Shared Flashcard Set

Details

27 vascular
absite
198
Accounting
Graduate
11/04/2017

Additional Accounting Flashcards

 


 

Cards

Term
Atherosclerosis stages
Definition
1. oxidization of LDL->art wall damage
2. Mphages absorb fat-->foam cells
3. SM proliferation 2/2 mphage GFactors
4. intimal disruption-> thrombus formation
Term
homocysteinemia tx?
Definition
folate, B6, B12
Term
first br ext vs int carotid?
Definition
External = sup thyroid a
Internal = ophthalmic a
Term
describe normal internal vs external carotid artery flow..
Definition
internal = continuous forward flow

external = triphasic
Term
MC diseased intracranial artery?
Definition
MCA
Term
MCC cerebral ischemic events?
Definition
arterial embolization (not thrombosis)
Term
MC sources of cerebral emboli?
Definition
1 = ICA
2 = heart
Term
Anterior vs middle vs posterior infarct sxs?
Definition
ant = AMS, slowing
mid = contralat motor/speech/droop
post = vertigo, tinnitus,
Term
amaurosis fugax =
-exam finding?
Definition
ophthalmic br occlusion = transient vision loss
-hollenhorst plaques
Term
Traumatic carotid injury basic mgmt?
Definition
occluded = no repair (exacerbate bleeding)

open? == repair with stent or open
Term
Indications for CEA?
Definition
symptomatic >50%
asymptomatic > 70%
Term
Bilateral carotid stenosis..
which side first?
Definition
tight side first if unequal
dominant side first if equal
Term
what is removed during CEA?
Definition
intima and part of media
Term
most important technical concern with CEA?
Definition
getting a good distal end point (avoid intimal flap)
Term
indications for shunt during CEA?
Definition
-pressure < 40
-neuro sx
-EEG changes/slowing
Term
mgmt of occluded ICA?
Definition
don't repair it
Term
mgmt of facial vein during CEA?
Definition
can ligate safely
Term
MCC nerve injury with CEA?
Definition
vagus (2/2 to clapming)
p/w hoarseness
Term
hypoglossal n injury
-location
-presentation
-cause
Definition
-near digastrics (2 cm above bifurcation)
-injured w/high dissection
-ipsi tongue deviation, speech/mastication problems
Term
n injured with retractor during CEA?
Definition
marginal mandibular br of facial nerve
Term
n injury causing loss of pitch?
Definition
ext br of sup lary
Term
Glossopharyngeal n injury
-cause
-sxs
Definition
VERY high dissection, retraction inj
trouble swallowing
Term
nerve and cause on injury (6 nerves)
Definition
-vagus = clamp

-Marg mandib br of facial = retractor at jaw

-ext br sup lary = ?

-hypoglossal = high dissection

-glossopharyngeal = very high disssection/retraction
Term
CEA stroke rate?
Definition
1-2%
Term
post-op CEA cause of HTN?
Definition
carotid body injury
Term
work-up of post-op (PACU) neuro event after CEA?
Definition
-->OR, open incision, doppler
1. good flow = embolic problem (plaque vs flap) -->re-open tack the flap, use shunt

2. poor flow = thrombotic problem (re-do it)

