Term
| Timing of CEA after strokes |
|
Definition
# pts with a non-disabling stroke, normal CT scan and a normal level of consciousness- within 2 weeks
# pts with a large stroke on CT and depressed level of consciousness should wait until pts improve and plateau in their recover ~4-6 wks |
|
|
Term
| Asymptomatic Carotid Athersclerosis Study (ACAS) findings |
|
Definition
Amongst pts with asymptomatic carotic artery stenosis of 60-90%:
# Relative risk of stroke reduction of 50%: 11% to 5%
# no benefit in women |
|
|
Term
| Asymptomatic Carotid Surgery Trial (ACST) findings |
|
Definition
Amongst pts with asymptomatic stenosis of 60-99%:
# 5- year relative risk reduction of all strokes or death was 46%: 6.4% vs. 11.8%
# 5-yr risk reduction of disabling or fatal strokes was 43%
# Max benefit in males < 75yo
# less benefit in women |
|
|
Term
| NASCET findings regarding post op ICH |
|
Definition
|
|
Term
| Definition of symptomatic sever ICA stenosis bay the NASCET study |
|
Definition
| 70-90% ICA stenosis with a non-disabling stroke, hemispheric TIA or amaurosis fugax |
|
|
Term
| Findings of NASCET in regards to women |
|
Definition
Women benefited from surgery if they had symptomatic stenosis plus one or more of the following:
# age > 70yo
# severe HTN
# h/o MI
# h/o hemispheric event (as oppopsed to amaurosis)
Women also had a higher perioperative mortaility |
|
|
Term
|
Definition
# Only pts with 50-69% stenosis and hemispheric sx and failure of medical management benefitted from CEA (not pt with retinal sx)
# greatest benefit from CEA is in pt with ICA stenosis of 70-99% and recent (within 120 d) sx |
|
|
Term
| MCC of new neurologic deficits that present within 12h of CEA |
|
Definition
# development of thrombus on operative side
# residual intimal flap in the iCA leading to occulusion
# residual flap in the ECA leading toe ECA thrombosis and retrograde embolization into the ICA |
|
|
Term
| Management of new neurologic deficits |
|
Definition
# if develop within 12h of surgery, then immediate heparinization and operative exploration
# if > 12h, CTA or arteriography |
|
|
Term
| Steps of operative exploration for neurological deficits s/p CEA |
|
Definition
# reopen the wound and palpate ICA and ECA for pulse
# if no pulse:
1. reopen the artery and look for and address cause of thrombosis
2. verify good back-bleeding from the ICA
3. reclose the arteriotomy with a patch
4. on-table arteriography to ensure distal ICA is patent
5. if embolus found on arteriography in ICA or MCA, local infusion of lytic agent
# if good pulse or normal doppler signals
1. on-table arteriography done first
2. reopen vessel to fix intimal flap or irregular mural thrombus at CEA site |
|
|
Term
| Type of pt who should always undergo shunting during CEA |
|
Definition
| Stroke pts because the area surrounding the infarcted brain is ischemic (ischemic penumbra) and therefore very sensitive to changes in blood flow |
|
|
Term
| Benefits of patch closure vs primary closure in CEA |
|
Definition
# decreased rate of early post-operative ICA occlusion
# decreased 30-day perioperative stroke rate
# decreased incidence of more than 50% restenosis in the first year |
|
|
Term
| Complications a/w vein patch closure in CEA |
|
Definition
# patch rupture
# false aneurysm formation
# thromboembolism from the dilated aneurysmal reconstructed bifurcation |
|
|
Term
| Optimal donor site for vein patch in CEA |
|
Definition
| Saphenous vein in the thigh (as opposed to the ankle) |
|
|
Term
| Risk factors for cerebral hyperperfusion |
|
Definition
# recent stroke
# very high grade stenosis
# poorly controlled pre- and post-operative HTN
# concomitant contralateral ICA occlusion
# evidence of chronic ipsilateral hypoperfusion |
|
