Vascular Disease Flashcards
1
Q
Signs / symptoms of chronic limb ischemia
A
Rest pain Ischemic ulcers Gangrene Elevation pallor Dependent rubor Sx > 2 weeks
2
Q
Thromboangiitis Obliterans (Buerger’s Disease) features
A
Age < 40 Smoker M > F Distal and proximal arteries and veins Superficial thrombophlebitis
3
Q
Treatment for thromboangiitis obliterans
A
Smoking cessation
Iloprost for pain
4
Q
ABI calculation
A
Highest ankle pressure / highest brachial systolic pressure
5
Q
Normal ABI
A
1 - 1.4
6
Q
Abnormal ABI
A
<0.9
7
Q
Borderline ABI
A
0.91 - 0.99
8
Q
Non-compressible ABI
A
> 1.4
9
Q
Exercise ABI for symptomatic patients indicated for
A
Borderline or normal ABI
10
Q
Positive exercise ABI
A
Decrease in ABI by 20%
Decrease in ankle pressure > 30 mm Hg
11
Q
TASC classification for aorta-iliac and femoral-popliteal PAD A
A
Short focal stenosis or occlusion
Endovascular
12
Q
TASC classification for aorta-iliac and femoral-popliteal PAD B treatment
A
Endovascular repair
13
Q
TASC classification for aorta-iliac and femoral-popliteal PAD C treatment
A
Surgery unless high risk
14
Q
TASC classification for aorta-iliac and femoral-popliteal PAD D
A
Long stenosis or occlusion
Surgery
15
Q
Indications for intervention for stable PAD
A
Lifestyle limiting symptoms +
Inadequate response to exercise and OMT or
favorable risk benefit ratio
16
Q
Chronic critical limb ischemia treatment
A
<2 year survival -> balloon
>2 year survival -> bypass
17
Q
Acute limb ischemia features
A
Pain Pulselessness Pallor Parasthesias Poikylothermia Paralysis
18
Q
Acute limb ischemia duration
A
<2 weeks after symptom onset
19
Q
Acute limb ischemia causes
A
Embolism
Thromobis
Dissection
Trauma
20
Q
Acute limb ischemia stage 1
A
Viable
+ Doppler
21
Q
ALI stage 2a
A
Salvageable
+/- Doppler
+/- Sensory loss
22
Q
ALI stage 2b
A
Threatened
No doppler
Paresthesias
Muscle weaknes
23
Q
ALI stage 3
A
Non-viable No doppler Profound sensory loss Paralysis -> Amputation
24
Q
ALI treatment
A
Endovascular < 2 weeks (Cather lyrics +/- device)
Surgical if > 2 weeks
25
Lytics contraindicated:
Recent surgery
Intracranial neoplasm / injury
Bleeding risk
Infected graft
26
Who to screen with US for AAA
Physical exam features of enlarged aorta, atheroembolism, peripheral aneurysm
1st deg FH in men > 60
Men smoking hx 65-75
Symptomatic PAD
27
Surveillance for AAA with US or CTA < 4 cm
3 years
28
Surveillance for AAA with US or CTA 4-4.9 cm
12 months
29
Surveillance for AAA with US or CTA 5-5.4 cm
6 months
30
Indications for AAA surgery
```
Diameter > 5.5 cm
Expansion > 1 cm in 1yr
Symptomatic
Rupture / contained rupture
Infectious or inflammatory
```
31
Endoleak 1 from AAA EVAR
Leak at graft attachment
| Need to fix
32
Endoleak 2 from AAA EVAR
Retrograde flow from collateral arteries
| May resolve on follow-up imaging
33
Endoleak 3 from AAA EVAR
Leak in endograft components
| Need to fix
34
Genetic causes of TAA
```
Marfan
Loeys-Dietz
Ehlers-Danlos
BAV
Familial non-syndromic
```
35
Acquired causes of TAA
```
GCA
Takayasu
Infectious
HTN
Toxic
Idiopathic
```
36
TAA preventive repair cut-off for Turner's
Aortic index >= 2.5
37
TAA preventive repair cut-off for Loeys-Dietz
> 4.0 cm
38
TAA preventive repair cut-off for Marfan's
>= 5.0
39
TAA preventive repair cut-off for BAV
>5.5
40
High risk features for TAA when considering repair
FH or personal history of dissection
Rapid enlargement
Planned pregnancy
41
Intramural hematoma
Hematoma in medial layer of aortic wall
May cause dissection
Manage like dissection
42
Penetrating aortic ulcer
Aortic plaque becomes ulcerated
| Usually descending aorta
43
Management of penetrating aortic ulcer
HTN, anti-platelet, statins
Surveillance imaging
Surgery
44
Surgical indications for penetrating aortic ulcer
Ascending aorta
Persistent symptoms
True or pseudo-aneurysm formation
Aorta > 5.5 cm
45
Suspect carotid dissection
CVA preceded by neck pain or Horner's syndrome
46
4Ts for HIT assessment