GET COMPLETION A GRAM
Term
w/u post op neuro event after CEA (several days out)
Definition
1. Duplex for flow at repair (re-op if need)
2. Angio for poss flap (stent if possible)
Term
MCC death after CEA?
Definition
MI
Term
Re-stenosis rate after CEA?
Definition
15%
Term
best indications for carotid stent?
Definition
1. post-op re-stenosis
2. hx neck XRT
3. poor operative candidate
Term
Carotid body tumor
-sxs/pphys
Definition
-painless neck mass w/bruit, near bifur
-PPhys = paraganglioma (releases NE = HTN, tachy)
-tx = rsxn
Term
Indications for external carotid endarterectomy?
Definition
occluded ICA w ispi symptoms AND tight external carotid
Term
MC location for LE atherosclerosis?
Definition
distal SFA @ Hunters canal (covered by sartorius m)
Term
Pain location vs disease location
-buttock
-thigh
-calf
-foot
Definition
-aortoiliac DZ
-External iliac DZ
-CFA/SFA DZ
-distal SFA/popliteal
Term
origin of vertebral a?
Definition
subclavian
(combine to form basilar a, which splits into two posterior cerebral aa)
Term
vertebral disease sxs?
Definition
diplopia, vertigo, tinnitus, drop attacks,
-tx = PTA and stent
Term
origin of carotid body tumors?
Definition
neural crest cells
Term
Arch vessels =
Definition
innominate (-->right SCA, CCA)
Left CCA
Left SCA
Term
indications for ascending aortic aneurysm repair?>
Definition
sxs
>5.5 (>5 with marfans)
>0.5 cm growth/year
Term
Desc aortic aneurysm
-repair indications
Definition
>5.5 cm
Term
% risk Endovascular vs open of mortality/paraplegia
Definition
2-3% endovasc
20% open
Term
how to help avoid paraplegia with open repair?
Definition
reimplant intercostal arteries below T8
Term
DeBakey classification?
Definition
type 1 = asc and desc
type 2 = asc only
type 3 = desc only
Term
Standford classification?
Definition
class A = any ascending involvement
class B = descending only
Term
what layer of bv wall does dissection occur in?
Definition
medial layer
Term
surgical approach to open type B dissection repair?
Definition
left thoracotomy
(fenestration also an option)
Term
% that get AAA after dissection?
Definition
30%
Term
cause of paraplegia after type B dissection repair?
Definition
occlusion of intercostals and artery of ademkiwicz
Term
MC location of AAA rupture?
Definition
left posterolateral wall, 2-4 cm below renal arteries
Term
major RF for AAA rupture?
Definition
HTN
COPD
Term
% mortality with rupture?
Definition
50% if reach hospital alive
Term
AAA size and repair indications?
Definition
> 5.5 cm @ males
>5 for women
>5 for high risk pts (severe COPD, fam hx rupture, HTN, weird shape)
>0.5 cm growth/year
Term
AAA repair-->when to re-implant IMA?
Definition
-if backpressure < 40 (poor backbleeding)
-hx colonic surg
-SMA stenosis
-inadequate appearing flow to left colon
Term
AAA repair-->tech aspect of aorto-bifem repair?
Definition
ensure flow to at least one internal iliac artery (hypogastric artery back bleeding)
-avoids vasculogenic impotence
Term
EVAR advantages?
Definition
less peri-op mortality, dec ICU, dec LOS
-no change in late survival
-requires more reviews/later interventions
Term
open AAA complications
-major venous injury?
Definition
cross clamp injures retro-aortic L renal v
Term
open AAA complications
-% with impotence?
Definition
33%
Term
open AAA complications
% mortality at elective repair?
Definition
5%
Term
open AAA complications
MCC death early vs late?
Definition
early = MI
late = renal failure
Term
open AAA complications
-RF for mortality
Definition
#1 = creatinine > 1.8
-CHF, abn EKG, pulm DZ, age, female
Term
% of AAA repair graft infections?
Definition
1%
MC org = staph epi (then s aureus, E coli)
Term
rate of graft pseudoaneurysm after AAA repair?
Definition
1%
Term
MC late complication after aortic graft placement for AAA?
Definition
atherosclerotic occlusion
Term
Concern with bloody D after AAA repair?
-w/u findings?
Definition
ischemic colitis 2/2 IMA ligation
-endoscopy findings: middle and distal rectum spared (br off internal iliac)
Term
criteria for EVAR?
Definition
-neck length > 1.5 cm
-neck diameter < 3 cm
-neck angulation < 60 deg
-common iliac length > 1 cm
-common iliac diameter = 0.8-1.8 cm
-also non tort, non calified target, no neck thrombus
Term
MCC mycotic aneursym?
Definition
staph #1
salmonella #2
Term
presentation of mycotic aneurysm?
Definition
pain, fevers, 50% w/+ve BCx
-peri-aortic gas, fluid
Term
mycotic aneurysm surgical option?
Definition
extra-anatomic bypass
Term
MC org aortic graft infections?
Definition
staph #1
E coli #2
MC in groin grafts
Term
Endoleak types?
Definition
1: leak @ prox/distal attachment sites
2: retrograde thru collaterals
3: leak overlap sites/junction of components
4: through stent graft wall
5: expansion without evidence of leak(endotension)
Term
Endoleak management by type
Definition
1: re-balloon, extension cuffs
2: observe +/- IR embolize
3: 2ndary endograft across leak
4: observe vs non-porous stent placement
5: EVAR/open repair
Term
inflammatory aneurysms
-% that get them
-complication
Definition
10%
adhesion to 3rd and 4th portion duod
ureteral entrapment 25%
Term
Aortoenteric fistula
-MC time frame for development
-presentation
Definition
-6 months after abd aortic surgery
-herald bleed (hematemesis)-> BBPR, exanguination
-graft erodes into 3rd/4th part of duod at proximal suture line
-bypass through non contam field
Term
what are the leg compartments?
Definition
anterior
lateral
deep post
SF post
Term
contents of anterior leg compartment?
Definition
-deep peroneal n (dflex, 1st web space)
-ant tibial a
Term
contents of lateral leg compartment?
Definition
SF peroneal n (eversion, lat foot sense)
Term
contents of Deep vs SF post leg compartments?
Definition
-deep: tibial n, post tibial a, peroneal a

