Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

What’s an indication for CABG?

A

Three vessels with 50% or more stenosis in 3 vessels or 2 vessels that includes the left decending coronary then there has to be less than 50% LV ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for mortality of CABG?

A

AGE**
Previous cardiac surgery**
(%) Ejection fraction
left main stenosis and total number of vessels w/ stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What vessels are used for CABG?

A

Most commonly internal thoracic artery (best long term patency)

    • Saphenous vein
    • Gastroepiploic artery
    • inferior epigastric artery
    • Radial artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What determines intravenous percutaneous intervention vs coronary artery bypass surgery?

A

1-2 vessel disease, intravenous intervention can be performed, but if more than that and criteria of 3 vessels or 2 with left decending and LV dysfunction = CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the disadvantages of a tissue heart valve placement?

A

– deteriorates over time, 30% of people need replacement in 10 years and 50% in 15 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Who gets what kind of heart valve mechanic vs tissue?

A
  • -If younger than 65 without contraindications to anticoagulants and can be reliable in taking anticoagulants = Mechanic (since tissue will degrade before they die)
  • -If older than 65, do not want or cannot take anticoagulants, and women of childbearing age = Tissue Valve replacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the major disadvantage to a mechanical heart valve replacement?

A

Need for life-long coagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are causes of thrombosis from valve obstruction?

A
  • Poor anticoagulation
  • formation of fibrous tissue ingrowth
  • vegetations due to poor antibiotic prophylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are possible prosthetic valve complications?

A

Wrong size causing leakage or too big
Hemolysis of RBCs
Tissue entrapment in the valve
Paravalvular leak around the edges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If a gram positive organism with dextrans and insoluble to bile is found to have colonized a heart valve, when might the individual have been infected?

A

Typically after damage to the valve over time, so Strep Viridans most commonly affects individuals years after placement with valve endocarditis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the types of infections that can lead to late prosthetic valve endocarditis?

A

Dental infections or any kind of dental work
GI or GU infections, even a small amount of bacteria can colonize the valve.
use prophalyxis when known exposure is going to occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What types of organisms are responsible for early valvular endocarditis? (can colonize at the time of surgery)

A 
Staph Aureus
Staph Epidermidis
Gram-Negative (HACEK Organisms)
[Culture negative organisms, hard to grow]
-- Haemophilus
-- Actinobacillus (Aggregatibacter)
-- Cardiobacterium
-- Eikenella
-- Kingella
**Pseudomonas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common arterial aneurysm and where is it located?

A

Abdominal Aorta

- below the renal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for developing an AAA?

A

– Caused by atherosclerosis weakening the walls of the vessel, thus AGE (55+), Smoking, Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you diagnose and screen for AAA?

A

Men between 65-75 should have one abdominal ultrasound performed.
Abdominal Ultrasound should be performed when AAA is suspected, highly specific and sensative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the indications for surgery correction of AAA?

A

When the risk of rupture exceeds the risk of mortality from the repair.

    • Diameter 5.5cm+
    • Rapidly increasing size on observational ultrasounds
    • Symptomatic (back pain and limb ischemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the types of surgical repair of an AAA?

A

Open abdomen surgery

Endovascular aneurysm repair – reduced 30day post-operative mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are complications associated with AAA repair?

A
  • Renal Failure from emboli from aorta atherosclerosis or too much contrast
  • Ischemic colitis – IMA occluded during surgery
  • Spinal cord ischemia – disruption of T12 artery of Adamkiewicz leading to anterior cord syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common cause of arterial embolization and where at?

A

Atrial thrombi production from Afib or recent MI (mural thrombi) – typically travel to brain or lower extremities (more rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 6 Ps of arterial occlusion?

A

Pulselessness
Pain – severe sudden onset at rest
Paralysis – reflects degree of neuron damage
Pallor
Paresthesia – pins and needles, peripherial nerve ischemia
Poikilothermia – skin is cold distally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the key amount of time the occlusion needs to be reperfused to prevent permanent damage?

A

6 hours before necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the first step in management of a patient with a cool distal extremity?

A

Begin a bolus of IV Heparin, then constant flow of heparin

+ Emergent vascular surgery evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Fogarty balloon catheter embolectomy used for?

A

Used in treating arterial occlusions from embolization in limb ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What should be performed at the same time as revascularization of an artery in limb ischemia?

A

Fasciotomy. This is performed to prevent compartment syndrome when the artery is reperfused and edema occurs in the comparment from the damaged muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the physical cause of an aortic dissection?

