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ABSITE > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

Indications for endovascular repair thoracic aortic aneurysm?

A

Endovascular:
1. Degenerative or traumatic > 5.5 cm
2. Saccular
3. Postop pseudoaneurysms

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2
Q

Indication for open thoracic aortic aneurysm repair?

A

Chronic and > 6.5cmm if comorbidities favorable.
Or >5mm growth in 6 mos
Connective tissue disorders.

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3
Q

Open exposure of the thoracic aorta for aneurysm repair?

A

Left posterolateral thoracotomy.
Proximal descending - 4th interspace
Distal descending - 6th interspace

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4
Q

Control of the thoracic aorta?

A

Proximal - clamp between the left common carotid and left subclavian
*avoid vagus, recurrent laryngeal, phrenic nerve as they cross arch here

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5
Q

Control of the abdominal aorta supraceliac access

A

Through gastrohepatic ligament, right under crus, press AORTA AGAINST SPINE

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6
Q

Indications for left subclavian artery revascularization during TEVAR?

A
  1. dominant L vertebral artery
  2. patent LIMA to coronary
  3. LUE AV fistula
  4. Hypoplastic/absent R vertebral artery
  5. Termination of L vert onto PICA
  6. Anomalous origin of L vertebral from aortic arch
  7. High risk SCI with high coverage
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7
Q

When to give heparin?

A

If single cross clamp, 5000U at time of clamp.
If assisted circulation/bypass, 400 U/kg.

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8
Q

Management of postoperative spinal cord ischemia?

A

MAP > 90.

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9
Q

Most important sign of new onset SCI?

A

Inability to flex at the hips.

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10
Q

Indication to operate on a pseudoaneuryms?

A

> 2 cm, any that have failed ultrasound guided compression q10 min holds, or thrombin failure, AC therapy, rapidly expanding.

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11
Q

fem PSA < 2-3cm tx

A

just observe and repeat imaging

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12
Q

Consideration of pseudoaneurysm neck size?

A

Shorter fatter necks have higher rate of thromboembolism during injection.

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13
Q

How to do US guided thrombin injection?

A

22G needle, confirm placement by injecting saline (see swirl on doppler), 3cc syringe injects 1000 IU/mL of topical thrombin (probably only need 1 cc), bed rest 6 hours, repeat duplex now and in 24 hours.

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14
Q

How to do open PSA repair?

A

obtain proximal/distal control, fully dissect artery and find injury/defect, administer systemic heparin, repair with full thickness prolene interrupted or horizontal mattress; give protamine, reapproximate sheath, leave a drain, close all defects.

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15
Q

How to perform open thrombectomy (I.e. after thromboembolic event after thrombin injection?)

A

control femoral artery, systemic heparin, Fogarty via transverse arteriotomy, close transversely,

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16
Q

steal syndrome AVF

A

hand ischemia

dx: compress fistula and >50% improvement in waveform of digits

mgmt: DRIL distal revasc with interval ligation

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17
Q

saphenous vein on US

A

“saphenous eye” between fascia (both great and lesser)

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18
Q

ischemic monomelic neuropathy

A

distal nerve fibers wipes after fistula formation
severe numb/pain, weakness with palpable pulses/warm hand
(usually with brachial arterial fistula)
mgmt: immediate ligation of fistula

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19
Q

landmarks for port and cannulation of subclavian vein

A

port is inferio to clavicle in deltopectoral groove
vein accessed at midclavicular line directed at sternal notch (prevent PTX)

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20
Q

medial ulcer valve incompetence?

A

GSV or medially located perforators

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21
Q

lateral ulcer valve incompetence?