-SF: sural n
Term
deep vs sf peroneal n location?
Definition
deep = ant leg compartment
SF = lateral leg comp
Term
Leriche syndrome?
Definition
--aortic bifurcation lesion
-->no fem pulses, butt/thigh claudication
-->impotence (dec int iliac flow)
TX = aorto-bifem
Term
routes for collateral flow with PAD?
Definition
-circumflex iliac to subcostals
-circumflex fem to gluteal a
-geniculate around the knee
Term
ABI value and sxs?
Definition
.9 = claud
.5 = rest pain
.4 = ulcers
.3 = gangrene
Term
vascular "imaging" options for PAD?
Definition
ABI
PVRs (show level)
gold standard = arteriogram/CTA
Term
graft type and location of repair?
Definition
-PTFE can only be used above the knee
-Dacron for large vessel
-
Term
best predictor of long term graft patency?
Definition
vein quality
Term
best test for post bypass surveillance?
Definition
duplex
Term
best method for inc patency and dec CV events after LE bypass?
Definition
asa
Term
tx for isolated iliac lesion?
Definition
1st = PTA w/stent
2nd choice = fem-fem crossover
Term
% patency of fem-pop vs fem-distal grafts?
Definition
fem-popo = 75% @ 5 year (improved rates wtih surgery for claudication vs salvage)

fem-distal = 50% 5 year (not influenced by distal target)
Term
relevant anatomy for pop artery exposure below the knee?
Definition
posterior muscle = gastroc
anterior = popliteus
Term
requirements for fem distal target?
Definition
needs run-off below the ankle
-distal lesions more limb threatening due to lack of collaterals
-
Term
issue with fem fem graft?
Definition
vascular steal in donor leg
Term
cause of early vs late edema after LE bypass?
Definition
Early = reperfusion injury/compartment synd

