremity ischemia or if contained rupture
endograft vs open repair (left thoracotomy); can also place fenestrations in dissection flap to restore blood flow to viscera or extremity if ischemia is the problem

37
Q

Post Op complications of thoracic aortic surgery

A

MI
renal failure
paraplegia (descending thoracic aortic surgery)

38
Q

What causes paraplegia in dissections?

A

spinal cord ischemia due to occlusion of intercostal arteries and artery of Adamkiewicz that occurs with descending thoracic aortic surgery

39
Q

Measurement of normal aorta

A

2-3 cm

40
Q

MCC AAA

A

atherosclerosis (results in degeneration of medial layer)

41
Q

Indications for repair of AAA

A 
> 5.5 cm in men 
>5 cm in women or those with high rupture risk (severe COPD, numerous relatives with rupture, poorly controlled HTN, eccentric shape)
Growth > 1.0 cm/ year 
Symptomatic 
Infected
42
Q 
Ideal Criteria for AAA Endovascular repair:
Neck length \_\_\_\_
Neck diameter \_\_\_\_\_
Neck angulation \_\_\_\_\_
Common iliac artery length \_\_\_\_\_
Common iliac artery diameter \_\_\_\_
Other \_\_\_\_\_\_
A 
Neck length > 15 mm
Neck diameter < 30 mm
Neck angulation < 60 degrees
Common iliac artery length > 10 mm
Common iliac artery diameter 8-18 mm
Other: non-tortuous, non-calcified iliac arteries, lack of neck thrombus
43
Q

Type I Endoleak

A

proximal or distal graft attachment sites

44
Q

Type I Endoleak treatment

A

extension cuffs

45
Q

Type II Endoleak

A

collaterals (patent lumbar, IMA, intercostals, accessori renal)

46
Q

Type II Endoleak Tx

A

observe most; percutaneous coil embolization if pressuring aneurysm

47
Q

Type III Endoleak

A

overlap sites when using multiple grafts or fabric tear

48
Q

Type III Endoleak Tx

A

Secondary endograft to cover overlap site or tear

49
Q

Type IV Endoleak

A

Graft wall porosity or suture holes

50
Q

Type IV Endoleak Tx

A

Observe, can place nonporous stent if that fails

51
Q

Type V Endoleak

A

expansion of aneurysm without evidence of leak

52
Q

Type V Endoleak treatment

A

repeat EVAR or open repair

53
Q

When does aortoenteric fistula usually occur?

A

> 6 months after abdominal aortic surgery

54
Q

S&S of aortoenteric fistula

A

herald bleed with hematemesis, then blood per rectum then exsanguination

55
Q

Cause of aortoenteric fistula

A

graft erodes into 3rd or 4th portion of duodenum near proximal suture line

56
Q

Tx of aortoenteric fistula

A

bypass through non-contaminated field (axillary-femoral bypass with femoral to femoral cross over), resect graft, close hole in duodenum

57
Q

Leg compartment- anterior

A

Anterior- deep perineal nerve (dorsiflexion and sensation between 1st and 2nd toes), anterior tibial artery

58
Q

Leg compartment- lateral

A

Lateral- superficial peroneal nerve (eversion, lateral foot sensation)

59
Q

Leg compartment- deep posterior

A

Deep posterior- tibial nerve (plantar flexion), posterior tibial artery, peroneal artery

60
Q

Leg compartment- superficial posterior

A

sural nerve

61
Q

Where is PAD?

1) buttock claudication
2) mid-thigh claudication
3) calf claudication
4) foot claudication

A

1) aortoiliac disease
2) external iliac
3) common femoral artery or proximal superficial femoral artery disease
4) distal superficial femoral artery or popliteal disease

62
Q

Leriche syndrome

A

no femoral pulses, buttock/thigh claudication, impotence, lesion at aortic bifurcation or above

63
Q

Leriche syndrome Tx

A

aorto-bifemoral bypass graft

64
Q

Most common atherosclerotic occlusion in lower extremity?

A

Hunters canal (distal superficial femoral artery exits here) the sartorious muscle covers Hunter’s canal

65
Q

Surgical indications for PAD

A

rest pain
ulceration or gangrene
lifestyle limitations
atheromatous embolization

66
Q

When to use PTFE (gore-tex) for PAD

A

ONLY for bypasses above the knee; have reduced patency below knee; need to use SVG for below knee bypasses

67
Q

Best predictor of long-term latency in PAD bypasses?

A

vein quality

68
Q

Best technique for graft surveillance?

A

Duplex U/S

69
Q

Best treatment for patency and reducing cardiovascular events after lower extremity bypass

A

ASA

SURG (6 decks)

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