ABITE ch 27 vascular.txt

  1. Most common congenital hypercoagulaboe disorder
    Leiden factor (resistance to protein C)
  2. Most common aquired hypercoagulability disorder
  3. Macrophages that have absorbed fat and lipids in the blood vessel wall
    Foam cells
  4. Exposure of collagen in vessel wall and eventual throbus formation
    Intimal disruption
  5. Atherosclerosis: layer that it effects
  6. Hypertension: layer that it effects
  7. 3rd most common cause of death in US
  8. amount of blood supply provided to brain by carotids
  9. flow pattern of a normal internal carotid artery
    continuous forward flow
  10. normal flow pattern of the external carotid artery
    triphasic flow
  11. 1st branch of external carotid artery
    superior thyroid
  12. vessels that provide communication between internal carotid and external carotid (2)
    ophthalmic artery, internal maxillary artery
  13. most commonly diseased intracranial artery
    middle cerebral artery
  14. most common source of cerebral ischemic events
    arterial embolization from ICA
  15. symptoms associated with anterior cerebral artery events
    mental status changes, release, slowing
  16. symptoms associated with middle cerebral artery events
    contralateral motor and speech, face droop
  17. occlusion of ophthalmic branch of ICA causing transient visual effects
    amaurosis fugax
  18. candidates for CEA
    >= 70% stenosis and symptoms
  19. stump pressures requiring shunt during CEA
  20. most commonly injured cranial nerve during CEA
  21. complications of CEA
    stroke, pseudoaneurysm, hypertension, MI
  22. signs of vertebrobasilar insufficiency (7)
    diplopia, dysarthria, vertigo, tinnitus, drop attack, incoordination, binocular vision loss
  23. tumor presenting as painless neck mass near bifurcation of carotid
    carotid body tumor
  24. symptoms of ascending aortic aneurysm
    aortic insufficiency, back pain, voice changes, dyspnea, dysphagia
  25. indications for repair of ascending aortic aneurysm (4)
    >=7cm, >=6cm with Marfan�s, diameter 2X normal, rapid increase in size
  26. aneurysm classification for those with any ascending aortic involvement
    Class A
  27. Aneurysm classification for those with descending involvement only
    Class B
  28. DeBakey classification for aneurysms with ascending an descending involvement
    Type I
  29. DeBakey classification for aneurysms with ascending involvement only
    Type II
  30. DeBakey classification for aneurysms with descending involvement only
    Type III
  31. Layer of blood vessel where dissection occurs
  32. Ascending aortic dissections that need operative repair
    ALL of them
  33. Descending aortic dissections that need operative repair
    Visceral, renal or leg ischemia, persistent pain, large size
  34. Artery perfusing spinal cord, whose injury causes paraplegia if occluded during repair
    Artery of Adamkiewicz
  35. Symptoms of AAA
    Rupture, distal embolixation, compression of adjacent organs
  36. Rupture risk of AAA 5cm
    15-20% 5-year
  37. rupture risk of AAA >8cm
    100% 5-year
  38. indications for AAA repair (3)
    symptomatic, >5cm, growth >0.5cm/yr
  39. situations when IMA should be reimplanted during AAA repair
    backpressure <40mmHg, previous colon surgery, SMA stenosis, inadequate flow to colon
  40. bloody diarrhea after AAA: dx?
    Ischemic colitis
  41. Organisms common in mycotic aneurysms (2)
    Salmonella, staph
  42. Treatment of mycotic aneurysm
    Extraanatomic bypass, resection of infected portion of aorta
  43. Organisms common in aortic graft infections (2)
    Staph, E.coli
  44. Treatment of aortic graft infection
    Resect graft, bypass through noncontaminated field
  45. Herald bleed with hematemesis, then blood per rectum ~6mos after AAA
    Aortoenteric fistula
  46. Treatment of aortoenteric fistula
    Axillary bifem, graft resection
  47. Endoleak that is proximal, distal, or through the stent
    Type I endoleak
  48. Endoleak that is persistent blood flow through lumbars or IMA
    Type II endoleak
  49. Nerve and vessel in anterior compartment of leg
    Deep peroneal nerve, anterior tibial artery
  50. Nerve in lateral compartment of the leg
    Superficial peroneal nerve
  51. Nerve and 2 vessels in the deep posterior compartment of the leg
    Tibial nerve, posterior tibial and peroneal arteries
  52. Nerve in superficial posterior compartment of the leg
    Sural nerve
  53. Treatment of homocysteinuria
    Folate, B6, B12
  54. Yearly risk of gangrene and amputation with claudication
    2%/year and 1%/year
  55. symptoms of aortoiliac occlusion
    buttock pain
  56. symptoms of external iliac occlusion
