Vascular Surgery Review Flashcards
give the ladder of reconstruction options for a vascular injury
- lateral arteriorraphy
- lateral suture patch angioplasty
- resection with end-to-end anastomosis
- resection and interposition graft
- bypass grafting
- ligation
when would you use lateral arteriorraphy to repair a vascular injury?
- when there is 50% circumferential damage, you can consider primary repair
How large of a vascular injury would you consider patch angioplasty as a repair option?
- generally 50-75% circumferential injury to vessel
Talking about vascular injuries…what is the upper limit of segmental loss you can safely transverse with an end-to-end anastomosis?
- 2cm is your upper limit
- beyond that you should consider an interposition graft vs bypass graft
Give Rutherford Classification and management
- slow capillary refill
- intact/minimal motor deficit
- partial/no sensory loss
- inaudible arterial doppler
- Rutherford class IIA (salvageable)
- urgent surgical revascularization vs thrombolysis
Give Rutherford Classification and management
- slow or absent capillary refill
- partial paralysis
- partial sensory loss with rest pain
- absent arterial doppler signal
- Rutherford class IIB (salvageable)
- immediate surgical re-vascularization
Give Rutherford Classification and management
- absent capillary refill
- profound paralysis, often with rigor
- profound loss, anesthetic
- absent arterial doppler
- Rutherford class III
- amputation this is not salvageable
patient presents with unilateral leg swelling, pain in said limb, cyanotic changes, faint doppler signals, and large DVT on US…what is the diagnosis
phlegmasia cerulea dolens
what is the treatment for phlegmasia cerulea dolens?
pharmacomechanical (systemic and endovascular thronbolysis) thrombolysis and fasciotomy
Thrombotic occlusion of SMA…what is affected?
proximal jejunum to distal transverse colon
embolic occlusion of SMA…what is affected
- proximal jejunum to ascending colon
if you have a thrombotic occlusion of the SMA, where is the occlusion
at the origin of the SMA
if you have an embolic occlusion of the SMA where is the occlusion
middle to distal SMA
most common adverse event after protamine infusion
hypotension
in who should you be worried about ischemic monomelic neuropathy
diabetic women
how do you diagnose ischemic monolemic neuropathy
diminished motor and sensation/pain out of proportion with exam, pulses must still be present…or this is then considered steal syndrome
what PSV is associated with >70% occlusion of SMA
PSV > 275 cm/sec
PSV for celiac stenosis > 70%
PSV > 200 cm/sec
Vasculopath with wet gangrene at left toe angiogram showing short stenosis > 75%, signs of sepsis…next step?
amputate the toe…once recovered from infection perform revascularization
ICA peak velocity of 125 cm/sec
50% stenosis
ICA peak velocity of 125-230 cm/sec
50-69% stenosis
ICA peak velocity > 230 cm/sec
70-99% stenosis
Patient with known thigh and hip claudication comes in with acute onset paralysis of both LEs and cyanosis inferior to umbilicus…what caused his paralysis?
- occlusion of the artery of Adamkiewicz
- main supply to the spinal cord below T8…patient has acute on chronic aorto-occlusive disease that took this artery out too
when do you use distal radial artery ligation in the setting of an AVF?
- when patient has palmer steal syndrome…there is no option for distal revascularization like in a brachia-cephalic AVF
when should you consider a carotid endarterectomy?
- symptomatic ICA stenosis
- asymptomatic ICA stenosis 60-99% if stroke risk is < 3%
one day out from EVAR patient has bloody diarrhea, what is happening and what do you do next?
- likely ischemic colitis
- if stable sigmoidoscopy
- if unstable immediate exploration
Renal arteriogram shows string bean appearance
Fibromuscular dysplasia
Treatment for fibromuscular dysplasia
- balloon angioplasty
initial therapy for pseudoaneurysm at access site
- compression under US guidance
- some places will go straight to thrombin injection
at what GFR should a patient be considered for an AVF to start HD?
- GFR <7 even if asx
- GFR 10-15 with sxs of CKD
which vessel does the internal thoracic artery come from?
1st branch off of the subclavian artery
function of the sural nerve
sensation to:
- posterolateral aspect of distal leg
- lateral foot
function of saphenous nerve
sensation to:
- medial aspect of leg
- medial aspect of calf
- medial aspect of foot
surgery along the saphenous vein carries risk of what kind of nerve injury?
- typically sural nerve injury (loss of sensation along lateral aspect of lower leg and foot)
function of peroneal nerve
sensation to dorsum of foot
dorsiflexion of foot
function of posterior tibial nerve
sensation to sole of foot
plantar flexion of foot
treatment for a complicated pseudo aneurysm
surgical repair