|
Term
| Common presentation of cerebral hyperperfusion syndrome |
|
Definition
| Heralded by ipsilateral frontal headache around POD5 |
|
|
Term
| Typical location of the carotid bifurcation |
|
Definition
| Jxn of the 3rd and 4th cervical vertebrae |
|
|
Term
| Steps to gain better exposure of the carotid |
|
Definition
# division of the posterior belly of the digastric for cephalad exposure
# division of the omohyoid for better caudad exposure of the COMMON carotid
# anterior subluxation of the mandible for exposure above the 2nd cervical vertebra
# division of the descendens hypoglossi to allow reflection of the hypoglossal nerve off the ICA |
|
|
Term
| Pathognomonic finding for a carotid body tumor |
|
Definition
| # widening of the carotid bifurcation by a well-defined tumor blush on arteriogram (lyre sign) |
|
|
Term
| Indication for preoperative tumor embolization in carotid body tumors |
|
Definition
|
|
Term
| Percentage of carotid body tumors that are malignant |
|
Definition
|
|
Term
| Cell of origin of carotid body tumors |
|
Definition
| Chemoreceptor cells at the bifurcation |
|
|
Term
| Presentation of a carotid body tumor |
|
Definition
| palpable and painless mass over the carotid bifurcation area of the neck |
|
|
Term
| Rate of cranial nerve injury after carotid body tumor surgery |
|
Definition
| 20% have permanent injuries and temporary deficits in 20% |
|
|
Term
| MC form of fibromuscular dysplasia of the ICA |
|
Definition
|
|
Term
| Other findings a/w fibromuscular dysplasia and incidence |
|
Definition
# 25% have intracranial aneurysms
# 65% have B/L carotid FMD |
|
|
Term
| Histological appearance of fibromuscular dysplasia |
|
Definition
| # compact fibrous tissue replacing smooth muscle cells in the outer meda and inner media contains excess collagen and ground substance in disorganized smooth muscle cells |
|
|
Term
| Management of fibromuscular dysplasia of the carotid |
|
Definition
| # graduated luminal dilation under direct vision followed by anti-platelet therapy in symptomatic patients with angiographically proven disease |
|
|
Term
| Ways of diagnosing temporal/giant cell arteritis |
|
Definition
# temporal artery biopsy
# duplex ultrasound with a clear halo around the temporal artery |
|
|
Term
| Signs and sx of Takayasu atertis |
|
Definition
# pulselessness
# blood pressure difference in both arms
# upper or lower extremity claudication
# syncope
# amaurosis fugax
# blurred vision
# palpitations |
|
|
Term
| Method of diagnosis of Takayasu arteritis |
|
Definition
| # arterial imaging: occlusive disease in the mid subclavian arteries (as opposed to the origin as in atherosclerosis) |
|
|
Term
| Distribution of affected arteries in Takayasu arteritis |
|
Definition
| Aorta, it's branches, coronary and pulmonary circulation |
|
|
Term
|
Definition
# steroid therapy with cytotoxic agents in those who do not achieve remission
# surgical bypass in patients that fail to respond to medical therapy |
|
|
Term
| Pathognomonic sign/sx of Takayasu arteritis |
|
Definition
|
|
Term
| Lateralizing neurological deficit after a trauma in a non-altered pt with a negative CTH |
|
Definition
| Suspect blunt carotid artery injury and perform angiography |
|
|
Term
| Management of blunt carotid injury causing intimal damage or dissection |
|
Definition
|
|
Term
| Management of radiation-induced carotid stenosis |
|
Definition
| Carotid stenting with a cerebral protection device |
|
|
Term
| Injuries a/w penetrating carotid injuries |
|
Definition
| Esophagus, c-spine and laryngeal injuries |
|
|
Term
| Management of penetrating carotid injury |
|
Definition
