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Surgery Final > Vascular Disease > Flashcards

Vascular Disease Flashcards

1
Q

Treatment for atherosclerosis?

A 
Stop smoking
Exercise
Nutrition
Antiplatelet drugs
Beta blockers, statins, antihypertensives
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2
Q

Is there infection with wet gangrene? Dry gangrene?

A

Wet: yes; with cellulitis and purulent drainage
Dry: no; mummification without infection

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3
Q

What diagnostics do we need with peripheral vascular disease?

A

ABI: >9 is normal; less then 0.8 is claudication; less than 0.4 is rest pain or tissue loss-DO THIS
Color flow doppler ultrasound-DO THIS
Magnetic resonance angiography-gold standard

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4
Q

What does an ABI >1 indicate?

A

Calcification

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5
Q

Treat for mild to moderate claudication without rest pain or tissue loss?

A

Non-operatively:

  • Graded exercise (40-60 mins most days)
  • Antiplatelets
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6
Q

Treatment for severe claudication with interference?

A

Stop smoking; control HTN, DM, cholesterol
Antiplateets
Operative management

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7
Q

What is an acute arterial occlusion?

A
  • Sudden onset of pain
  • Usually an acute thrombosis from a chronically stenosed vessel; can be thromboembolism (a-fib; AA)
  • The 6 P’s
  • Treatment: immediate thrombectomy if ischemia; anticoagulation; if no ischemia thrombolytic therapy
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8
Q

How long does leg ischemia take to cause a reperfusion injury?

A

Over 6 hours

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9
Q

What is a reperfusion injury?

A
  • Leg ischemia over 6 hours

- Neutrophils migrate; limb swells; cell leakage leads to acidosis, hyperkalemia, ATN and free radical formation

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10
Q

Can you have carotid bruits without stenosis?

A

Yes, and you can have stenosis without a bruit

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11
Q

How do we diagnose/screen for carotid artery stenosis?

A

Carotid US
MRA?
Arteriography

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12
Q

Treatment for mild to moderate carotid artery stenosis?

A

Antiplatelet or anticoagulation: controversia
Routine surveillance
Tx of risk factors

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13
Q

Treatment for severe or symptomatic carotid stenosis?

A

Endarterectomy of carotid

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14
Q

When should we treat carotid artery stenosis?

A

Symptomatic patients with >50% stenosis

Asymptomatic, healthy patients with >60% stenosis

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15
Q

Contraindications to carotid artery endarterectomy?

A

Occluded artery
Severe neurologic deficit following CVA
Concurrent serious medical illnesses

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16
Q

Treatment for Buergher’s disease?

A

STOP SMOKING

Patients may have superficial thrombophlebitis of hands and feet

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17
Q

What can cause renal artery stenosis in young female patients?

A

Fibromuscular dysplasia

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18
Q

Treatment for renal artery stenosis?

A

Angioplasty w/ stenting

Endarterectomy

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19
Q

How doe we diagnose renal artery stenosis?

A

Renal US

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20
Q

Most common spots for aneurysms?

A

Infrarenal aorta
Iliac arteries
Popliteal arteries

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21
Q

What are false aneurysms associated with?

A

Injuries and infections

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22
Q

Which aneurysms tend to rupture?

A

AAA and iliac aneurysms

Popliteal and femoral rarely rupture; can cause thrombi that embolize arteries of the calf and foot

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23
Q

Best diagnostic for an asymptomatic aneurysm?

A

US

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24
Q

If elective surgery is planned on an aneurysm, what do we always need?

A

CTA or arteriogram

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25
Q

At what size do AAAs become pulsatile?

A

Over 5 cm

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26
Q

Classic triad of symptoms for ruptured AAA?

A

Sudden back pain
Hypotension
Pulsatile abdominal mass

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27
Q

When should we operate on an AAA?

A

-Asymptomatic: Over 5-5.5 cm in men
Over 4.5 cm in women
-Rapidly enlarging
-Symptomatic

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28
Q

If patient presents with classic triad for ruptured AAA, should we get a CT?

A

No CT scan
Call surgeon
Get ready for bleed: large bore IVs, crystalloid, etc.
Can do US if readily available and can be transported to patient

29
Q

What is the elective surgery for an AAA?

A

Endovascular repair

  • Done with radiologist
  • Get CTA
30
Q

Complications of AAA repair?

A

MI, renal failure, colonic ischemia

Graft infection, aorto-enteric fistula, endoleak (endovascular)

31
Q

Most false aneurysms are found where?

A

Femoral artery: after arteriograms

32
Q

When should we repair femoral aneurysms?

A

True> 2 cm if throwing emboli

Repair pseudo aneurysms if they don’t resolve on own: US guided thrombin injection

33
Q

What aneurysms are usually found with AAAs?