A

small saph vein or lateral perforators

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22
Q

diagnosis varicosities

A

> 0.5 seconds rflux on duplex

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23
Q

varicose vein tx

A

sclerotherapy stop smoking, lose weight

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24
Q

brawny edema in venous ulcers

A

hemosiderin deposits

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25
Q

what size can you medically manage venous ulcers

A

<3 cm just Unna boot (otherwise need to ligate perforators or vein strip)

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26
Q

MC reason for long term failure of prosthetic AV access

A

intimal hyperplasia at distal anastomosis (graft to vein)

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27
Q

phlegmasia cerulean dolens

A

extension of DVT

blue leg causing gangrene/amputation

requires AC and thrombectomy

50% have concurrent cancer- work up required

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28
Q

GSV SVT?

A

fondaprinux (I don’t think you treat other SVT)

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29
Q

sclerosants

A

sotradecol (sodium tetradecyl sulfate) and polidocnol (asclera)

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30
Q

AV graft requirement measurements for absite

A

2mm artery, 2.5mm veind

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31
Q

difference arterial/neuro vs venous TOS

A

compression in venous is at intersection of 1st rib and clavicle (resect it either way

instead of in TOS

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32
Q

advanced removal of IVC filter indicated after how much time

A

7 mos

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33
Q

first branch of ICA vs ECA

A

ICA: opthalmic
ECA: superior thyroid aa

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34
Q

main collateral between ICA and ECA

A

opthalmic (ICA) and internal maxillary (ECA)

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35
Q

MC cause of ischemic event

A

ARTERIAL embolization from ICA

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36
Q

hollenhorst plaques on fundoscopy

A

little bright filling defects after AMAUROSIS FUGAX (occlusion to opthalmic)

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37
Q

if carotid injured with big defecit and it’s OCCLUDED vs NOT OCCLUDED

A

OCCLUDED: don’t touch it (rebleed)
NOT OCCLUDED: stent or open fix

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38
Q

CEA indications

A

sx >50%
or asx > 70% or EDV > 100

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39
Q

order of CEA

A

repair tighter side first (if b/l)
or dominant side if equally tight

clamp ICA then CCA then ECA
release flush ICA to back bleed; replace clamp
release ECA and CCA
then ICA

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40
Q

CEA what is removed

A

intima and part of media

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41
Q

indication to shunt in CEA

A

back pressure < 50 mm Hg (butterfly stump pressure) or diseased contralateral side

can also do awake CEA
EEG monitoring
brain ox

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42
Q

nerve injury CEA

A

vagus (from clamping)&raquo_space;> hypoglossal > glossopharyngeal (if high repair, under digastric)

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43
Q

carotid sheath components

A
  1. carotid aa
  2. internal jugular vein
  3. CN X
  4. sympathetic plexus with ansa cervicalis (innervate straps), C1-C3 loopca
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44
Q

carotid body tumor

A

painless
near bifurcation
neural crest, VERY VASCULARIZED, can secrete catecholamines

mgmt: resect

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45
Q

indication to repair a thoracic ASCENDING aortic aneurysm

A

acutely sx
5.5+ cm
(Marfan 5+ cm)
>0.5 cm / year

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46
Q

indication to repair an thoracic DESCENDING aortic aneurysm

A

endovascular is 5.5+ cm M
open is 6.5+ cm

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47
Q

stanford calssification

A

A vs. B yeah ok

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48
Q

debakey classification

A

I: ascending and descending
II; ascening only
III: descending only

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49
Q

spinal cord ischemia after aortic graft placed? what artery is occluded

A

intercostals and artery of Adamkiewicz (perfuses the anterior spinal artery)

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50
Q

spinal cord ischemia rate

A

endovascular <5%
open 20%

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51
Q

MC site of AAA rupture

A

left posterolateral wall 2-4cm below the RENALS

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52
Q

indication for AAA (non thoracic) repair

A

5.5+ cm for male
5+ cm for female or with high rupture risk (severe COPD, bad HTN, eccentric)
> 1+ cm / yr

or if: infected, symptomatic

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53
Q

anti impulse control for ruptured AAA or dissection aorta?

