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Ch. 11: Venous Disease > Venous Disease > Flashcards

Venous Disease Flashcards

1
Q

Aortomesenteric angle NCS

A

usually < 20 degrees

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2
Q

Most common symptoms of NCS

A

hematuria

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3
Q

Work of for NCS

A

1st: UA - if negative hematuria; unlikely diagnosis.
2nd: renal vein venography for pressure measurements

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4
Q

Renal vein venography for NCS pressure gradient

A

> 3-5 mmHg

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5
Q

Duplex diagnosis of NCS

A

PSV ratio > 5

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6
Q

Classic CT/MRV finding for NCS

A

“bird beak” of renal vein

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7
Q

Management of NCS based on age

A

< 18 years: observation & weight gain –> may self resolve.

> 18 years: RVT (gold standard)

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8
Q

Primary concern for renal vein stenting

A

Migration of stent and/or stent fracture.

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9
Q

Which side is more common to develop PCS

A

LEFT reflux much more common

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10
Q

1st line diagnosis of PCS

A

1st: Transabdominal ultrasound: Dx if ovarian vein dilates to > 6 mm with valsalva. does NOT rely on reflux times.
2nd: transvaginal ultrasound

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11
Q

Best axial imaging for PCS

A

MRV

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12
Q

Diagnosis of PCS by venography

A

Ovarian vein dilated > 5-6 mm

Retention of contrast in vein > 20 seconds

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13
Q

1st line treatment for PCS

A

coil embolization of refluxing segments

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14
Q

What is considered “hemodynamically” significant lesion on venography

A

> 5 mmHg

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15
Q

Women are at much higher risk compared to men for development of which complication secondary to MTS

A

PE (9x more likely)

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16
Q

1 year primary patency of iliocaval reconstruction`

A

~60%

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17
Q

Preferred conduit for surgical venous bypass

A

contralateral GSV

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18
Q

When should AVF creation be considered as adjunct for surgical vein bypass

A

PTFE conduit or conduit size > 10 mm

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19
Q

When does majority of venous recanalization occur following acute DVT

A

first 3 months (~50% thrombus burden reduction)

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20
Q

C1-C6 disease

A

1: telang/reticular veins
2: varicose veins (> 3 mm)
3: edema
4A: hyperpigmentation or eczema
4B: lipodermatosclerosis / atrophic blanche
5: healed venous ulcer
6: active venous ulcer

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21
Q

Pathologic reflux times

A

Superficial / Profunda / Perforator: > 0.5 seconds

Femoral vein / popliteal vein: > 1 second

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22
Q

“Pathologic perforator vein”

A

> 3.5 mm diameter
reflux > 0.5 seconds
adjacent to ulcer (C5 or C6)

–> warrants intervention

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23
Q

Duplicate GSV

A

~25% population.

If present, duplicate GSV will course in superficial dermis (not deep in parallel)

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24
Q

Most common configuration of popliteal fossa (deep –> superficial)

A

artery -> vein -> tibial nerve

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25
Q

Most common cause of therapy failure: endo vs. open (CVI)

A

open: neovascularization
endo: recanalization

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26
Q

Which artery classically crosses between GSV & femoral vein –> AVF after RFA

A

external pudendal artery

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27
Q

Contraindications to ablation therapies for CVI

A

Tortuous proximal segment (unable to pass wire/device)

Chronic/acute thrombophlebitis

Vein diameter > 2.5 cm

vein to skin surface < 1 cm

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28
Q

ESCHAR trial

A

Compared compression vs. compression + GSV Ablation for C5or 6 disease:

Rates of ulcer recurrence were LOWER with combo therapy, but healing rates were similar.

Follow up EVRA trial showed both recurrence and healing time was lower with combo therapy

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29
Q

Deep venous valve transposition

A

transposing a competent venous valve segment that is DISTAL to an incompetent segment onto a competent segment

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30
Q

IVC develops from which primitive veins? (3)

A

Supracardinal vein (right)
Subcardinal vein
Posterior cardinal vein

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31
Q

Cuase of duplicate IVC system

A

persistence of both right & left supracardinal veins (left should normally regress)

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32
Q

Course of IVC relative to aorta with LEFT sided IVC

A

courses ANTERIOR crossing aorta at level of renal veins

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33
Q

Most common complication of venous ablation therapies

A

Ecchymosis

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34
Q

FDA approved sclerosing agents

A

Sotradecol (sodium tetradecol sulfate)

Asclera (pilodocinol)

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35
Q

Patients should avoid _____ ~48 hrs post procedure to avoid reversal

A

NSAIDS

Warm compress

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36
Q

Most common complication of sclerotherapy

A

Hyperpigmentation (self resolves)

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37
Q

Telengiectatic matting

A

Formation of new telangiectasias following sclero therapy –> resolves.

38
Q

Neurologic symptoms following sclerotherapy treatment

A

Treat with 100% oxygen

39
Q

Primary benefit of MOCA compared to ablation therapy

A

does NOT require tumescent anesthesia

40
Q

CariVein

A

Mechanical rotation + sotradecol

41
Q

VenaSeal

A

Cyanoacrylate glue

42
Q

Common complication of VenaSeal

A

Delayed Type IV HS RXN

Tx: Antihistamines & steroids

43
Q

DVT PPx in patient with HITT

A

Fondaparinux

44
Q

Which patients SHOULD receive DVT PPx throughout pregnancy? How long is this continued?

A

F5L Homozygous
ATIII deficiency
Prothrombin Homozygous

Continue 6 weeks post partum

This is IRREGARDLESS of DVT history

F5 hetero, Prothrombin hetero & Protein C/S def does NOT require PPx.

45
Q

Etiology of venous gangrene tissue loss

A

venous hypertension –> microvessel thrombosis.

Is NOT due to primary arterial hypoperfusion

46
Q

PT & PTT levels with DIC

A

both elevated

47
Q

Most common symptom of LE DVT

A

pain

48
Q

T/F. Wells score has proven to be accurate in both outpatient & inpatient setting.

A

FALSE.

Grossly underestimates DVT in IN-patient setting.

49
Q

Preferred anticoagulation during pregnancy

A

Lovenox

50
Q

Classic EKG for PE

Most common EKG for PE

A

S1Q3T3

Sinus tachycardia

51
Q

RV:LV end-diastolic ratio to suggest severe PE on TTE

A

> 1.0: RV-strain

> 1.5: “severe PE”

52
Q

McConnell Sign

A

TTE shows RV basal hypokenesis with sparing of apex –> suggests PE

53
Q

When is V/Q scan considered

A

Dx of PE

COnsidered during pregnancy and/or poor renal function

V/Q: 0.8 = normal
V/Q: > 0.8 –> mismatch –> consistent with PE

54
Q

Regular

Submassive

Massive PE

A

Regular; stable & no RV strain

Submassive: stable, + RV strain

Massive: unstable, + RV strain

55
Q

When is systemic tPA and/or CDT therapy indicated for PE

A

Massive PE

56
Q

FDA approved CDT catheters for PE

A 
Ekos catheter (ultrasound lysis)
FlowTreiver
57
Q

Most common cause of death with PE

A

acute RV failure

58
Q

When is risk of PE highest during pregnancy?

A

Immediate post-partum period

59
Q

Most common location for primary SVT

A

GSV

60
Q

Trousseaue Syndrome

A

Migratory primary SVT; likely undiagnosed malignancy (pancreatic most common)

61
Q

SVT saltans vs. migrans

A

Saltans: SVT in several Separate veins

Migrans: SVT in several segments of the Same vein

62
Q

CALISTO Trial

A

SVT in GSV: >5 cm length AND < 5 cm from SFJ: treat with PPx dosing Fondo (2.5 mg BID) or LMWH for 45 days

63
Q

Management of purulent thrombophlebitis

A

Remove offending IV/line

IV antibiotics

+/- excision of infected vein if refractory to medical management and/or gross purulence tracking

64
Q

ATTRACT trial

A

Acute LE DVT: CDT + AC vs. AC alone.

For iliofemoral DVT: CDT therapy reduced SEVERITY of PTS at 2 years follow up, but did NOT reduce incidence of PTS or recurrent DVT

NO benefit of CDT for fem/pop DVT without iliac vein involvement.

65
Q

Technique for distal femoral/pop open venous thrombectomy

A

Attempt ESMARC exsanguination FIRST (balloon can damage valves); but if fails then proceed with balloon embolectomy.

66
Q

Most common cause of SVC syndrome

A

Malignant etiology (NSCL)

Malignant etiology ~60%
Benign etiology ~40%

67
Q

Type I-IV SVC syndrome

A

I: antegrade flow maintained through SVC (< 90% stenosis)

II: antegrade flow lost through SVC (> 90% stenosis), antegrade flow maintained through Azygous

III: retrograde flow through azygous & IVC

IV: no flow through azygous system, all flow retrograde through IVC

68
Q

SVC syndrome management

A

All managed conservatively at first.

If malignant etiology: focus should be on tumor burden reduction (chemo/radiation)

Endovascular first line invasive therapy

69
Q

Open surgical management of SVC syndrome

A

Typically only considered in those planned for open tumor resection and/or young patients

Spiral saphenous vein graft preferred (rPTFE if not available) –> IJ/innominate –> atrial appendage.

70
Q

CVC with highest associated thrombotic & infection compications

A

Femoral vein (both)

71
Q

3 subtypes of primary aortic tumors

A

Intimal (most common) - branch occlusion

Polypoid - embolic potential

Adventitial - grows OUTWARDS, invades adjacent organs

72
Q

Most common Primary & Secondary IVC tumor

A

Leiomyosarcoma & RP Leiomyosarcoma

73
Q

Most common secondary IVC tumor to cause tumor thrombus

A

RCC

74
Q

Neves & Zencke classification (RCC)

A

Tumor thrombus extent

I: < 2 cm from renal vein ostium (out into IVC)
II: > 2 cm out from renal ostium (into IVC)
III: retrohepatic
IV: Supra diaphragm / right atrium

75
Q

When to perform IVC primary repair vs. patch/interposition

A

< 50% residual stenosis: primary repair OK

> 50% residual stenosis: patch or interposition

76
Q

Patch diameter estimate for IVC reconstruction

A

patch diameter = 3.14 x IVC diameter x % resection

77
Q

Conduit for IVC reconstruction

A

rPTFE (1st line)

Spiral vein graft if concern for infection

78
Q

Largest IVC filter

A

Birds Nest: < 40 mm IVC diameter.

Majority of filters treat up to 30 mm IVC

79
Q

PREPIC-1 & PREPIC-2 Trial

A

1: IVC filter increases risk of recurrent LE DVT at 2 years follow up.
2: filter + AC vs. AC alone is NOT superior for prevention of PE

80
Q

Variable most associated with failure of IVC filter removal

A

Duration of placement.

81
Q

Most common peripheral venous aneurysm

A

Popliteal

Treat > 2 asymptomatic and/or Symptomatic any size.

lateral venorraphy with aneurysmectomy

82
Q

Primary concern with venous aneurysms

A

thromboembolic&raquo_space;» rupture

83
Q

Type I-IV IVC aneurysm

A

I: suprahepatic NO obstruction
II: OBSTRUCTION
III: infrarenal NO obstruction
IV: anything else

84
Q

Most common visceral venous aneurysm

A

Portal vein (> 1.5-2 cm)

All visceral venous aneurysm treat when > 3 cm.

Splenic vein: any size child-bearing age.

85
Q

Race & blood type PROTECTIVE of VTE

A

Japanese

Blood type O

86
Q

Malignancy most associated with VTE complications

A

Pancreatic

87
Q

T/F. chemotherapy increases risk of VTE

A

True.

88
Q

Most common heritable hypercoag condition

A

F5L deficiency (F5 is resistant to protein C degredation)

89
Q

Blood type with increased VTE risk

A

A

90
Q

Most common location for acute DVT

A

calf vein > femoral > popliteal

Ch. 11: Venous Disease (1 decks)

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