    midthigh claudication
  57. symptoms of common femoral or proximal superficial femoral artery occlusion
    calf claudication
  58. symptoms of distal SFA or popliteal disease
    foot claudication
  59. syndrome with a lesion at or above aortic bifurcation, causing lack of femoral pulse, buttock/thigh claudication, impotence
    Leriche syndroma
  60. Most common atherosclerotic occlusion in lower extremities
    Hunter�s canal (exit of SFA)
  61. ABI where claudication starts
  62. ABI where rest pain starts
  63. ABI where ulcers start (usually on toes)
  64. ABI where gangrene starts
  65. studies to find significant occlusion and at what level
    PVRs (peripheral vascular resistance studies
  66. Gold standard for vascular imaging to detect occlusion
  67. Surgical indications for PVD (4)
    Rest pain, ulceration or gangrene, lifestyle limitation, atheromatous embolixation
  68. Graft material good for aorta and large vessels
  69. Typeical repair for aortoiliac disease
    Aortobifemoral repair
  70. 5-year patency of femoropopliteal grafts
  71. 5-year patency of femoral-distal grafts
  72. complications of reperfusion of ischemic tissue (4)
    lactic acidosis, hyperkalemia, myoglobinuria, compartment syndrome
  73. tx for patients with heel ulceration to bone
  74. tx for patients with dry gangrene
    allow to autoamputate
  75. tx for wet gangrene
    amputation to remove infected necrotic tissue + antibiotics (surgical emergency)
  76. good lesions for PCTA
    common iliac lesions, short segments
  77. tx for pseudoaneurysm after arteriography
    thrombin injection (u/s guided)
  78. most common compartment of leg to get compartment syndrome
  79. pressures requiring fasciotomies
  80. mild intermittent claudication in med in their 40�s; primary symptom is loss of pulses with plantarflexion
    popliteal entrapment syndrome
  81. treatment for popliteal entrapment syndrome
    resection of medial head of gastroc
  82. intermittent claudication with changes in symptoms with knee flexion and extension
    adventitial cystic disease
  83. tx of adventitial cystic disease
    vein graft if occluded, resection of cyst
  84. 3-year mortality after BKA or AKA
  85. % of patients who walk again after BKA
  86. % of people who walk again after AKA
  87. most common cause of acute arterial emboli
    atrial fibrillation
  88. most common site of peripheral obstruction from emboli
    common femoral artery
  89. flaking of atherosclerotic emboli off abdominal aorta or branches; good distal pulses
    blue toe syndrome
  90. treatment of acute arterial thrombosis
    heparin, OR for thrombectomy (if limb threatened), angio for thrombolytics (if limb not threatened)
  91. treatment of thrombosed PTFE graft
    thrombolytics, anticoagulation
  92. source of most renal emboli
  93. most common location for renal atherosclerosis
    Left proximal 1/3, more in men
  94. Most common location for renal fibromuscular dysplasia
    Right distal 1/3, more in women
  95. Diagnostic study for renal artery stenosis
    Renal angiogram
  96. Tx of renal artery stenosis
    PTA with stent
  97. Indications for nephrectomy with renal HTN
    Atrophic kidney <6cm with persistently elevated rennin level
  98. Most common site of upper extremity stenosis
  99. Proximal subclavian artery stenosis resulting in reversal of flow through ipsilateral vertebral artery into subclavian
    Subclavian steal syndrome
  100. Treatment of subclavian steal syndrome
    Carotid to subclavian bypass or PTA
  101. Normal position of subclavian vein in relation to ribs, scalene and clavicle
    Vein passes over 1st rib anterior to anterior scalene, then behind clavicle
  102. Normal position of subclavian artery and brachial plexus in relation to ribs, scalene and clavicle
    Artery passes over 1st rib posterior to anterior scalene and anterior to middle scalene
  103. Test looking at radial pulse with head turned to the ipsilateral side
    Adson�s test
  104. Location of ulnar nerve on brachial plexus (superior, middle, or inferior)
    Inferior portion
  105. Location of radial nerve on brachial plexus (superior, middle or inferior)
    Superior portion
  106. Treatment of thoracic outlet syndrome
    Cervical rib resection, division of anterior scalenes and middle scalenes. Possible 1st rib resection
  107. Effort induced thrombosis of subclavian vein
    Paget von Schrotter disease
  108. CT findings that suggest intestinal ischemia
    Bowel wall thickening, intramural gas, portal venous air, vascular occlusion
  109. Most common cause of visceral ischemia
    Acute embolic occlusion (50%)
  110. Causes of visceral ischemia (4)
    Embolus, thrombotic occlusion, low flow state, venous thrombosis