A

SBP 80-100 (permissive hypotension)

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54
Q

indication to reimplant IMA

A

if backpressure < 40 mm Hg / bad
previous colonic surgery
stenosis at SMA
flow to L colon is bad

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55
Q

impotence after endovascular repari

A

hypogastric aa covered - vasculogenic impotence

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56
Q

AAA morphology that is repairable

A

neck length > 1.5 cm
neck diameter > 3 cm
neck angulation < 60 degrees
common iliac aa length > 1 cm
common iliac artery diameter .8-1.8cm

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57
Q

endoleak four types

A

I: ATTACHMENT SITES (treat now)
II: COLLATERALS (observe mostly or coil if growing - lumbars, IMA, intercostals, accessory renals ie) *** MOST COMMON
III: OVERLAPS of grafts (treat now - overlap the overlaps)
IV: POROSITY or small suture holes (observe)
V: ENDOTENSION?? (repeat EVAR or open repair

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58
Q

inflammatory aneurysms causing adhesive disease - to what organs

A

D3 and D4
ureteral entrapment

mgmt: fix the aneurysm

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59
Q

MC bug in mycotic aneurysm

A

S. aureus > Salmonella

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60
Q

MC bug in aortic graft infection

A

S.epi

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61
Q

leriche syndrome

A

ATHEROSCLEROTIC (not embolic) at aortic bifurcation or above; lose fem pulses too

sx: impotence
, buttock/thigh claudication

mgmt: aortobifem or endo reconstruction

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62
Q

MC atherosclerotic occlusion in legs to cause claudication

A

Hunters canal - distal SFA (sartorius mm covers this)

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63
Q

hunters canal contents and borders

A

borders: vastus medialis, adductor magnus and longus, sartorius

content: SFA and SFV, saph NERVE

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64
Q

MC atherosclerotic lesion in thigh claudication

A

iliac

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65
Q

ABIs 0.9, 0.5, 0.4, 0.3

A

<0.9 claudication
<0.5 reset pain
<0.4 ulcers
<0.3 gangrene

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66
Q

PTFE use in PAD bypass

A

only ABOVE knee (saphenous below)

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67
Q

dacron

A

for aorta and large vessels only

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68
Q

what med decreases CV events after bypass

A

ASA

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69
Q

what muscles border the popliteal artery

A

posterior: gastrocnemius
anterior: popliteus

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70
Q

popliteal entrpment syndrome sx

A

loss of pulses with PLANTARflexioon

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71
Q

cause of popliteal entrapment syndrome

A

medial deviation of pop artery around medial head of the gastrocnemius muscle

because can lead to popliteal aa fibrosis

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72
Q

mgmt popliteal entrapment syndrome

A

resection of medial gastrocnemius head

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73
Q

adventital cystic disease

A

popliteal fossa&raquo_space;»
sx: intermittent claudication but change in s with KNEE FLEXION?EXTENSION (not plantar flexion)

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74
Q

mgmt of adventitial cystic disease

A

resect cyst; use vein graft if vessel is occluded

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75
Q

MC site of peripheral embolization

A

CFA

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76
Q

indication OR for thrombectomy vs angiography for thrombolytics in arterial THROMBOSIS

A

threatened limb = sensory/motor loss needs OR.

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77
Q

treatment of renal artery stenosis vs fibromuscular dysplasia

A

stent the stenosis

percutaneous transluminal angioplasty for dysplasia

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78
Q

indication for npehrectomy with renal HTN

A

if atrophic kidney < 6 cm with persistently high renin levels

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79
Q

fibromuscular dysplasia dx, path, tx

A

dx: CTA beads on a string
MC variant of path: medial layer fibroplasia
tx: anti plt then balloon angioplasty (no stent); bypass if fails

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80
Q

subclavian steal

A

proximal SCA stenosis causes ipsilateral vertebral flow into subvlavian instead

mgmt: stent and angioplasty if fails

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81
Q

MC TOS

A

neurogenic

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82
Q

MC abnormality in TOS

A

cervical rib

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83
Q

dx of neurogenic (brachial plexus compression) in TOS

A

EMG

see Tinsel test: tapping reproduces sx
ulnar nerve distribution mostly

84
Q

mgmt neurogenic TOS

A

1, PT (first line)

fails?…
2. confirm dx with scalene block

  1. cervical and 1st rib resection
    divide anterior scalene mm
85
Q

Paget von Schrotter disease in pitchers/swimmers

A

effort induced thrombosis of subclavian VEIN (venous TOS) at costoclavicular junction

