Term
|
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
|
Definition
|
|
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
|
|
Term
| MCC cerebral ischemic events? |
|
Definition
| arterial embolization (not thrombosis) |
|
|
Term
| MC sources of cerebral emboli? |
|
Definition
|
|
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
|
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
|
|
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
|
Definition
|
|
Term
| mgmt of facial vein during CEA? |
|
Definition
|
|
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
|
|
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
|
Definition
|
|
Term
| post-op CEA cause of HTN? |
|
Definition
|
|
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
|
Definition
|
|
Term
| Re-stenosis rate after CEA? |
|
Definition
|
|
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
|
Definition
subclavian
(combine to form basilar a, which splits into two posterior cerebral aa) |
|
|
Term
|
Definition
diplopia, vertigo, tinnitus, drop attacks,
-tx = PTA and stent |
|
|
Term
| origin of carotid body tumors? |
|
Definition
|
|
Term
|
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
|
|
Term
| % risk Endovascular vs open of mortality/paraplegia |
|
Definition
|
|
Term
| how to help avoid paraplegia with open repair? |
|
Definition
| reimplant intercostal arteries below T8 |
|
|
Term
|
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
|
|
Term
| surgical approach to open type B dissection repair? |
|
Definition
left thoracotomy
(fenestration also an option) |
|
|
Term
| % that get AAA after dissection? |
|
Definition
|
|
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
|
|
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
|
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
|
|
Term
open AAA complications
% mortality at elective repair? |
|
Definition
|
|
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
|
|
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
|
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
|
Definition
|
|
Term
| presentation of mycotic aneurysm? |
|
Definition
pain, fevers, 50% w/+ve BCx
-peri-aortic gas, fluid |
|
|
Term
| mycotic aneurysm surgical option? |
|
Definition
|
|
Term
| MC org aortic graft infections? |
|
Definition
staph #1
E coli #2
MC in groin grafts |
|
|
Term
|
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
|
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
|
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
|
|
Term
| best test for post bypass surveillance? |
|
Definition
|
|
Term
| best method for inc patency and dec CV events after LE bypass? |
|
Definition
|
|
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
|
|
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
|
|
Term
| nerve injured with lateral incision for fasciotomies? |
|
Definition
|
|
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
|
|
Term
|
Definition
| bilateral femoral cut downs, embolectomies |
|
|
Term
| MC location for atheroma embolization? |
|
Definition
|
|
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
|
|
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
|
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
|
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
|
Definition
PTA w/stent
-2nd option = Carotid CS bypass
-intervene for limb/neurogenic sx (vertebrobasilar sxs) |
|
|
Term
|
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
|
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
|
Definition
cervical rib and 1st rib resection
anterior scalene division |
|
|
Term
|
Definition
-effort induced thrombosis (paget-von schrotter disesase, baseball players)
-(venou>>>arterial origin of TOS, but nero symptoms MC than vascular) |
|
|
Term
|
Definition
-venography gold standard (but can get duplex)
-for artery duplex vs angiogram |
|
|
Term
|
Definition
compression from anterior scalene hypertrophy (weight lifters)
-hand pain, cold/pale hand
- |
|
|
Term
|
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
|
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
|
|
Term
| MC location of embolci occlusion causing mesenteric ischemia? |
|
Definition
|
|
Term
| tx embolic mesenteric ischemia? |
|
Definition
| embolectomy-->resect bowel |
|
|
Term
|
Definition
-divide Lig of Treitz
-SMA located to the right, near base of transverse colon mesentery |
|
|
Term
|
Definition
| chronic problems (Food fear, weight loss) |
|
|
Term
| Mesenteric vein vs SMA thrombosis difference? |
|
Definition
| mesenteric vein usually short segment, tx with anticoag |
|
|
Term
|
Definition
watershed
(griffiths = splenic flex, Sudak = upper rectum) |
|
|
Term
|
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
|
|
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
|
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
|
|
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
|
Definition
popliteal artery
-MCC athero dz
-rare rupture
-1/2 BL, 1/2 have another aneurysm (AAA, fem etc) |
|
|
Term
|
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
|
|
Term
|
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
|
|
Term
|
Definition
young F
HTN if DZ at renals
headache/stroke if DZ at carotids |
|
|
Term
| MC vessels involved in FMD? |
|
Definition
|
|
Term
| imaging appearance of FMD? |
|
Definition
|
|
Term
|
Definition
|
|
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
|
Definition
| severe rest pain w/ulceration, digit gangrene, |
|
|
Term
|
Definition
fibrillin defect
-cystic medial necrosis |
|
|
Term
|
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
|
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
|
Definition
-Ca channel blockers
-warmth |
|
|
Term
|
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
|
Definition
radial a to cephalic v
-wait 6 weeks to use |
|
|
Term
|
Definition
|
|
Term
|
Definition
| venous valve incompetence (90%) |
|
|
Term
| venous ulcer MC location? |
|
Definition
| above and post to medial malleoli |
|
|
Term
|
Definition
|
|
Term
|
Definition
zinc oxide and calamine compression wraps
=cure 90% of venous ulcers |
|
|
Term
| Contraindication to vein stripping? |
|
Definition
|
|
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
|
Definition
|
|
Term
| Migrating thrombophlebitis a/w..? |
|
Definition
|
|
Term
| Findings on normal venous doppler us? |
|
Definition
| augmented flow with distal compression/release of proximal compression |
|
|
Term
|
Definition
| prevent clots by decreasing venous stasis and increasing tPA release |
|
|
Term
|
Definition
left leg 2x more than right
-longer left iliac vein gets compressed by right iliac artery |
|
|
Term
|
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
|
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
|
|
Term
| Contraindications to vein stripping? |
|
Definition
DVT
outflow obstruction
pregnancy |
|
|
Term
| lymphatic histo findings? |
|
Definition
|
|
Term
| where are lymphatics NOT found? |
|
Definition
bone/muscle/tendon/cartilage
brain
cornea |
|
|
Term
| which lymphatics have valves? |
|
Definition
|
|
Term
|
Definition
| secondary lymphedema (MC ALND vs Breast CA) |
|
|
Term
|
Definition
| woody edema 2/2 subcutaneous fibrosis |
|
|
Term
| MC infection with lymphedema? |
|
Definition
|
|
Term
| MC location of congenital lymphedema? |
|
Definition
|
|
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
|
Definition
groin after surgery
-leaks clear fluid |
|
|