Thrombocytopenia >50% fall, nadir 20-100
Timing 5-10 days or <1 day with prior heparin
New thrombosis, skin necrosis
No other causes
47
Duration for provoked PE
3 months
48
Duration for unprovoked PE
Lifelong
49
Definition of unstable. massive PE
Shock / hypotension with SBP < 90 or >= 40 drop for >= 15 minutes
50
Treatment for massive PE
Lytics, catheter directed therapy, surgical therapy
51
Contraindications to thrombolytics
Brain pathology, bleeding risk
52
Submassive PE definition
RV dysfunction or positive cardiac markers
53
APLS classification criteria
Clinical event - thrombosis, thrombocytopenia, fetal loss, valve destruction, skin ulceration
Lab testing - anticardiolipin, b2gp1, lupus anticoagulant
54
Definitive APLS criteria
>= 1 clinical + >=1 lab
| Labs must persist at 3 months
55
Treatment for APLS
Heparin -> warfarin
56
Lymphedema causes
Congenital
Cancer or related surgery / radiation
Recurrent infection
57
Lymphedema features
Waxy skin
Non-painful
Non-dependent edema
58
Treatment for lymphedema
Compression
Manual drainage
Intermittent pneumatic pumping
59
Indications for tPA for acute ischemic stroke
Within 4.5 hours of symptoms
| NIHSS >= 6
60
Contraindications to tPA for acute ischemic stroke
```
Intracerebral hemorrhage, recent GIB
<3 months stroke, head trauma, brain / spine surgery
Brain / spine tumor
PLT < 100, INR > 1.7
Anticoagulation
Endocarditis
Aortic dissection
```
61
Window for mechanical thrombectomy for acute ischemic stroke
Early window up to 6 hours
| Up to 24 hours with perfusion imaging
62
Indication for mechanical thrombectomy for acute ischemic stroke
Large occlusion in anterior circulation
63
Goal BP for tPA
<185 / 110
64
Therapy for stroke NIHSS <= 3
DAPT within 24 hours for 21 days
65
US carotid stenosis >= 50%
Peak systolic velocity >= 125
| ICA / CCA 2-4
66
US carotid stenosis >= 70%
Peak vel >= 230
| ICA / CCA >= 4
67
Carotid stenosis symptoms
Within 6 months
Ipsilateral amaurosis fugax
Contralateral motor / sensory symptoms
Aphasia
68
Carotid stenosis revasc
50-99% if symptoms
Unclear if asymptomatic
Not CTOs
CEA > CAS
69
Medical therapy for asymptomatic carotid stenosis
ASA
Statin
Anti-HTN
70
Medical therapy for symptomatic carotid stenosis
ASA or plavix or ASA + dipyridamole
71
Contraindication to CEA to know
Contralateral laryngeal nerve palsy
72
Carotid dissection features
- Middle aged, spontaneous or traumatic
- Pain, Horner's, ischemic symptoms
- No RCTs of intervention but treat medically
- Anticoagulation or anti platelet therapy (non-inferior)
73
Carotid FMD features
- 2nd most common location
- Association with SCAD
- Pulsatile tinnitus, HA, TIA /s troke
- May cause dissection
- Antiplatelet therapy and BP control, rarely intervene
74
US for renal artery stenosis
Peak systolic velocity > 300
75
Diagnosis of renovascular hypertension
- New increase in BP
- Failure medical therapy
- Increased Cr after ACE-I
- Progressive increase in Cr with ischemic neuropathy
- FMD in young woman
- Recurrent flash pulmonary edema / refractory CHF
76
Treatment of renal artery stenosis
Stenting for postal atheromatous disease if renovascular hypertension
77
Stage I PAD
Viable
| limb not immediately threatened, no sensory loss, no muscle weakness, audible arterial and venous
78
Stage II PAD
Threatened
| mild to moderate sensory or motor loss, inaudible arterial Doppler, audible venous Doppler.
79
Stage III PAD
non viable
- major tissue loss or permanent nerve damage inevitable, profound sensory loss, anesthetic,
- profound muscle weakness or paralysis (rigor), inaudible arterial and venous Doppler.
80
May Thurner Syndrome
Iliofemoral DVT due to R common iliac overlying and compressing left common iliac vein against lumbar spine
81
Preferred anti-platelet for stroke secondary prevention
Plavix
82
Rapid VKA reversal
4F PCCs
1000u for any bleed
1500u for intracranial bleed
INR 2-4 25 U/kg, 4-6 35 U/kg, >6 50 U/kg