86
Q

tx of Paget Schroetter syndrome

A

catheter directed thrombolysis followed by 1st resection & ant scalene division during same admission

87
Q

compression of subclavian artery

A

mostly 2/2 anterior scalene hypertrophy (arterial TOS) weight lifters

88
Q

arterial TOS mgmt

A

first rib resection and interposition graft for artery if needed

89
Q

Adsons test arterial TOS

A

turn head towards side and hold breath, causes absent RADIAL pulse

90
Q

MC cause of mesenteric ischemia

A

embolic 50% (MC From heart) > thrombotic 25% > nonocclusive > venous thrombosis

91
Q

median arcuate ligament syndrome

A

celiac aa compression (bruit at epigastric region, chronic pain, diarrhea) by crura of diaphragm

92
Q

mgmt median arcuate ligament syndrome

A

confirm with celiac plexus block (if that relieves the pain)

transect median arcuate ligament; likely wont need arterial recon

93
Q

chronic mesenteric angina dx

A

lateral visceral vessel aortographym; 30 min after meal pain

94
Q

mgmt chronic mesenteric angina

A

stent, bypass if fails

95
Q

MC visceral aneurysm

A

splenic aa aneurysm

96
Q

stenting of splanchnic artery aneurysm

A

> 2cm - REPAIR! except splenic

only operate if splenic is symptomatic, if pregnant, or if >3-4 cm (3rd tri rupture)

** REPAIR ALL SMA ANEURYSMS

97
Q

when to stent renal aa aneurysm

A

> 1.5 cm

98
Q

when to stent iliac aa aneurysm

A

3.5+cm, commonly seen with aortic aneurysm

99
Q

when to treat femoral aa aneurysm

A

> 2.5cm
may be able toobserve

high risk clot… so resect with interposition

100
Q

MC peripheral aneurysm

A

POPLITEAL

101
Q

MC complication of popliteal artery aneurysm

A

THROMBOSIS

102
Q

rate of AAA with popliteal aneurysm

A

50% have aortic disease too

103
Q

mgmt of popliteal aneurysm

A

> 2cm + mycotic/symptomatic/sig thrombus needs EXCLUSION AND BYPASS OR VEIN INTERPOSITION (NOT STENT, unless cannot tolerate IR)

if lots thrombus and smaller, tx.

104
Q

Buergers disease

A

young M, smokers
rest pain with b/l ulceration, gangrene fingers

105
Q

dx Buergers disease

A

Angiogram: corkscrew collaterals and distal disease bad (SMALL VESSEL DISEASE)

106
Q

Marfans disease defect

A

fibrilllin defect (connective tissue elastic fibers) causing medial cystic necrosis

107
Q

temporal arteritis dx

A

biopsy: giant cell arteritis; granulomas

108
Q

mgmt temporal arteritis

A

steroids, bypass if needed ( NO ENDARTERECTOMY)

109
Q

mgmt Raynaud’s

A

CCBs and warm

110
Q

traumatic AV fistula mgmt

A

lateral venous suture & arterial patch vs bypass graft
interpose tissue between to avoid recurrence

111
Q

unna boot

A

has zinc oxide and calamine - compression wrwap for venous ulcers

112
Q

what is associated with migrating thrombophlebitis

A

pancreatic ca

113
Q

lymphatics are not in what areas

A

bone, muscle, tendon, cartilage, brain corner
NO BASEMENT MEMBRANE

114
Q

papverine

A

intestinal vasodilation without increasing O2 consumption in intestine

115
Q

infected aortobifem graft tx

A

explant and RIGHT axillobifem

or remove graft and reconsruct with femoral vein or crypreserved aorta

116
Q

walk at what speed to improve claudication

A

when claudication can onset 3-5 min

117
Q

fenestrated graft must get thru what size of iliacs

A

at least 7.5 mm

118
Q

carotid sstent vs CEA

A

stent has more stroke

119
Q

least compartment syndrome in thigh

A

medial comartment

120
Q

sma acute lodges into what artery

A

ileocolic (jej to transverse dusky)