# if signs of ongoing hemorrhage, surgery
# if HD stable, angio or CTA:
* if neurodeficit and surgically accessible: surgery
* Intimal injury: observe
* PSA: surgery
* surgically inaccessible, EV suite |
|
|
Term
| Complications of carotid to subclavian bypass |
|
Definition
# Graft infxn
# Phrenic nerve injury (hemidiaphragm paralysis) from division of the anterior scalene
# Injury to vagus nerve during carotid dissection (hoarseness)
# chylothorax (only on left-sided surgery) |
|
|
Term
| Cause of recurrent carotid stenosis by time frame and management |
|
Definition
# < 2 years- myointimal hyperplasia, observation if asx and stenting if sx
# > 2 years- atherosclerosis |
|
|
Term
| MC cranial nerve injuried during CEA and sx |
|
Definition
| # Vagus/recurrent laryngeal nerve; hoarseness |
|
|
Term
| Possible CN injuries during CEA |
|
Definition
# recurrent laryngeal- hoarseness
# hypoglossal- ipsilateral tongue deviation
# Superior laryngeal- easy voice fatigueability |
|
|
Term
| Risk of CN injury during CEA |
|
Definition
|
|
Term
| Stroke or TIA in carotid distribution in a person < 40 yo, work up and management |
|
Definition
# carotid dissection (can be spontaneous)
# angiogram- will show flame-shaped occlusion
# anticoagulation |
|
|
Term
| Area of carotid bulb affected by atherosclerosis and why |
|
Definition
| Outer/Lateral b/c it corresponds to areas of low velocity and low shear stress |
|
|
Term
| Management of pt with symptomatic sever stenosis with an asx cerebral aneurysm |
|
Definition
# if aneurysm < 10 mm, leave it alone and perform CEA
# if aneurysm > 10 mm, fix aneurysm then do CEA |
|
|
Term
| Diagnostic criteria for Buerger's dz |
|
Definition
# < 45 yo
# current or recent smoker
# distal extremity ischemia (claudication, rest pain, ischemic ulcers, gangrene)
# exclusion of autoimmune dzs, hypercoagulable states, DM, proximal sources of emboli (echo and arteriography)
# Characteristic findings on arteriography of involved limbs |
|
|
Term
| Areas typically spared of Buerger's dz |
|
Definition
| aortoiliac and coronary arteries |
|
|
Term
| Characteristic angiographic findings in Buerger's dz |
|
Definition
# disease confinement to distal circulation (infra-popliteal and distal to brachial artery)
# Segmental occulsions ans skip lesions with extensive wispy collateralization (corkscrew collaterals) |
|
|
Term
| Management of Buerger's Dz |
|
Definition
|
|
Term
| Problem encountered in DM and ESRD pt and ABIs, eponym, definition, areas affected and alternative methods of measuring disease severity |
|
Definition
# mecdial calcinosis
# Monckeberg arteriosclerosis
# calcification of the arterial medial layer
# affects tibial vessels and spares digital vessels
# Toe pressures and PVRs |
|
|
Term
| Absolute contraindications to thrombolytic therapy for acute limb ischemia |
|
Definition
# recent stroke or TIA
# active or recent GIB
# significant coagulopathy |
|
|
Term
| Relative contraindications to thrombolytic therapy for acute limb ischemia |
|
Definition
# recent major surgery
# recent trauma
# uncontrolled HTN
# intracranial tumors
# pregnancy
# ischemia that has already progressed to motor and sensory loss (thrombolytic therapy will take too long) |
|
|
Term
| Length of time thrombolytic tx can be safely used for acute limb ischemia before risk of bleeding becomes too dangerous |
|
Definition
|
|
Term
| Causes of acute limb ischemia |
|
Definition
# Embolic:
* Afib (MCC)
* mural thrombus s/p MI
* valvular dz
* atrial myxoma
* ANEURYSMS
* atherosclerotic plaques
# Thrombotic:
* atherosclerosis in a peripheral artery (usually has a h/o claudication) |
|
|
Term
| Components of irreversible ischemia which develops after acute limb ischemia |