A

Iliac

34
Q

When should we repair iliac aneurysms?

A

Over 4 cm

CTA needed if elective

35
Q

Do popliteal aneurysms usually rupture?

A

NO
But they can embolize
Blue toe syndrome

36
Q

When do we repair popliteal aneurysms?

A

Over 2 cm

CTA if elective

37
Q

How do we diagnose a DVT?

A

Duplex US

38
Q

Prevention for DVTs?

A

Ambulation
LMWHm warfarin
SCDs/IPC

39
Q

How does a DVT present in the extremity?

A

Unilateral swelling or pain

Holman sign?

40
Q

Risk factors for DVT?

A 
OCPs
HRT
Neurologic disease
Pregnancy
Cancer
41
Q

What are some genetic hyper coagulable states?

A

Deficiencies of antithrombin III, protein C or S
Factor V Leiden
Elevated factor VIII

42
Q

What is phlegmasia alba dolens?

A

Pale, pulseless, cool skin

43
Q

What is phlegmasia cerulea dolens?

A

Cyanosis then gangrene

44
Q

What is criterion standard for diagnosing DVTs?

A

Venography

45
Q

What imaging do we need if we suspect a DVT in the IVC or iliac vein?

A

CT

46
Q

How does the Wells Rule apply to DVTs?

A

> 3 points: high risk 75%
1-2 points: moderate risk 17%
<1 point: low risk 3%

47
Q

Prophylaxis for DVTs from surgery?

A

Mechanical therapy
Early ambulation
SQ heparin, LMWH, or warfarin

48
Q

Pharm treatment for DVTs?

A

Anticoagulation: First LMWH or IV heparin
Then long-term Warfarin
Ist DVT: 3-6 months 2nd: Prolonged or lifelong; lifelong w/ risk factors
Thrombectomy/thrombolysis if renal, subclavian, SVC, or iliofemoral

49
Q

When should we initiate therapy for DVTs without diagnostic results?

A

If high suspicion: do it
Intermediate suspicion: do if >4 hours till data
Low suspicion: wait 24 hours

50
Q

Treatment of what DVTs are controversial?

A

Calf DVTs

-Of you don’t treat: need follow-up Doppler US

51
Q

Main symptoms of PE?

A

Dyspnea, pleuritic chest pain, hemoptysis

52
Q

Criterion standard for diagnosis of PE?

A

Pulmonary angiography

53
Q

Imaging of choice for diagnosing a PE?

A

CT angiography

-Stable patients

54
Q

When should we use a V/Q scan?

A

If there is renal insufficiency

55
Q

How does Well’s Prediction for PE work?

A

> 6: high risk
2-6 points: moderate
<2 points: low risk

56
Q

How do we treat a PE?

A

Anticoagulation
Thrombolytics if pt. stable but compromised
IVC filter if pt. can’t take above
Last resort: embolectomy (80% mortality rate)

57
Q

Treatment for superficial thrombophlebitis?

A

NSAIDS
Heat
Elevation
Compression and walking

58
Q

Treatment for varicose veins?

A

Stockings, elevation and exercise-1st line!

Surgery: recurrent thrombophlebitis; erosions; pain

59
Q

What should we do if superficial thrombophlebitis is near saphenofemoral junction (SFJ)?

A

Full anticoagulation

60
Q

What causes primary varicose veins?

A

Valve incompetence at SFJ

61
Q

Recommended surgery for varicose veins?

A

Endovenous laser treatment (EVLT)

Radiofrequency ablation

62
Q

What causes chronic venous insufficiency?

A

Venous HTN:

  • Obesity
  • Vein obstruction
  • Valve incompetence
63
Q

Presentation of chronic venous ultrasound?

A

Swollen legs
Hemosiderin deposits at ankles
Venous stasis ulcers: medial or lateral malleolus

64
Q

Treatment for chronic venous insufficiency?

A 
Elevation
Unna boots
Leg elevation
Exercise
Surgery in rare cases
65
Q

What is lymphedema?

A

Painless edema of LE
Pitting first then rubbery
Lymphangitis and cellulitis

66
Q

Diagnostics/treatment for lymphedema?

A

Duplex US to rule out venous insufficiency and DVT
Compression/massage/good skin care
Elevation and diuretics DO NOT HELP

67
Q

Color changes in Raynaud’s syndrome?

A

White—->Blue (cyanosis)—->Red (hyperemia)

68
Q

Difference between Raynaud disease and Raynaud phenomenon?

A

Disease: common and benign
Phenomenon: older women: SLE and scleroderma; positive ANA and see rate; more severe w/ occasional tissue loss

69
Q

Treatment for Raynaud’s

A

Avoid OCPs, drugs that reduce CO

CCBs and ARBs

Surgery Final (5 decks)

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