Late = DVT
Term
MCC early vs late failure w/reverse saph vein graft?
Definition
early = technical

late = vein atherosclerosis
Term
Tx for heel ulcer to bone?
Definition
amp
Term
MC location of DM foot ulcer?
Definition
metatarsal heads (MC 2nd MTP joint)
heel
Term
best lesions treated with PTA?
Definition
Common iliac artery stenosis
short segment stenosis
(must be able to pass lesion with wire)
Term
MC leg compartment to get compartment syndrome?
Definition
anterior compartment (foot drop 2/2 deep peroneal n injury)
Term
pressures found in CSynd?
Definition
> 20-30 mmHg
Term
nerve injured with lateral incision for fasciotomies?
Definition
Sf peroneal n
Term
popliteal entrapment syndrome presentation?
Definition
-mild, intermittent claudication, can be bilateral
-loss of pulse w/plantarflexion (men)
Term
pphys of popliteal entrapment syndrome?
tx?
Definition
medial deviation of artery around medial head of gastroc
-tx = medial head resection
Term
MC location/pres of adventitial cystic disease?
Definition
-popliteal fossa (in men)
-p/w intermittent claudication, symptoms with knee flexion/extension
-dx angiogram
Term
adventitial cystic disease definition?
Definition
Term
Tx adventitial cystic disease?
Definition
cyst resection, +- vein graft
Term
best arterial autograft options?
Definition
radial artery, IMA for cabg
Term
Amputations
BKA vs AKA for % heal/walk/mortality
Definition
BKA 80/70/5%

AKA 90/30/10%
Term
MC location for peripheral obstruction from embolus?
Definition
CFA
Term
aortoiliac embolus tx?
Definition
bilateral femoral cut downs, embolectomies
Term
MC location for atheroma embolization?
Definition
renal areteries
Term
cause of blue toe syndrome?
Definition
flaking atherosclerotic emboli off aorta or branches (MC aorto-iliac dz)
-pts still have good distal pulses
Term
atheroma embolism
-w/u and tx
Definition
CT CAP (look for aneurysmal source)
ECHO (clot or myxoma)
possible repair of source issue
Term
how to distinguish acute art thrombosis vs embolus?
Definition
thrombosis pts have hx claudication, poor vascular flow on contralat leg, hx chronic ischemia etc
-tx = OR if limb threatened, if not then angio/thrombolytics
Term
right renal artery relative location?
% with accessory renal a?
Definition
posterior to IVC
25%
Term
typical renovascular HTN pt/pres?
Definition
females
bruits
Diastolic > 115
drug resistant HTN
Term
location of renal athero vs fibromusclar dysplaisa?
Definition
renal athero = left side, prox 1/.3, MC men

FM dysplasia = right side, distal 1/3, MC F
Term
tx of renovascular HTN?
Definition
PTA WITHOUT stent if FMD
-w/stent if atherosclerosis
Term
indications for nephrectomy with renal HTN?
Definition
atrophic kidney < 6 cm
persistently high renin levels
Term
MC site UE stenosis?
Definition
SCA
-tx w/stent +/- CCA-SC bypass if needed
Term
subclavian steal syndrome definition?
Definition
prox SCA stenosis causes flow reversal thru ipsi vertebral into the SC
Term
-tx options SC steal?
Definition
PTA w/stent
-2nd option = Carotid CS bypass
-intervene for limb/neurogenic sx (vertebrobasilar sxs)
Term
normal path of SC vein?
Definition
-over the first rib ANT to ANT scalene
-then behind clavicle
Term
normal path brachial plexus and SCA?
Definition
-over first rib POST to ant scalene
-ANT to mid scalene
Term
MC type of TOS?
Definition
neurologic sxs >> vascular
-pain from brachial plexus irritation
MC anatomic variant = cervical rib
Term
part of brachial plexus irritated in TOS?
Definition
ulnar nerve distribution
-C8-T1 = intrinsic hand m weakness, weak wrist flexion
Term
Tx neurogenic TOS?
Definition
cervical rib and 1st rib resection
anterior scalene division
Term
subclavian vein TOS sxs?
Definition
-effort induced thrombosis (paget-von schrotter disesase, baseball players)
-(venou>>>arterial origin of TOS, but nero symptoms MC than vascular)
Term
dx of vascular TOS?
Definition
-venography gold standard (but can get duplex)

