vascular.txt

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Author:
nsmallwood
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125949
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vascular.txt
Updated:
2012-01-04 20:35:48
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vascular
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  1. how does fatty build up in the arterial wall cause luminal narrowing and HTN
    smooth muscle proliferation
  2. most important RF for stroke
    HTN
  3. 2nd MC source of emboli
    heart
  4. signs of amaurosis fugax on ophthalmic exam
    hollenhorst plaques
  5. signs of stroke in ant cerebral artery
    • mental status changes
    • slowing
  6. time frame for CEA after a completed stroke
    6 weeks
  7. most important technical part to CEA
    getting a good distal end point without an intimal flap
  8. what pressure is indicated for shunting during CEA
    <40
  9. MC injured nerve with CEA
    vagus
  10. location of ext branch of sup laryngeal
    posterior to carotid just superior to bifurcation
  11. injury to this nerve occurs with a high dissection
    hypoglossal
  12. nerves which could be injured during CEA
    • vagus
    • marginal mandibular
    • ext branch of sup laryngeal
    • hypoglossal
    • glossopharyngeal
    • ansa cervicalis
  13. most likely problem in a pt taken back to OR after CEA where the doppler shows poor flow
    stenosis at the arteriotomy
  14. mgmt of neuro changes multiple days post op from CEA
    • u/s and reoperate if no flow
    • angio to look for flap
    • CT head and start heparin if no hemorrhagic component
  15. MCC of mortality following CEA
    MI
  16. restenosis rate following CEA
    15%
  17. best indications for carotid stents
    • stenosis post CEA
    • neck XRT
    • medically unfit
  18. sxs of carotid body tumors
    painless neck mass with bruit
  19. MCC of PVD
    atherosclerosis
  20. source of stenosis for mid thigh pain
    ext iliac
  21. source of vascular dz for foot claudication
    dist SFA or popliteal
  22. leriche syndrome
    • no fem pulses
    • buttock/thigh claudication
    • impotence
  23. where is the vascular lesion in Leriche syndrome
    above aortic bifurcation
  24. indications for revascularization in PVD
    • lifestyle limiting despite max medical tx
    • rest pain
    • tissue loss/ulcers
    • atheromatous embolization
  25. what is the pathology observed after PTA
    the intima is ruptured and the media is stretched
  26. tx for isolated common femoral lesion
    PTA + stent
  27. bypasses distal to knee are only indicated when
    limb or tissue salvage
  28. best predictor of long term patency in extremity vein graft
    vein quality
  29. late swelling following lower ext bypass
    likely DVT
  30. MCC of late failure of reversed saphenous vein graft
    atherosclerosis
  31. tx of popliteal entrapment syndrome
    rsxn of medial head of gastrocnemius
  32. sxs of adventitial cystic disease
    intermittent claudication with changes noted with knee flexion and extension
  33. arterial autograft for renal artey repair in children
    internal iliac
  34. incisions for fasciotomies
    • 2 cm below tibia
    • 2cm above fibula
  35. nerve injured with fasciotomy
    sup peroneal
  36. late hemorrhage or pseudoaneurysm after bypass graft is
    caused by graft infxn
  37. mcc overal vs acute graft infection
    • overall staph epi
    • acute staph aureus
  38. most sensitive test for graft infxn
    tagged WBC
  39. best tx for subclavian aa stenosis
    pta + stent
  40. mortality rate for AKA and BKA
    50% within 3 years
  41. where do foot ulcers occur in diabetics
    at metatarsal heads and heel
  42. tx of heel ulceration exposing calcaneus
    amputation
  43. abx for dry gangrene of diabetic ulcer
    augmentin
  44. abx for diabetic foot ulcers
    • unasyn + gent
    • fluoroquin + clinda
  45. what pt gets screened for AAA
    men smokers bwtween 65-75
  46. zinc dependent enzymes implicated in AAA
    metal matrix metalloproteinases
  47. MC site of rupture of AAA
    left posterolateral wall 2-4 cm below renals
  48. increase risk of rupture in AAA is associated with
    • diastolic HTN
    • COPD
  49. criteria to repair AAA
    • > or = 5.5cm
    • mycotic
    • symptomatic
    • > 0.5 cm/yr growth
  50. indications for reimplantation of IMA in AAA repair
    • back pressure < 40
    • previous colonic surgery
    • SMA stenosis
    • if flow to left colon appears inadequate
  51. re-implantation of internal iliac aa in AAA surgery prevents
    • vasculogenic impotence
    • pelvic ischemia
    • spinal cord problems
    • rectosigmoid ischemia
  52. MCC of late death in repair of AAA
    renal failure
  53. Major vein injury with proximal aortic clamp
    retro-aortic left renal vein
  54. incidence of impotence in AAA repair
    50%
  55. best test to diagnose ischemic colitis s/p aaa repair
    c-scope
  56. MC late complication after aortic graft placement
    atherosclerosis
  57. where is the cisterna chyli
    just right of the aorta near renal artery
  58. initial treatment for leg ischemia post ABF
    heparinize then go back to OR
  59. when do aortoduodenal fistulas typically take place
    > 6mo
  60. how do you prevent aortoduodenal fistulas
    cover suture line with aneurysm sac
  61. landing zones needed for EVAR
    • > or = 1.5 cm
    • < or = 3cm Diameter
  62. tx of type I endoleak
    • balloon area
    • if this does not work place another graft proximal or distal
  63. tx for type II endoleak
    can watch for 6 months and operate if not getting better or sac getting larger
  64. tx of type III leak
    place graft across joining site
  65. tx of type IV leak
    place another graft inside
  66. signs and sxs of inflammatory aortic aneurysms
    • weight loss with increase ESR
    • thickened wall peripheral to calcifications
    • adhesions to 3rd/4th portion of duodenum
    • ureteral entrapment
  67. MCC of mycotic aneurysm
    salmonella
  68. tx indications for iliac aneurysms of the extremity
    • sxs
    • > 3 cm
    • mycotic
  69. best tx for iliac aneurysm
    stent across
  70. size criteria to fix femoral aneurysm
    2.5cm
  71. tx for femoral aa aneurysm
    bypass with exclusion
  72. MC peripheral aa aneurysm
    popliteal
  73. size criteria to fix popliteal aa aneurysm
    2 cm
  74. size criteria for renal aa aneurysm
    > 1.5 cm
  75. tx intrahepatic hepatic aa aneurysms
    coil embolization
  76. MC visceral aa aneurysm
    splenic
  77. criteria for repair of splenic aa aneurysm
    • sx
    • pregnancy or child bearing age
    • size > 3-4 cm
  78. MC site of obstruction from emboli
    common fem
  79. best tx for pt with arterial emboli and intact motor/sens
    catheter directed tPA
  80. vascular contraindication for catheter directed tPA
    common fem or more proximal clot