|
Definition
# absence of aterial or venous Doppler signals
# ischemia > 6-8 hrs
# mottling
# no cap refill
# complete anesthesia and paralysis |
|
|
Term
| Management of acute limb ischemia |
|
Definition
# for normal motor and sensory or sensory deficit only: trial of heparin alone, thrombolytic therapy, or operative embolectomy
# for motor and sensory deficit: operative embolectomy only
# for irreversible ischemia: amputation |
|
|
Term
| Percentage of peripheral embolization involving the upper extremity and MC location involved |
|
Definition
|
|
Term
| Management of acute upper extremity ischemia from embolization |
|
Definition
# immediate heparinization
# fluid hydration (as lon as pt not having ACS)
# place arm in dependent position
# perform operative embolectomy as soo as possible |
|
|
Term
| Location of incision for upper extremity embolectomy |
|
Definition
| # at elbow near the distal brachial a. and origins of the radial a. and ulnar a. |
|
|
Term
| MCCs of distal bypass failure by timeperiod |
|
Definition
# Early (within 30d)- technical error: anastamotic stenosis, kink or twis within the graft, poor choice of proximal or distal target, inadequate caliber of vein conduit
# Intermediate failures (30d - 2 yrs): intimal hyperplasia
# Late failures (> 2 yrs): progression of atherosclerotic occlusive dz either in the inflow or outflow vessels |
|
|
Term
| Evidence of chronic ischemia on physical exam |
|
Definition
# hair loss
# thin, dry skin |
|
|
Term
| Theoretical advantage of insitu technique vs RSVG |
|
Definition
| Better size matching (larger part of the vein to larger artery) allows for a smaller caliber greater saphenous vein to be used |
|
|
Term
| MC arteries affected by fibromuscular dysplasia in order |
|
Definition
|
|
Term
| Conditions commonly a/w fibromuscular dysplasia |
|
Definition
# intracranial aneurysms
# ICA dissection |
|
|
Term
| Management of fibromuscular dysplasia of renal arteries |
|
Definition
# percutaneous transluminal angioplasty (technical success rate up to 100%, improvement rates 21-63%, cure rates 14-59%)
# Surgical bypass with saphenous vein or synthetic graft for pts who fail medical and percutaneous management |
|
|
Term
| Best choice of conduit for renal artery bypass in children |
|
Definition
|
|
Term
| Types of acute mesenteric ischemia and MCCs of each |
|
Definition
# Embolic, most commonly from Afib
# mesenteric arterial thrombosis in setting of mesenteric artery atherosclerosis, will have h/o food fear
# Mesenteric venous thrombosis, hypercoagulable state which causes such venous distension that it leads to arterial insufficiency
# nonocclusive mesenteric ischemia, from hypoperfusion 2/2 to shock |
|
|
Term
| Management of Acute mesenteric ischemia |
|
Definition
# if in setting of classic acute ischemia from cardiogenic source, can do embolectomy without formal angiography; mannitol to minimize reperfusion injury (free radical scavenger)
# if hx is suggested of mesenteric atherosclerosis, need ateriogrphy to plan bypass
# If CT scan shows mesenteric vein thrombosis, heparinization unless there is peritonitis in which case the tx should be operative
# non-occlusive disease: correction of hypoperfusion |
|
|
Term
| Definition of and management of Goldblatt kidney |
|
Definition
# Unilateral hypoperfused kidney from renal artery stenosis
# ACEi |
|
|
Term
| Difference b/w presentation of steal syndrome after AVF creation with graft vs native fistula |
|
Definition
| AV grafts are more prone to steal and present earlier |
|
|
Term
| Pharmacologic agent with best efficacy in improving claudication sx |
|
Definition
|
|
Term
| MCC claudication in a young, non-smoking male and classic presentation |
|
Definition
| Popliteal entrapment syndrome- swelling and claudication of isolated calf muscle groups after exercise (usually unlateral) |
|
|
Term
| Non-invasive tests for w/u of popliteal entrapment syndrome |
|
Definition
| # ABI with knee extended and foot in a nuetral, forced dorsiflexion and forced plantar flexion- will show a decrease in pressure of 50% or more and dampening of the plethysmographic waveforms |
|
|
Term
| Natural history of untreated popliteal artery entrapment |
|
Definition
| # repetitive trauma to the artery leads to occlusion either by thrombus or aneurysmal formation and the risk of embolization |
|
|
Term
| Anotomical variants a/w popliteal entrapment syndrome |
|
Definition
# aberant course of the artery medial to the medial head of the gastroc
# fibrous bands that compress the artery
# enlarged popliteus muscle that compressess the artery |
|
|
Term
| Presentation and pathologic finding of popliteal cystic adventitial disease |
|
Definition
# males 30s-50s with claudication sx and a mass in a non-axial vessel close to the knee, minimal risk factors for PVD
# synovium like, mucin-filled cysts in the subadventitial layer of the vessel |
|
|
Term
| MC peripheral artery aneurysm and presentation |
|
Definition
# Popliteal artery aneurysm
# presents in an older male smoker with chronic distal embolization or sudden-onset occulsion of the popliteal artery, pulsatile mass and diminished distal pulses |
|
|
Term
| MCC of LE swelling several days s/p fem-pop bypass |
|
Definition
|
|
Term
| MC locations of cardiac embolization in decreasing order of prevelance |
|
Definition
# 70% go to lower extremities (CFA- 34%, followed by CIA and popliteal)
# 13% in upper extremities
# 10% in cerebral circulation
# 5-10% in visceral circulation |
|
|
Term
| Most important factor in determing the outcome of pts with claudication |
|
Definition
| Smoking cessation- reduces the 10-yr all cause mortality rate in claudicants from 54% to 18%. |
|
|
Term
| First step in management of claudication |
|
Definition
# smoking cessation
# exercise program
# statin and apirin
# HTN control |
|
|
Term
| Duplex finding indicative of vein grafts at high risk of thromosis |
|
Definition
| 300 cm/sec peak systolic velocity at the site of stenosis |
|
|
Term
| Indications for lumbar sympathectomy |
|
Definition
# (not for non-healing ulcers)
# Complex regional pain syndrome (reflex sympathetic dystrophy)
# lower extremity Raynaud syndrome that fails medical management |
|
|
Term
| Worrisome cause of early postoperative PSA of aortobifem anastamosis |
|
Definition
|
|
Term
| MC bacterial pathogen a/w infected femoral anastomotic PSA |
|
Definition
|
|
Term
| MCC cause of late anastomotic PSA |
|
Definition
| deterioration of graft or suture material |
|
|
Term
| Management of late anastomotic PSA |
|
Definition
| Surgery: resection of the diseased segment of artery and graft and placing an interposition prosthesis connecting ligated end of old graft in an end-to-end fashion to the SFA and PFA |
|
|
Term
| Progression of sx in acute limb ischemia |
|
Definition
# numbness of toes and slightly decreased sensation to light touch or pin prick
# complete anesthesia of the foot (indicative of tissue loss)
# weakness -> paralysis |
|
|
Term
| Physical exam findings indicative of irreversible ischemic changes in a lower extremity |
|
Definition
# anesthesia and paralysis
# palpable firmenss of the muscle and stiffness of the extremity |
|
|
Term
| Management of acute aortic occlusion |
|
Definition
# if caused by saddle embolus from afib, acute MI, sudden thrombosis of AAA, dissection-> B/L transfemoral embolectomies
# if pt has a h/o claudication or PVD, either aortobifem or ax-bifem depending on timing |
|
|
Term
| Factors a/w good healing of BKA site |
|
Definition
# presence of a palpable pulse just above the amp site - popliteal
# Trancutaneous oximetry readings > 40 mm
# SBP > 70 mm Hg (in popliteal for a BKA) as measured by a Doppler ultrasound and a BP cuff |
|
|
Term
| Factors a/w with non-healing of a BKA |
|
Definition
# presence of gangrene above the ankle
# Transcutaneous oximetry < 20 mm Hg |
|
|
Term
| Management of acute ischemia in an infant s/p catheterization |
|
Definition
# first step is heparin, hydration and rewarming of the extremity
# if surgery needed, papaverine injection into the vessel prior to manipulation due to the greater muscle component of infant vessels
# close arteriotomy with patch to prevent narrowing
# use saphenous vein reinforced with Dacron if replacement vessel needed
# suturing with interrupted sutures to allow for growth of the artery |
|
|
Term
| Possible long term complication of transfemoral catheterization |
|
Definition
| # chronic femoral occlusion which could lead to limb length discrepancy |
|
|
Term
| Carpenter who is 2 yrs s/p CABG who p/w angina, fatiguability of left arm and found to have must lower BP in left arm |
|
Definition
| Coronary-subclavian steal syndrome: SCA stenosis proximal to take off of IMA; Use of L arm causes vasodilation in that arm and blood preferentially flows to arm retrograde via the IMA, away from heart) |
|
|
Term
| Angiographic appearance of popliteal cystic adventitial dz |
|
Definition
| # Scimitar sign- looks like a curved blade |
|
|
Term
| Management of popliteal cystic adventitial dz |
|
Definition
| Resection of diseased portion of artery and transposition graft |
|
|
Term
| Presentation of persistance of the sciatic arter |
|
Definition
| # pt with LE ischemia, apparent occlusion of SFA and pulsatile butt mass (artery is often aneurysmal)- may cause acute and critical ischemia if thrombus from aneurysm embolizes |
|
|
Term
| 5-yr risk of limb loss in a pt p/w claudication |
|
Definition
|
|
Term
|
Definition
# 1 pt each for: h/o CAD, IDDM, h/o CVA, Cr > 2, h/o CHF, and high risk surgery (aortic, thoracic, major abdominal)
# 0 = Class I = very low risk (0.4% complications)
# 1 pt = Class II = low risk (0.9%)
# 2 pts = Class III = mod risk (6%)
# > 3 pts = Class IV = high risk (>11%) |
|
|
Term
| Minimal preoperative medical management for high risk vascular surgery |
|
Definition
| # BB and statin for Revise Cardiac Index score of 0 or 1 |
|
|
Term
| MC type, location, side, and demographic for fibromuscular dysplasia |
|
Definition
# medial fibroplasia
# Renal artery
# R > L
# young multiparous women |
|
|
Term
| MCC of arterial complications of Thoracic Outlet syndrome |
|
Definition
|
|
Term
| Nerve most commonly affected and sx in neurogenic TOS |
|
Definition
| Ulnar nerve producing pain and parasthesias in the medial arm and 4th and 5th fingers |
|
|
Term
| 5-yr survival rate of pts with claudications and MCC of death |
|
Definition
| 70%; 40-60% die of CAD and 10-20% die of cerebrovascular disease |
|
|
Term
| Earliest identifiable lesion in atherosclerosis |
|
Definition
|
|
Term
| Contraindication to using cilostizol |
|
Definition
|
|
Term
| Beneficial effects of cilostazol in claudicants |
|
Definition
# inhibition of platelet aggregation
# inhibition of smooth muscle proliferation
# increases vasodilation
# lowers TG levels
# lowers HDL |
|
|
Term
| Likely cause of acute unilateral finger ischemia in a young healthy person |
|
Definition
| Embolus from atherosclerotic plaque in a subclavian artery aneurysm from TOS (causes a post-stenotic aneurysm) |