A

A tear in the tunica intima, which then causes a true and false lumen both filling with blood. The false lumen can expand and expand down the aorta until it ruptures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the predisposing risk factors for aortic dissection?

A

HTN***

  • Connective Tissue Disease (Marfans/Ehlers-Danlos)
  • Bicuspid Aortic Valve
  • Coarctation
  • Vasculitis (Takayasu, Giant Cell, Syphilitic)
  • Crack cocaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

If a patient presents with sudden onset tearing chest pain that radiates to the back with diaphoresis with unequal pulse pressures with BP taken on each arm, what might be cause?

A

Aortic Dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are clinical manifestations of progessing aortic dissection?

A
    • Dissection of media layer of aorta can move proximally to the heart occluding the RCA – Posterior MI
    • Rupture through adventitia – hemorrhage, most common cause of death
    • Rupture into cardiac sac –> cardiac tamponade
29
Q

What are the different types of aortic dissections?

A

Type A – proximal in the ascending aorta can involve the descending as well, MOST COMMON and most dangerous
Type B – descending aorta only that can extend down

30
Q

What will be suspicious on a CXR for an aortic dissection?

A
  • Loss of aortic knob
  • Widened mediastinum** (sensative, no specific)
  • tracheal deviation to the right
  • calcium layer displacement in aorta
31
Q

If a patient is suspected of having an aortic dissection and vital signs are unstable, what should be ordered to confirm the diagnosis?

A

Transesophageal echocardiography - TEE

Cannot do CTA, due to unstable vital signs

32
Q

What are the imaging options for evaluating an aortic dissection?

A
  • TTE
  • CTA Chest – only if stable vital signs
  • MRI/MRA – worst option due to time requirement
33
Q

How is the management of Type A and Type B dissections different?

A

Type A dissections require emergent surgery

Type B only requires medical management of HTN and observation

34
Q

What should be the initial treatment of aortic dissection to prevent worsening?

A

Blood Pressure Control!

    • Beta Blockers – Labetalol
    • Reduce afterload – Clevidipine, Nicardipine, Nitroprusside
  • *Give B-blockers first to prevent reflexive tachycardia
35
Q

What are signs and risk factors for developing a venous ulcer?

A

Varicose Veins
Venous Stasis Dermatits (hemosiderin deposition = hyperpigmentation)
Heaviness in the legs, improves with elevation
Chronic edema

36
Q

What is the most common location of venous stasis ulcers?

A

Medial aspect of the ankle and calf

37
Q

What is an underlying cause of venous stasis and ulcers? How can you diagnose?

A

Incompetent venous valves

– Venous doppler duplex scan (Ultrasound)

38
Q

What are the best treatment options for venous stasis ulcers?

A

Elevation, Compression, Unna boots (compression dressing with zinc oxide to help healing)

39
Q

What is Ankle Brachial index? When is it useful to assess?

A

ABI is where you use the doppler to check systolic blood pressure in the upper extremities using the higher of the two brachial arteries, then use find the DP and PT of the feet, using the higher of the two.
ABI = Pressure-Leg / Pressure-Arm (should be around 1, the smaller the ratio the worse Peripherial Vascular Disease)

40
Q

What are the key characteristics of arterial ulcers?

A

Arterial usually are painful especially at night due to decreased blood flow. Typically located on dorsum of the toes, feet, and ankle – increased pressure areas.
Appears as necrotic tissue with a “punched out” lesion.

41
Q

How do venous ulcers usually appear?

A

Typically medial aspect of the calf and ankle

    • Granulation tissue present
    • shallow irregular margins
    • Painless
42
Q

Where do most DVTs occur at?

A

Proximal to popliteal vein in the femoral / iliac veins

— Risk of embolization to the lungs

43
Q

What are the risk factors in developing a DVT?

A

Virchow’s Triad

  • Venous stasis
  • Damage to endothelium
  • Hypercoagulability
44
Q

What are key risk factors for developing a DVT?

A
  • Recent Surgery, orthopedic
  • Pregnancy
  • Cancer (hypercoagulable)
  • Significant immobilization – plane ride
  • Prolonged Bedrest
45
Q

What are the classic symptoms of a DVT?

A

Unilateral leg pain and swelling with warmth

– Confirmed with Compression Ultrasound, which would show a noncompressible venous lumen

46
Q

What can be used to exclude a DVT from differential diagnosis?

A

Negative Ultrasound

Negative - Normal level D-Dimer (high negative predictive value)

47
Q

What are factors that increase risk of extension of DVT?

