Vascular and Cardiac/Thoracic Flashcards
pulse volume recording
type of plethysmography which is used with a doppler to assess perfusion of distal extremities assuming that change in volume corresponds to change in arterial pressure
Ankle brachial index categories
> or equal to 1= normal
0.5-0.7= claudication
<0.3= ischemic rest pain, gangrene
what penile brachial index indicates vascular etiology for impotence
PBI <0.6
post arteriography guidelins
maintain patient supine for at least 6h
check for hematomas, aneurysms
check neuro status (embolus r/O)
well hydrated state
to be a TIA, resolves in
24h
earliest sign of acute arterial insufficiency in lower extremity
distribution of peroneal nerve- no dorsiflexion,foot drop
likely site of occlusion: can feel femoral but no popliteal or pedal pulses
localize lesion above site where pulse first loss
here- likely in thew superficial femoral artery (SFA)
common sites of atheroembolism
distal vessels, usually lower extremity- common femoral and popliteal
suspect esp if digital ischemia WITH palpable pulses (since at least one of the proximal vessels is still patent)
most common sites of chronic ischemia
infrarenal aorta, iliac arteries, superior femoral artery
Leriche syndrome
aortoiliac disease- claudication, impotence, decreased/absent femoral pulses
subclavian steal syndrome
cerebrovascular symptoms with mild arm claudication due to decreased flow to PCA when blood flows retrograde through vertebral artery to subclavian artery
due to proximal SCA lesion
if neuro symptoms- then consider carotid stenosis also
Syme
amputation at base of tibia and fibula- for terminal arterial disease of distal foot
uncommon
when is below knee amputation contraindicated
gangrene more proximal than ankle or if patient has hip or knee contractures, and for elderly non ambulatory patients
postphlebitic syndrome
after DVT, patients get chronic venous insufficiency due to vascular incompetence of recanalized veins.
Degenerative aneurysm
atherosclerosis- intima replaced by fibrin, fragmented media.
Imbalance in elastin metabolism- between elasase and alpha-1-antithrombin
Poststenotic aneurysm
occurs distal to cervical rib in thoracic outlet syndrome, distal to coarctation of aorta, or to valvular stenosis
Anastomotic aneurysm
separation between graft and native artery (can be seen in CFA wit aortofemoral bypass)
painless, pulsatile groin mass
size at which AAA considered for surgical repair
5cm
AAA Open vs Endovascular repair
Open repair
Endovascular- involves grafts, stents, and a delivery mechanism. considered in elderly patients or patients with high comborbidities. in this case, aneurysm isnt actually resected
in pregnant women, ilaic aneurysms associated with
fibromuscular dysplasia
which lower extremity arteries affected in diabetes
spares aortoiliac
distal profunda femoris, popliteal, tibial, digital
intimal and basement membrane thickening
why might ABI be falsely elevated or normal in diabetes
vessel calcification- increases pressure
false elevation when ischemia/claudication actually exists
patient with a left carotid bruit and duplex showing stenosis of 70% of left internal carotid
2 options: aspirin or surgical (carotid endarterectomy)
-with stenosis of 70% or more- surgical management advantageous for stroke prevention
What structures and nerves at risk with a carotid endarterectomy?
the cut is made along the SCM, and the carotid sheath is opened
- vagus runs alongside internal carotid
- need to protect carotid body at external/internal carotid junction
- exposure up to hypoglossal nerve which needs to be protected
-marginal mandibular branch of facial nerve
facial vein
first branch of internal carotid, transient blindness
ophthalmic artery= amaurosis fugax
when should revascularization done after acute arterial embolus
immediate! apply heparin and go to the OR
-more than 6 h after ischemia can result in sev impaired limb or even amputation
