VASCULAR PERIPHERAL

Question 1

Berger disease

Answer 1

small to medium-sized arteries and veins and nerves
 man who smoke
 upper and lower extremities
 20-50-year-old
 can cause superficial thrombophlebitis
  HAND AND  foot claudication
 infrapopliteal and brachial artery
Segmental occlusions of skip lesions

Aortoiliac system usually spared

surgical treatment and minimal no palpable target vessels for bypass

Question 2

time was higher his ankle pressure and supine patient in brachial

Answer 2

20 mmHg

Question 3

Normal ABI

Answer 3

One-1.2

Question 4

Criteria for peripheral arterial disease ABI

Answer 4

0.9

Question 5

Claudication ABI

Answer 5

There 0.5-0.7

Question 6

Rest pain ABI

Answer 6

less than 0.4

Question 7

ABI findings with chronic renal disease

Answer 7

false elevation of ABI from calcinosis of the medial layer

Causes vessel rigidity off and tibial vessels there is digital vessels and toes

Question 8

utility transcutaneous oximetry and diabetics

Answer 8

not reliable

Question 9

Absolute contraindications for thrombolytic therapy

Answer 9

recent stroke or TIA
recent bleeding
Significant coagulopathy

Question 10

Relative contraindications to thrombolytic therapy

Answer 10

motor and sensory deficit acute limb ischemia 
recent major surgery
Recent trauma
Uncontrolled hypertension
Intracranial tumor
Pregnancy

Question 11

guidelines for thrombolytic therapy for the time course

Answer 11

after 48 hours increased bleeding risk

With normal motor he consents her exam or sensory deficits only:
heparin and possibly thrombolytic therapy may be used; versus open embolectomy / bypass

Question 12

treatment for acute limb ischemia with motor and sensory deficit

Answer 12

relative contraindication for thrombolyzes

take this patient to the operating room

Question 13

treatment for acute limb ischemia with complete motor and sensory loss

Answer 13

amputation almost universal

Question 14

criteria to define irreversible ischemia

Answer 14

Doppler signal absence venous or arterial system
Duration of ischemia greater than 6-8 hours
Modeling scan
Absence of capillary refill
Complete anesthesia and paralysis

Question 15

most common site for embolus to lodge and upper extremity

Answer 15

Brachial artery!

Question 16

Management for brachial artery embolus

Answer 16

If atrial fibrillation related:
( and not presenting with acute coronary syndrome)
Heparinization
to the operating room embolectomy
May be performed under local making an incision at the elbow
Brachial, radial, ulnar arteries isolated
Transverse arteriotomy in the brachial artery proximal to radial and ulnar origins a Fogarty embolectomy

Question 17

most common cause of occlusion of femoropopliteal bypass a month after surgery

Answer 17

Intimal hyperplasia

Question 18

Early failure and occlusion of femoropopliteal bypass within 30 days

Answer 18

Technical error

This includes poor choice of target vessel and in adequate caliber of saphenous vein

Question 19

Failure of femoropopliteal bypass from 30 days to 2 years

Answer 19

Intimal hyperplasia

Question 20

Leg femoropopliteal bypass occlusion

Answer 20

After 2 years progression of atherosclerotic occlusive disease either inflow or outflow problem

Question 21

Treatment of femoral occlusion acute onset in patient with a atrial fibrillation 4 hours of neurosensory symptoms

Answer 21

heparin

The femoral embolectomy

Question 22

where is the occlusion was an absent femoral pulse most likely with embolic disease

Answer 22

Common femoral artery

Question 23

Which responds best to thrombolytic therapy embolic disease or thrombosis

Answer 23

Thrombolytic therapy is best for thrombosis

Embolism best treated with embolectomy

Question 24

pros and cons of in situ saphenous vein bypass

Answer 24

in situ:
vasa vasorum maintained
better size match
Kidneys and overall smaller saphenous vein

Due to drainage
More likely to produce technical error
valves must be cut-incomplete valve excision can cause thrombosis
Tributaries must be ligated-and if missed because an adequate distal perfusion

Question 25

findings of bilateral renal artery stenosis and cause

Answer 25

fibromuscular dysplasia
String of beads
 effects medium-sized arteries
Mostly young women
 internal carotid second most common site after renal arteries
The fascia with intracranial aneurysm

Question 26

Treatment of bilateral renal artery stenosis at

Answer 26

Initial management of medical

Refractory hypertension more responsive to percutaneous transluminal angioplasty stenting not routinely needed!

Question 27

treatment of renal artery stenosis if failed percutaneous management

Answer 27

open surgical bypass-NOT endarterectomy

Saphenous vein or synthetic graft-curate higher than those with percutaneous approach

Question 28

Graft choice for renal artery bypass and 6 her old girl

Answer 28

Internal iliac artery!
Vein conduit (example saphenous vein) tendon to become aneurysmal over time in kids

Question 29

acute mesenteric ischemia causes and presentations

Answer 29

embolization:
Cardiac most common source
thrombosis:
Carefully long-standing pain and food fovea
Exam diffuse atherosclerosis and bruits
Mesenteric venous thrombosis:
These are hypercoagulable state
acute venous occlusion needs a massive bowel edema - presentation is often more subtle
nonocclusive mesenteric ischemia:
Shocks or causes hypoperfusion
Sudden onset pain out of proportion elevated lactic acid

Question 30

Most common site of mesenteric embolism

Answer 30

Proximal branch off of the SMA
celiac artery is rare given the angle of takeoff
Inferior mesenteric artery is rare given small caliber of takeoff

Question 31

workup for acute mesenteric embolization

Answer 31

CT scan provided the best diagnostic yield initially
Surgery offers best chance of treatment which is SMA embolectomy
Go to the operating room without angiography

Question 32

His history is suggestive of underlying mesenteric arthrosclerosis or thrombosis with his workup

Answer 32

Arteriography helps plan arterial bypass

Question 33

A CT scan shows thrombosis and mesenteric vein was treatment

Answer 33

Heparin alone

Providing no peritonitis

Question 34

Initial management for nonocclusive mesenteric ischemia

Answer 34

Fluids for underlying shock his initial management

typically not lytic therapy

Question 35

pathophysiology of unilateral renal artery stenosis

Answer 35

this is an ischemic kidney and it produces hypertension
Hypertension is caused by angiotensin II mediated vasoconstriction to increased renin secretion from infected kidney

Increased aldosterone initially to sodium one retention

Question 36

Pathophysiology of bilateral renal artery stenosis and treatment

Answer 36

There’s no healthy kidney to compensate for fluid and sodium overload that is produced by angiotensin II mediated vasoconstriction-
Congestive heart failure
ACE inhibitor his contraindicated because of decreased glomerular filtration rate

Question 37

was indicated and contraindicated for bilateral renal artery stenosis

Answer 37

diuretics very helpful
Creatinine clearance reduced
Congestive heart failure
Ace inhibitors contraindicated

Question 38

most common site were cardiac embolus lodge

Answer 38

common femoral artery
 next common iliac artery
Then was popliteal artery
 70% lower extremities
13% upper extremity
10% cerebral
5-10% visceral

Question 39

thoracic outlet syndrome arterial disease is most commonly caused by

Answer 39

cervical rib

(Arterial involvement at least, and symptom) - arterial component at risk for poststenotic aneurysm
Neurogenic most common

Other causes arterial pathology including one long transverse process of C7
 osteoarthritis
Scalene hypertrophy
Trauma
 fibrous band