    ( i.e you cant feel a fem pulse)
  81. tx for acute arterial thrombosis
    • non threatened leg- heparin alone for mild sxs and tPA for moderate
    • threatened leg- thrombectomy
  82. MC vessels in fibromuscular dysplasia
    renal> carotid > iliac
  83. best test for fibromuscular dysplasia
    angiogram
  84. syndrome with associated with uterine rupture
    ehlers-danlos
  85. what should you avoid in ehlers danlos
    angiograms
  86. manifestation of polyarteritis nodosa
    aneurysms that thrombose in medium size arteries
  87. mc involved artery in PAN
    renals
  88. dx of Kawasakis requires
    • 5 days of fever + 4 of:
    • erythema of lips oral cavity
    • rash on trunk
    • swelling or erythema of hands/feet
    • red eyes
    • swollen LNs
  89. MCC of death in Kawasakis
    arrhythmias
  90. tx Kawasakis
    • IVIG
    • ASA
    • steroids
    • CABG for aneurysms
  91. early manifestation of radiation arteritis
    obliterative endarteritis
  92. late manifestation of radiation arteritis
    fibrosis + stenosis
  93. what are you checking for with an angiogram for steal after AVF
    arterial obstruction proximally
  94. CHF from acquired AVF is suggested by what examination technique
    compression of graft outflow results in decreased HR
  95. DDx of abdominal pain after CABG
    • pancreatitis
    • Mesenteric ischemia
    • acalculous cholecystitis
    • ischemic colitis
    • ischemic liver
  96. ulceration in venous insuff occurs where
    above and post to maleoli
  97. MC infxn in lymphedema
    strep

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