121
Q

chronic SMA fails stent/plasty

A

C loop iliac to sma bypass

122
Q

indications for CEA

A

50% + asx
7-% asx or >100 cm/s EDV
(start with medical therapy)

123
Q

PAD medical therapy?

A

smoking cessation
ASA
high intensity statin (LDL < 100)

124
Q

nascet stroke risk carotid stenosis

A

70% to 99%: 2-year risk of ipsilateral stroke of 26% if treated with medical therapy alone
9% if treated with carotid endarterectomy

50%-69%) had a 2-year risk of ipsilateral stroke of 22.2% if treated with best medical therapy. T
15.7% with carotid endarterectomy

125
Q

plavix indication

A

if no surgery indicated or <50% symptomatic carotid stenosis….
plavis + Statin + ASA + meds

126
Q

LDL goal

A

<70-100

127
Q

tx for 100% occlusive sx carotid artery disease?

A

AC or DAPT to prevent progression of clot; otherwise no recanalization due to risk of hemorrhagic conversion

128
Q

dacron pseudoaneurysm

A

weakening of the material; painelss bulge (not rly seen with PTFE)

129
Q

emergent CEA

A

crescendo TIAs… inevitable big stroke

130
Q

rutherfords

A

class I indicates a viable limb
class II indicates a threatened limb
class III indicates a nonviable limb

class I ischemia (viable tissue with intact sensory and motor function) can be managed on an elective basis.

class IIa (issue viability is threatened but has not yet been completely lost) endovascular thrombolysis catheter x 48 hours +/- embolectomy/thrombectomy if can’t tpa. start AC

class IIb (sensory and motor dysfunction), embolectomy/thrombectomy in OR

class III ishcemia (tissue loss with profound anesthesia and paralysis)
debride/amputate.

131
Q

popliteal entrapment syndrome

A

gastrocnemius compressing in the deep compartment

132
Q

incisions for LATERAL/ANTERIOR leg compartment fasciotomy

A

between tibia and fibular cheat towards tibia… watch out for SUPERFICIAL PERONEAL NERVE injury (foot eversion)

133
Q

what incision SUPERFICIAL AND DEEP posterior compartment fasciotomy?

A

2 cm posterior/medial to tibia

take soleus off tibia in order to get the deep compartment

134
Q

increased energy use after BKA

A

10-40% more

135
Q

screening for aortic aneurysm?

A

1 time 65 to 75 years of age with a history of tobacco use

65 to 75 years of age with a history of a first-degree relative with abdominal aortic aneurysm or for those older than 75 years of age and in good health.

136
Q

size cut offs for EVAR

A

external iliac arteries must range in diameter from 7 to 16 mm. The length of the neck of the proximal aorta can be as short as 15 mm. The diameter of the aneurysm can be up to 26 mm and still be repaired endovascularly

137
Q

how to expose the peroneal artery?

A

laterally: need to do a partial fibulectomy

138
Q

MC bugs for mycotic aneurysm?

A

S. aureus > Salmonella

139
Q

vertebral aa segments

A

V1: SCA to C6 foramina
V2: foraminal C2-C6
V3: C2 to dura
V4: intracranial

140
Q

what overlies the carotid aa bifurcation?

A

facial V

141
Q

high vs low resistance artery: ICA vs ECA

A

ICA is low resistance to brain (biphasic)
ECA is high resistance to facial arteries (triphasic)

142
Q

ipsilateral mouth droop after CEA?

A

marginal mandibular nerve injury from retraction on MANDIBLE

143
Q

IX, X, and XII relative to digastric mm?