-for artery duplex vs angiogram
Term
arterial SCA TOS cause?
Definition
compression from anterior scalene hypertrophy (weight lifters)
-hand pain, cold/pale hand
-
Term
arterial TOS dx?
Definition
absent radial pulse with head turned to ipsilateral side (Adson's test)
Term
CT findings suggesting intestinal ischemia?
Definition
vascular occlusion , bowel wall thickening, intramural gas, portal venous gas
Term
MCC visceral ischemia?
Definition
-embolic occlusion = 50% (MC heart source)
-thrombotic = 25% (MC athero DZ)
-NOMI = 15% (Low CO state)
-venous thrombus = 5% (MC hypercoag state)
Term
overall acute mesenteric ischemia mortality rate?
Definition
60%
-MC involves the SMA
Term
MC location of embolci occlusion causing mesenteric ischemia?
Definition
near origin of SMA
Term
tx embolic mesenteric ischemia?
Definition
embolectomy-->resect bowel
Term
how to expose SMA?
Definition
-divide Lig of Treitz
-SMA located to the right, near base of transverse colon mesentery
Term
SMA thrombosis pres?
Definition
chronic problems (Food fear, weight loss)
Term
Mesenteric vein vs SMA thrombosis difference?
Definition
mesenteric vein usually short segment, tx with anticoag
Term
NOMI location?
Definition
watershed
(griffiths = splenic flex, Sudak = upper rectum)
Term
NOMI tx options?
Definition
-Vol resus
-Cath directed nitroglyc = inc viseral flow
-inc CI
Term
median arcuate ligament syndrome
-def
-sxs
-tx
Definition
-celiac artery compression
-epiastric bruit, pain, weight loss
-transect median arcuate lig
Term
best image for chronic mesenteric angina?
Definition
-lateral visceral vessel aortography (origins of celiac and sma)
-tx PTA/stent possible bypass
Term
collateral between SMA/IMA?
Definition
arc of roilan
Term
MC Complication of aneurysm above vs below ing lig?
Definition
above = rupture
below = embolic/thrombotic dz
Term
criteria for repair of splanchnic artery aneurysms?
Definition
repair ALL > 2 cm (50% rupture)
-EXCEPT splenic
Term
MC visceral aneurysm ?
Definition
splenic a
-MC in women, 2% rupture risk
Term
when to repair splenic a aneurysm?
Definition
-sxs
-pregnant
-childbearing age
-> 3 to 4 cm
Term
MC timing for preg rupture of splenic a?
Definition
3rd trimester
Term
best tx for visceral aneurysm tx?
Definition
covered stent = best
-if splenic can just ligate
Term
size criteria for tx of visceral aneursyms:
-renal
-iliac
-fem
-popliteal
Definition
renal > 1.5 cm
iliac > 3 cm
fem > 2.5 cm
pop > 2 cm
Term
MC peripheral aneurysm?
Definition
popliteal artery
-MCC athero dz
-rare rupture
-1/2 BL, 1/2 have another aneurysm (AAA, fem etc)
Term
MCCx with pop aneurysm?
Definition
embolic/thrombotic dz and limb ischemia
-rarely rupture
-1/2 have another aneurysm
Term
indications/approach for pop aneurysm tx?
Definition
> 2 cm, symptomatic, mycotic
-tx = exclusion and bypass of all pop aneurysms (NO COVERED STENT)
-->25% have complication that requires amputation if not treated
Term
MC location pseudoaneurysm?
Definition
femoral artery
Term
tx pseudoA?
Definition
-if 2/2 perc intervention? US guided thrombin/compression