A
  • Malignancy
  • Hospitalization
  • DVT close to proximal veins
  • 5cm+ in length
48
Q

If a patient without risks of extension of a DVT and has an isolated distal DVT, what is the treatment?

A

Supportive and Observation

- Early Ambulation with follow up ultrasound to monitor progression of the thrombosis

49
Q

Who should be started on anticoagulation for DVT?

A

Patients with a proximal DVT with risk of extension or signs of embolization.

50
Q

What kind of patients is a IVC filter useful to prevent pulmonary embolization?

A

Patients who have contraindications to anticoagulation therapy and/or have recurrent DVT with failed therapy

51
Q

What is the most significant risk factor in PAD?

A

Smoking, even more significant than CAD

52
Q

Where is the most common location for stenosis in PAD?

A

superficial femoral artery at the level of adductor canal

53
Q

What are the common symptoms associated with PAD?

A

intermittent claudication with improvement at rest, cramping/tightness/tiredness

54
Q

What are some common clincal manifestations of PAD?

A
  • dry skin, arterial skin ulcers, loss of hair growth

- ED and buttock/hip claudication

55
Q

What is the best way to evaluate for PAD and severity?

A

Ankle-Brachial Index
- Normal ratio of brachial to ankle systolic BP is 0.9-1.3
If below 0.9 ratio of leg to arm = PAD, the lower the worse.

56
Q

What is the best treatment for PAD?

A

Exercise! Promotes collateral circulation

– Cilostazol, PDE inhibitor, shown to increase walking distance and intermittent claudication

57
Q

When is surgical treatment useful for patients with PAD?

A

If failure of medical therapy with continued ABI below 0.4, percutaneous transluminal angioplasty with or without stenting or bypass grafting
If damage is irreversible, amputation

58
Q

What are the differences in ascending and descending thoracic anuerysms?

A

Ascending typically attributed to genetic and mechanical factors
Descending - atherosclerosis from HTN, HLD, Smoking

59
Q

What are the pathologic steps involved in development of an aneurysm?

A

HTN most important risk factor.
– Hypertrophy of media (to combat HTN) > diminished blood flow to aortic wall (since dependent on diffusion) > loss of smooth muscle in media > Weakness of wall

60
Q

What are the genetic factors that contribute to aortic aneurysms?

A

Marfan’s Syndrome
Ehlers-Danlos
Loeys-Dietz syndrome
Copper metabolism defects

61
Q

How does syphilis contribute to aortic aneurysms? When to suspect?

A

Treponema Pallidum invades the vaso vasorum of the ascending and transverse aortic arch weakening the walls in a similar process as HTN.
– New onset diastolic murmur of the aortic valve (this is due to the dilation of the aorta and backflow around the valve usually from aneurysm)

62
Q

What is the most common cause of varicose veins and where?

A

Incompetence of venous valves in superficial or deep systems most commonly located in saphenous vein.
- the back up causes dilation and tortuosity

63
Q

What are the risk factors for developing varicose veins?

A

Increasing Age, Female
Oral contraceptives
Pregnancy
DVT

64
Q

What are the clinical characteristics of varicose veins?

A

Visible long dilated tortuous superficial veins in the thigh and lower leg

    • evidence of venous stasis with hyperpigmentation and ulceration on the medial aspect of lower leg
    • heaviness in the legs
65
Q

How can you definitively test to ensure clinical findings are varicose veins?

A

Brodie-Trendelenberg Test
– supine patient raises leg and the saphenous vein is compressed at the thigh, then have patient stand up. If veins fill from top down, conclusive evidence incompetent valves

66
Q

What are best treatments for varicose veins?

A

Leg elevation and/or compression stockings
- If further treatment is needed, then injection sclerotherapy or laser therapy of saphenous and tributaries. Consideration must be made in case patient ever might need the saphenous later.

67
Q

What are clinical signs of superficial thrombophlebitis?

A

Inflammation over superficial vein that causes pain

  • Palpable cord (distention of vein)
  • Pain
  • Mild fever
68
Q

Where does superficial thrombophlebitis usually occur?

A

Past IV site

Varicose veins of the lower extremities

69
Q

If a patient is found to have thrombophlebitis of the lower extremity, should the patient be concerned for PE?

A

NO. Thrombophlebitis does not have a risk of embolizing to PE or DVT.
– NO Anticoagulation should be used
Best Treatment – ASA + Warm compresses and time.

Surgery (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions