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tax > Week 8 > Flashcards

Week 8 Flashcards

1
Q

Locations:
proximal popliteal artery
Pop a
distal popliteal

A

above knee, distal thigh
crease
proximal part of calf

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2
Q

Do we leave color on as we look at the vessel? (after interrogating w/ 2-D)

A

Yes

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3
Q

In limbs affected by DVT _____% had at least one segment of incompetent vein

A

69

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4
Q

Varicose veins usually come from the superficial or deep venous system?

A

superficial

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5
Q

Gaiter area indicates

A

the most common area where venous ulcers occur

mid to distal calf

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6
Q

If a patient comes in with a palpable leg mass, consider:

A

thrombosed varicose vein

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7
Q

Read over reflux testing b/c it’s not good flashcard content

A

ok

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8
Q

Have to treat the varicose veins from the inside out. Why?

A

We have to treat (with heat) the cause/source. They’re a symptom of venous insufficiency, so we need to find the valves, once that’s closed they we can treat the varicose veins/spider veins (sclerosis therapy a month or so after and it’s multiple sessions)

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9
Q

There is no treatment for deep venous insufficiency, only superficial. True or false.

A

True, only thing we can do is treat symptoms with compression stalkings or elevation

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10
Q

What are the 3 main recurrence patterns for varicose veins (? i think, slide doesn’t say what this is for)

A

1- patent long saph vein may be present suggesting that it may be missed at the time of operation
2-small collateral veins along line of LSV may enlarge to reconstitute the path of vein
3- drainage can occur through venous collaterals which take a variety of courses remote from normal line of vein

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11
Q

What’s useful for the pattern of recurrence to decide on the appropriate surgical intervention?

A

CD

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12
Q

What are the 6 tributaries draining into the LSV at the level of the SFJ can be the source of primary/recurrent varicose veins?

A 
superficial inferior epigatric vein** see this all the time
deep external pudendal vein
superficial external pudendal vein
medial accessory saphv
anterolateral thigh vein
superficial circumflex iliac vein
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13
Q

Never (ever ever ever she said) perform a venous reflux on a patient with:

A

DVT

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14
Q

Terminal valve and subterminal valves will be seen at:

A

SFJ

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15
Q

What is the most convenient method to assess competent or incompetence of the venous segment?

A

squeeze calf or lower thigh

valsalva

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16
Q

When valsalva manuever is not effective, we use

A

augmentation. useful for popv and calf veins

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17
Q

Venous reflux is considered significant when it is longer than:

A

0.5s

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18
Q

Shorter periods of reversed flow may represent the valve cusps ______ ________.

A

coming together

19
Q

Reflux should not be confused with

A

reversal of flow which occurs with turbulence– see this on spectral doppler as reverse and forward flow occuring at the same time

20
Q

Can we augment with color Doppler?

A

Yes –if patient can’t tolerate exam any longer than we can quickly get something by using CD

21
Q

Where is the most common location for an incompetent imperforating vein?

A

level of the junction of the mid and lower thirds of the thigh
Hunterian perforator

22
Q

What’s the mid to distal thigh perforator vein called?

A

Hunterian perforator. Common location for varicose veins

23
Q

Valsalva is reliable until where? What’s used after?

A

mid (sometimes distal) thigh.

compression

24
Q

Varices should be traced _________ to identify the point of communication with deep or superficial segments.

A

proximally

25
Q

Name the perforators:

A 
soleus and gastrocneumius
lateral ankle
medial lower ankle
Dodd's
gastrocneumius
Cockett
26
Q

Perforators are greater in calf or knees?

A

Calves

27
Q

Where is Dodd’s perforator located? Boyd’s? Cockett’s?

A

Dodds- inferior 1/3 of thigh
Boyd’s-knee level
Cockett’s- inferior 2/3 of leg (usually there are 3. Superior, medium and inferior perfs)

28
Q

Perforator abnormal measurements:

A

> 3mm in calf

>4mm in thigh

29
Q

What’s the preferred conduit for arterial bypass grafting in the coronary arteries and lower limb?

A

LSV

30
Q

The measurement for vein mapping is taken in what plane?

A

Trv

31
Q

What measurements should the vein be for a graft to be considered?

A

3-4 mm wide and >2mm at the ankle for a long femoral-distal graft

32
Q

If an insitu lower limb arterial graft is to be performed, then perforating veins and superficial branches must be ligated to prevent an arteriovenous fistula from developing. True or false

A

True

33
Q

Limitations and pitfalls for vessel mapping:

A 
patient unable to stand
body habitus and tolerance for compression
bandages
casts 
swelling
34
Q

If leg veins aren’t good for mapping, they’ll use what veins?

A

Arm (basilic and cephalic)

35
Q

Patients who have claudication only with exercise have an ABI of _____ prior to exercise, and ____to_____ following exercise.

A

1.0, 0.6-0.8

36
Q

What does exercise cause in people with claudication?

A

temporary limb ischemia due to the diseased arterial tree’s inability to supply flow in increased flow requirements

37
Q

Read the exercise testing steps

A

ok

38
Q

A normal patient will show a slight decrease in pressure drop following an exercise test. True or false

A

False– no drop and in fact maybe a slight increase in pressure

39
Q

How is the degree of arterial disease assessed?

A

by the magnitude of immediate pressure drop following exercise and the length of time required for the ankle pressure to return to the pre exercise level

40
Q

Yea just read the exercise testing ppt cause not good flashcard content

A

but good info

41
Q

People with pseudoclaudication should be evaluated for

A

MSK or neurospinal disorders

42
Q

Normal patients criteria with reactive hyperemia:

A

return to pre-exercise levels within 30-60s

ankle pressure taken immediately after occlusion falls no more than 35% below resting level

43
Q

Abnormal patients criteria with reactive hyperemia:

A

require >1minute to return to pre-exercise pressure levels
ankle pressure falls more than 35%
single level dx <50%
multi level dx >50%

tax (16 decks)

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