-if early and @ suture line..OR
Term
origin of pseudoA at suture line, months after operation?
Definition
suggests graft infection
Term
pres of FMD?
Definition
young F
HTN if DZ at renals
headache/stroke if DZ at carotids
Term
MC vessels involved in FMD?
Definition
renals > carotid > iliac
Term
imaging appearance of FMD?
Definition
string of beads
Term
MC FMD variant?
Definition
medial fibrodysplaisa
Term
imaging findings of Buerger's DZ?
Definition
-corkscrew collaterals on angio
-normal art tree proximal to pop and brachial arteires (SMALL vessel dz)
Term
buergers presentation?
Definition
severe rest pain w/ulceration, digit gangrene,
Term
marfan pphys?
Definition
fibrillin defect
-cystic medial necrosis
Term
temporal arteritis pres?
Definition
-F > 55, h/a, fever, blurry vision/blindness
-large vessel dz
Term
vessel appearance with temp arteritis?
Definition
-long segments of smooth stenosis alternating with large diameter segments
-
Term
temp art treatment?
Definition
steroids
possible bypass procedures
NO ENDARTERECTOMY
Term
radiation arteritis pres vs time frame?
Definition
-early = sloughing and thrombosis (obliterative endarteritis)
-Late 1-10 years = fibrosis, scar, stenosis
-very late 3-30 years = advanced athero dz
Term
tx Raynaud's?
Definition
-Ca channel blockers
-warmth
Term
renal vein ligation?
Definition
can ligate left near the IVC due to collaterals (gonadal, adrenal). No such collat on right side
Term
MCC AV graft failure for HD?
Definition
venous obstruction 2/2 intimal hyperplasia
Term
cimino graft =?
Definition
radial a to cephalic v
-wait 6 weeks to use
Term
MCC acquired AV fistula?
Definition
trauma
Term
MCC venous ulcers?
Definition
venous valve incompetence (90%)
Term
venous ulcer MC location?
Definition
above and post to medial malleoli
Term
cause of brawny edema?
Definition
hemosiderin deposition
Term
unna boot =
Definition
zinc oxide and calamine compression wraps
=cure 90% of venous ulcers
Term
Contraindication to vein stripping?
Definition
DVT
Term
Tx SF vs suppurative thrombophlebitis?
Definition
SF = non infectious inflamm->NSAIDS, warm packs, ambulation,

Suppurative = pus in vein. p/w fever/wbcs,
-tx = resect vein
Term
MC suppurative thrombo?
Definition
staph aureus
Term
Migrating thrombophlebitis a/w..?
Definition
pancreatic CA
Term
Findings on normal venous doppler us?
Definition
augmented flow with distal compression/release of proximal compression
Term
How do SCDs work?
Definition
prevent clots by decreasing venous stasis and increasing tPA release
Term
DVT MC location?
Definition
left leg 2x more than right
-longer left iliac vein gets compressed by right iliac artery
Term
swelling and DVT origin?
Definition
calf = minimal
fem = ankle/calf
iliofem = leg swelling
Term
phlegmasia alba dolens vs
phlegmasia cerulea dolens?
Definition
alba = painful, swollen white leg
cerulea = painful, swollen BLUE leg (more severe) 2/2 iliofem DVT
Term
cause of cerulea dolens?
Definition
iliofemoral DVT
-tx cath-directed thrombolytics
-tx emergent thrombectomy if limb threat
Term
associated finding with cerulea dolens?
Definition
50% have malignancy somewhere
Term
Central line associated thrombosis>?
Definition
pull line if not needed
Term
Contraindications to vein stripping?
Definition
DVT
outflow obstruction
pregnancy
Term
lymphatic histo findings?
Definition
no basement membrane
Term
where are lymphatics NOT found?
Definition
bone/muscle/tendon/cartilage
brain
cornea
Term
which lymphatics have valves?
Definition
deep lymphatics
Term
MCC lymphedema
Definition
secondary lymphedema (MC ALND vs Breast CA)
Term
sings of lymphedema?
Definition
woody edema 2/2 subcutaneous fibrosis
Term
MC infection with lymphedema?
Definition
strep
Term
MC location of congenital lymphedema?
Definition
L>R LE
Term
Stewart Treves syndrome def?
Definition
lymphangiosarcoma a/w breast axillary dissection and resulting chronic lymphedema
Term
method of location source vessels for lymphocele?
Definition
Isosulfan blue dye into foot..follow lymph to groin
Term
MC locaion lymphocele?
Definition
groin after surgery
-leaks clear fluid
Supporting users have an ad free experience!