Vascular Surgery

Question 1

Why does ruptured AAA cause leg numbness?

Answer 1

Lack of perfusion to LE

Question 2

Why do you need to control the HR in an aortic dissection?

Answer 2

With each beat of the heart, the flap will bounce back and forth. That movement can increase the risk of rupture and bleed.

Question 3

You need to contact vascular surgery for what location of LE DVT?

Answer 3

Iliofemoral

People with IF DVTs are at high risk of post-thrombotic syndrome which is a syndrome in which people develop symptoms from synechiae and scarring of the vein. Vascular surgery can perform embolectomies that can help prevent post-thrombotic syndrome.

Question 4

What is the empiric treatment regimen for diabetic foot infections at UNC?

Answer 4

Vancomycin
Ceftazidime
Flagyl

Question 5

What scale is used to grade arterial occlusion?

Answer 5

Rutherford

Question 6

The most significant risk factor for aneurysm expansion and rupture is ____________.

Answer 6

cigarette smoking

Question 7

What blood pressure and HR goals do you need to get for confirmed or suspected aortic dissection?

Answer 7

HR: <60
BP: 100-120

Note: do this with labetalol or esmolol. Most BP meds can cause reflex tachycardia that will be counterproductive.

Question 8

The artery that supplies the spine is the _____________.

Answer 8

artery of Adamkiewicz

Question 9

What dose of esmolol drip should you start for aortic dissection?

Answer 9

Loading dose: 250 - 500 mcg/kg

gtt: 25-50 mcg/kg/min up to a max of 300 mcg/kg/min

Question 10

A SBP difference of ______ mm Hg or greater is concerning for aortic dissection.

Answer 10

20

Question 11

What movements happen that lead to traumatic aortic disruptions in whiplash injuries?

Answer 11

The aortic arch is relatively free to move around, whereas the descending aorta is fixed to the posterior chest wall through the many intercostal arterial connections. In sudden decerlations (such a high-mechanism MVCs or falls from great height), the arch flies forward relative to the descending aorta and gets torn at the ligamentum arteriosum.

Question 12

Explain the pathophysiology of phlegmasia cerulea dolens?

Answer 12

It is “venous ischemia” which means a proximal lower extremity clot that is so extensive that it causes venous congestion to the point that there is limited circulation through the extremity. This leads to a blue, congested leg.

Question 13

What syndrome causes diffuse AVMs and telangiectasias?

Answer 13

Osler-Weber-Rendu (aka hereditary hemorrhagic telangiectasias)

AD

Leads to CHF from high-output.

Question 14

Why do some people with acute mesenteric ischemia develop a sudden loss of pain without intervention?

Answer 14

The intramural neurons of the intestine die and the pain lets up.

Question 16

Review ABI ranges and their meanings.

Answer 16

> 1.4 vascular calcification
1.0 - 1.4: normal
0.9 - 1.0: reduced but acceptable
0.8 - 0.9: medical management
< 0.8: concerning disease, needs assessment by vascular

Question 17

True or false: Raynaud’s always affects multiple fingers at once.

Answer 17

False

It can be isolated to a single finger.

Question 18

Raynaud’s, if unresolved, can progress to ____________.

Answer 18

ulcers and gangrene

Question 18

What is nutcracker syndrome?

Answer 18

The SMA passing over the left renal vein causes flank pain and hematuria