A

IX: deep to posterior belly
X: under and extends inferiorly
XII: inferior to the digastric (and parallel); is cephalad to carotid bifurc

144
Q

MC morbidity and mortality NON-STROKE after CEA?

A

MI

145
Q

timing of CEA

A

2 wks after TIA/CVA
6-8 wks after hemorrhagic stroke

146
Q

immediate thrombus in PACU after CEA?

A

return to OR for saphenous vein

(diagnosed with EMERGENT DUPLEX)

147
Q

indication for TCAR/stenting instead of CEA

A

previous neck surgery/irradiation, recurrent disease, severe cardiac disease

148
Q

asx BCVI carotid dissection tx

A

AC (heparin or plavix) with repeat imaging

149
Q

sx BCVI caroti dissection tx

A

AC then stent

150
Q

total occlusion traumatic carotid artery

A

neuro work up… AC or antiplt to worsen extension

151
Q

subclavian steal syndrome

A

proximal subclavia stenosis/occlusion..

exertion of arm steals from cerebral through vert (vertebrobasilar symptom)t

152
Q

subclavian steal mgmt

A

endovascular recanalization/stent or

open carotid SCV bypass or SCV transposition

153
Q

how long can you keep a vascath in before infection risk?

A

3 wks (femoral is only 5 days)

154
Q

permacath line duration

A

1 year

155
Q

size cut offs for A and V for fistula creation

A

3mm vein
2mm artery with triphasic flow

156
Q

MC complication of AVF?

A

venous outflow problems (scar down with high pressure)

157
Q

venous outflow for AVF presentation

A

BLEEDING fistula

158
Q

mgmt of venous outflow stenosis

A

fistulogram with angioplasty

159
Q

rule of 6s fistula access

A

6mm in diameter
6cm long
<6mm to skin
600+cc/min of flow
6 wks typically to mature

160
Q

landmark Type A vs B dissection

A

L SCA

161
Q

MC malperfusion in TBAD

A

mesenteric > renal, limb

162
Q

mgmt of acute SMA

A

revascularization, heparin, and ex lap (don’t resect marginal bowel at index… give it 12-24 hours and takeback)

** embolic: SMA embolectomy open (via cephalad Tcolon)
** thrombotic: SMA bypass vs ostial stenting rather than removal
** venous thrombotic: SMV… heparinize and OR for dead bowel vs TPA lysis catheter

163
Q

embolic and thrombotic mesenteric ischemia locations

A

embolic: mostly 1st branch SMA (jejunals)
thromotic (MC cause in severe atherosclerosis): at ostium/takeoff of SMA

164
Q

jejunal sparing SMA syndrome

A

points more to embolic cause because it lodges distal to the ostium of the first jejunal branch

165
Q

MC emboli locations for UE and LE?

A

UE: brachial @ bifurc radial/ulnar
LE: CFA @ bifurc profunda/SFA

166
Q

big bleeding after clamping aorta proximally from what anomalous anatomy?

A

retro-aortic L renal vein (should be normally in front of aorta)

167
Q

chyle leak after open AAA

A

low fat
high protein
MCFA supplementation

168
Q

AAA surveillance

A

yearly duplex 4-4.9cm
q6mo duplex 5+cm

169
Q

extra anatomic bypass with aortic graft excision complication and how to prevent

A

stump blow out

interrupted mattress and continuous sutures to stump closure
omentum over stump
tensor fascia lata buttress

170
Q

mgmt aortoenteric fistula

A

stent if dying
eventual: resection and ligation aorta + extra-anatomic bypass or in line reconstruction/repair duodenum

171
Q

end to side vs end to end in aorto-bifem bypass?