|
|
Term
|
Definition
Triad:
# buttock or thigh claudication
# impotence
# absent femoral pulses |
|
|
Term
| Sx of hypothenar hammer syndrome |
|
Definition
# digital pain
# numbness and tingling
# weakness of grip
# discoloration of fingers
# digital ulceration |
|
|
Term
| Pathogenesis of hypothenar hammer syndrome |
|
Definition
| # repetitive trauma to the ulnar artery causes fibromuscular dysplasia in the artery, aneurysmal degeneration, thrombus formation and distal embolization |
|
|
Term
| Management of hypothenar hammer syndrome |
|
Definition
| Resection of the diseased portion of the ulnar artery and reconstruction using vein graft |
|
|
Term
| Dysphagia lusoria: meaning and MCC |
|
Definition
| Dysphagia by a freak of nature most commonly caused by a Kommerell diverticulm- a diverticulum at the origin of an atretic aortic arch leftover from an abnormal regression of vestigial aortic arch |
|
|
Term
| Management of splenic artery aneurysm |
|
Definition
# in women of childbearing age: resection and splenectomy
# if symptomatic- immediate repair
# men or asx women not of child-bearing age- observation if < 2 cm; repair if > 3 cm |
|
|
Term
| Management of femoral atery pseudoaneurysms from cardiac cath procedures |
|
Definition
# ultrasound-guided direct thrombin injection
# if infected or rapidly expanding-> surgery |
|
|
Term
| MC and 2nd MC sites of aneurysms in HIV pts |
|
Definition
|
|
Term
| management of arterial aneurysms in HIV+ patients |
|
Definition
# if no advanced manifestations, reconstruction using autogenous tissue (saphenous vein, e.g.)
# if advanced HIV with short life expectancy, endovascular repair |
|
|
Term
| Features of an inflammatory AAA |
|
Definition
# thickened aneurysmal wall
# extensive peri-aneurysmal and RP fibrosis
# dense adhesions to adjacent abdominal structures |
|
|
Term
| Structures that may be involved in inflammatory AAA |
|
Definition
# RP structures
a. 4th portion of duodenum
b. IVC
c. left renal vein
d. ureters |
|
|
Term
| Way to approach adherence of an inflammatory AAA that involves the duodenum |
|
Definition
| # DO NOT DISECT ANEURYSM OFF THE DUODENUM |
|
|
Term
| Meaning of hydronephrosis in a pt with an inflammatory AAA and natural history |
|
Definition
# inflammation involves the ureters
# hydronephrosis resolves after repair |
|
|
Term
| Way to approach adherence of an inflammatory AAA that involves the L renal vein |
|
Definition
# ideally via a L RP approach and elevation of the kidney;
# if not, ligate the renal vein close to the IVC |
|
|
Term
| Risk of rupture of an inflammatory AAA compared to a non-inflammatory AAA |
|
Definition
|
|
Term
| Criteria for AAA amenable to EVAR |
|
Definition
# 15 mm proximal neck
# max diameter of neck 25-30 mm
# < 60 degree angulation
# adequat access vessels (??)) |
|
|
Term
| Indications for intervention in RAS |
|
Definition
# Sudden worsening of pre-existing HTN
# resistant HTN despite at least 3 meds
# worsening renal function after ACEi
# unexplained atrophy of one kidney
# HTN resulting in end-organ damage such as renal insufficiency or recurrent CHF |
|
|
Term
|
Definition
# type I: Heparin Induced Thrombocytopenia- within first 2 days of administration and recovers despite continued heparin administration
# type II: causes clotting in venous and arterial system |
|
|
Term
|
Definition
| Clott of HIT type II because it is platelet rich and devoid of red cells and fibrin |
|
|
Term
| Complications of heparin use |
|
Definition
# HIT
# skin necrosis
# Osteopenia |
|
|
Term
| Management of pt with hemodynamic instability and pulsatile abdominal mass |
|
Definition
# permissive hypotension
# open repair of AAA
# clamp aorta at diaphragm |
|