  111. Most common source of SMA embolus
  112. Treatment of SMA embolus
    Resuscitation, antibiotics, embolectomy, resection, heparin
  113. Treatment of SMA thrombus
    Thrombectomy, SMA bypass, resection, heparin
  114. Treatment of mesenteric vein thrombosis
    Heparin, thrombolytics, thrombectomy if diagnosed early
  115. Nonocclusive mesenteric ischemia: definition
    low cardiac output state to visceral vessels caused by spasm, low-flow states, or hypovolemia
  116. most vulnerable areas for nonocclusive mesenteric ischemia (2)
    Griffiths and Sudak�s points
  117. Celiac compression causing chronic abdominal pain, weight loss, diarrhea
    Median arcuate ligament syndrome
  118. Visceral angina 30 min after meals, weight loss due to food fear
    Chronic mesenteric ischemia
  119. Most common complication of aneurysms above inguinal ligament
  120. Most common complication of aneurysms below inguinal ligament
  121. Most common visceral aneurysm in women
  122. Indications for splenic artery aneurysm repair
    Symptomatic, pregnancy, women of childbearing age
  123. Treatment of visceral, iliac and femoral aneurysm
    Exclusion and bypass graft
  124. Indications for surgery for iliac aneurysm
    Symptomatic, >3cm, mycotic
  125. Indications for surgery for femoral aneurysm
    Symptomatic, >2.5cm, mycotic
  126. Most common peripheral aneurysm
  127. % of people with popliteal aneurysm who have another aneurysm
  128. surgical indications for popliteal aneurysm
    symptomatic, >2cm, mycotic
  129. collection of blood in continuity with arterial system but unenclosed by all 3 layers of arterial wall
    femoral pseudoaneurysm
  130. disease with string of beads appearance on angiogram
    fibromuscular dysplasia
  131. gangrene of fingers>toes, severe rest pain with bilateral ulceration
    Buerger�s disease
  132. Type I collagen defect causing retinal detachment, aortic root dilatiation
    Marfan�s syndrome
  133. Collagen defect resulting in easy bruising, hypermobile joints, arterial rupture
    Ehlers-Danlos syndrome
  134. Large artery arteritis causing fever, arthralgia, visual changes, myalgia, anorexia (common in women >55)
    Temporal arteritis
  135. Large artery arteritis causing fever, arthralgia, myalgia, and anorexia (common in women <35)
    Takayasu�s arteritis
  136. Treatment of large vessel arteritis
    Steroids, bypass
  137. Medium vessel arteritis (2)
    Polyarteritis nodosa, kawasaki�s disease
  138. Small vessel arteritis, often secondary to drug/tumor antigens
    Hypersensitivity angitis
  139. Vasculitis of young women with subsequent vasoconstriction and cyanotic extremities
    Raynaud�s disease
  140. Most common failure of AV grafts for dialysis
    Venous obstruction secondary to intimal hyperplasia
  141. Indications for surgical treatment of varicose veins
    Symptomatic, recurrent ulcers, severe varicosities
  142. Disease secondary to venous incompetence
    Venous ulcers
  143. Treatment of venous ulcers
    Unna boot, ligate perforators, vein stripping
  144. Trendelenburg test
    Test of venous insufficiency: elevate leg, occlude greater saphenous, then lower leg to see how rapid the refilling of the vein is
  145. Disease with achy, swollen legs and night cramps, as well as brawny edema
    Venous insufficiency
  146. Nonbacterial inflammation of superficial veins
    Superficial thrombophlebitis
  147. Bacterial infection of superficial veins
    Suppurative thrombophletibis
  148. Self-limiting thrombophlebitis of the breast
    Mondor�s disease
  149. Methods by which SCD�s prevent clots (3)
    Decreased venous stasis, increased ATIII and tPA, increased fibrinolysis
  150. Leg more commonly affected by DVT
    Left (longer iliac vein compressed by iliac artery)
  151. Virchows triad
    Venous stasis, hypercoaguability, venous wall injury
  152. Tenderness, pallor and edema of lower extremity
    Phlegmasia alba dolens
  153. Tenderness, cyanosis and massive edema of lower extremity
    Phlegmasia cerulea dolens
  154. Source of PE when a DVT filter is in place (3)
    Ovarian veins, IVC superior to filter, upper extremities
  155. Treatment of 1st DVT
    Coumadin 6 months
  156. Treatment of 2nd DVT
    Coumadin 12 months
  157. Treatment of 3rd DVT or PE
    Lifetime Coumadin
  158. ABG changes of PE
    Dec pO2, dec pCO2, respiratory alkalosis
  159. Tissue types with no lymphatics (6)
    Bone, muscle, tendon, cartilage, brain, cornea
  160. Lymphangiosarcoma associated with breast axillary dissection
    Stewart-Treves syndrome
  161. Dilation of preexisting lymphatic channels
Card Set
ABITE ch 27 vascular.txt
ABSITE ch 27 vascular