A

if external iliac PATENT, end to end
if external iliac OCCLUDED, end to side

172
Q

how to tunnel aorto bifem bypass relative to ureters

A

tunner under ureter to prevent hydro

173
Q

PAD lesion tx ways

A

ENDO: if short, not too calcified (have to be able to hold stent/get pushed with balloon)

OPEN: if long, calcified with good inflow/outflow/conduit (bypass vs endarterectomy)
also if FEMORAL OR POPLITEAL… highly kinkable and easily accessed open

174
Q

when to avoid roto rooter PAD (atherectomy)

A

when bulky disease or limited tibial vessel runoff (cuz you can embolize and then they lose foot perfusion without collaterals)

175
Q

thrombosed bypass graft etiology based on timing

A

<1 mo: technical
2mo-2yr: neointimal hyperplasia
>2 yr: atherosclerosis

176
Q

claudication with normal ABIs

A

do walking treadmill test and then recheck

177
Q

how to access L COMMON ILIAC VEIN

A

divide overlying RIGHT ILIAC artery

178
Q

deep venous reflux dx

A

seen on duplex after presenting with duplexde

179
Q

deep venous reflex mgmt

A

compression stocking
can’t ablate deep veins

180
Q

saph vein reflux

A

if above the knee: heat ablation (RF or laser)
if below the knee: chemical ablation with glue (venaseal) or scerlosant (varithena)

181
Q

saph vein reflux close to SFJ

A

close to saphenofemoral junction… need to stay 2-3 cm away to prevent:
endotheraml heat-induced thormbosis EHIT

182
Q

EHIT tx

A

protrude into CFV: AC x 3 mos
flush with CFV: repeat imaging 2 weeks vs short course AC
within 2cm of CFV: repeat imaging 1-2 weeks if not touching CFV

183
Q

spider vein/ reticular vein tx

A

sclerosant CHEMICAL : polidocanol or sotradecol

184
Q

MC DVT

A

iliofemoral/Fiser: Calf DVT on the LEFT (2x more than right due to compressing Right iliac artery on Left iliac vein)

185
Q

where to place IVC

A

above (“distal”) to renals

186
Q

DVT AC duration

A

3 mos if provoked
active ca: LVX until cancer cured
hypercoagulable disorder: for life

187
Q

GSV superficial thrombophlebitis PALP CORD

A

focal < 5 cm away from SFJ: NSAID and warm compress

longer thrombus or near SFJ: fondaparinux 2.5mg for 45 days

188
Q

chronic venous insufficiency treatment

A

Unna boot (5-7 day soft boot)

189
Q

subclavian line landmarks

A

just more than 50% length of clavicle; aim at sternoclavicular junction and flattenunder the bone; aim cephalad if don’t get blood

190
Q

ESRD anemia morphology

A

normocystic normochromic hypoproliferative

191
Q

acute limb revascularization heparin dosing

A

80 U/kg followed by 1000 U/hr

192
Q

access to innominate

A

median sternotomy

193
Q

access to distal LSCA and descending aorta

A

L thoracotomy

194
Q

access to distal R SCA

A

midclavicular with resection of middle third clavicle

195
Q

calf claudication lesion

A

SFA

196
Q

foot claudication lesion

A

popliteal

197
Q

thigh claudication lesion

A

external iliac artery

198
Q

collaterals in legs

A

circumflex iliacs to subcostals
femoral to gluteal
geniculate around knee

199
Q

DFI most common place

A

2nd MTP > heel

200
Q

atheroma MC location and cause

A

renals (think bigger than just a blood clot)
and atherosclerotic emboli (cholesterol clefts)

201
Q

MC site UE embolic disease

A

bifurc brachial to ulnar/radial

202
Q

MC site UE stenosis

A

SCA

203
Q

tx SCA stenosis

A

stent > bypass (Carotid-sCA) just like in subclavian steal

204
Q

radiation arteritis pathogenesis early/late

A

early: sloughing/thrombosis (obliterative endarteritis)
late 10 years: fibrosis/scar/stenosis
late 30 years: advanced atherosclerosis

205
Q

central line thrombosis

A

pull if line not needed
treat with heparin gtt or TPA if access required

206
Q

MC bug in infected lymphangitis

A

STREP (NOT STAPH!!!!)

ABSITE (37 decks)

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