|
Term
| Predictors of colonic ischemia after open AAA repair (and arguments for IMA reimplantation) |
|
Definition
# presence of a menadering mesenteric artery
# absent doppler signals on the bowel surface
# decrease in intramural colonic pH
# IMA stump pressure < 40 mm Hg
# IMA orefice is patent and back-bleeding is poor after opening the sac |
|
|
Term
| Cause of clot formation during AAA repair and an unaffected ACT despite adequate heparin dosing and normal ACT and management |
|
Definition
| ATIII deficiency; give ffp in order to provide ATIII to the pt that the heparin could then induce. |
|
|
Term
| Incidence of B/L aneurysms in pts found to have a pop artery aneurysm |
|
Definition
|
|
Term
| Incidence of AAA in pts with popliteal aneurysmal disease |
|
Definition
|
|
Term
| MC locations for arterial aneurysms |
|
Definition
1. Aorta
2. iliac
3. popliteal (mc peripheral artery aneurysm) |
|
|
Term
| Indications for repair of popliteal artery aneurysms |
|
Definition
1) > 2 cm
2) presence of intraluminal thrombus regardless of size
3) symptomatic
4) evidence of previous embolization |
|
|
Term
| management of popliteal artery aneurysms |
|
Definition
# bypassing the aneurysm with saphenous vein and interval ligation of the pop artery
# if p/w acute ischemia, thrombolysis |
|
|
Term
| Reason why arteriography should not be used for diagnosis of pop artery aneurysms |
|
Definition
# does not accurately measure the size
# does not detect intraluminal thrombus |
|
|
Term
| Steps of operative repair of aortoenteric fistula |
|
Definition
# prox control of aorta at diaphragm
# explantation of the graft
# closure of the aortic stump in 2 layers
# closure of the duodenum
# placing omentum in the area of the stump closure
# extra-anatomic bypass |
|
|
Term
| Management algorhythm for suspected aorto-enteric fistula |
|
Definition
# UGIB in pt with h/o of aortic surgery is preseumed to have an aorto-enteric fistula
# if unstable, directly to OR and explant graft
# if stable:
* EGD, if negative
* repeat EGD with pediatric colonoscope, if equivocal
* Cat scan, if equivocal
* nuclear tagged RBC scan
# if above negative, proceed to surgery |
|
|
Term
| Management of an infected pseudoaneurysm of the CFA (from IVDU) |
|
Definition
|
|
Term
| Threshold for elective repair of iliac artery aneurysms |
|
Definition
# symptomatic: fistula creation with the iliac vein or compression of the iliac vein
# > 3.5 cm in asymptomatic pt |
|
|
Term
| Common complication of endovascular repair of iliac artery aneurysm |
|
Definition
|
|
Term
| MC presenting symptom of a popliteal artery aneurysm |
|
Definition
| acute or chronic ischemia (caused by thrombosis in 49%, followed by embolization) |
|
|
Term
| Indications for repair of AAA |
|
Definition
# if expands > 1 cm/yr
# if becomes symptomatic
# diameter > 5.5 cm in men; 4.5-5 in women
# EVAR for older, high-risk patients with shorter life expectancies; Open for younger |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Affect of compressing fistula on HR |
|
Definition
| # decrease = Branham sign |
|
|
Term
| Effect of a chronic traumatic AVF on hemodynamics |
|
Definition
# increase HR
# lower SBP and DBP
# increase in venous BP
# increase CO
# slight cardiomegaly |
|
|
Term
| MC bacteria isolated from mycotic aneurysm |
|
Definition
| # staph (Salmonella is #2) |
|
|
Term
| Pathogenesis of mycotic aneurysm |
|
Definition
| # most commonly seeding from a remote site (MC source is heart) |
|
|
Term
| MC location of mycotic aneurysm |
|
Definition
|
|
Term
| Best method of surveillance of an asx small AAA |
|
Definition
| annual ultrasound until approaches 5 cm, then every 3-6 mo |
|
|
