Term
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Definition
| GSV/SSV are assessed with duplex US preoperatively to determine suitability for coronary artery bypass grafts (CABG)& revascularize leg with a femoro-popliteal or femoro-tibial bypass graft. |
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Term
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Definition
Cephalic vein can be used for short segment grafts.
Cephalic & Basilic are carefully evaluated pre-op for hemodialysis access placement.
The radial artery can be harvested for CABG material. |
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Term
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Definition
Determines vein suitability. Is the saphenous vein present and patent?
Is it continuous? Does it consist of a double or duplicated system? Does it harbor regions of residual thrombus?
Is it of appropriate size? |
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Term
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Definition
| Includes procedure #1 (vein suitability), but also involves mapping & marking course of vein(s). |
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Term
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Definition
| Determines the suitability of the radial artery for CABG. |
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Term
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Definition
| 90% of incompetent PVs are ≥ 3.5 mm. |
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Term
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Definition
| Rule out chronic DVT. If the GSV is functioning as a collateral , removal is contraindicated. |
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Term
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Definition
Using a 7.5-14 MHz transducer measure the diameter of the GSV at: Upper thigh, Mid thigh, Lower thigh,
Upper calf, Mid calf, Lower calf. Measure both vein segments in a bifid system. |
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Term
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Definition
Vein diameter will expand by 1.5 - 2 times when arterialized.
Vein diameters of ≥ 2.5 mm have higher graft patency rates.
Veins < 2.5 mm have high graft failure rates. |
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Term
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Definition
Advantages over saphenous v.;
Appropriate vessel caliber.
Thicker walls, less hyperplasia.
better availability (not everyone has appropriate GSV). |
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Term
| Radial Artery Harvest: Contraindications |
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Definition
Ischemic digits.
Raynaud’s syndrome.
Ipsilateral athero-occlusive disease in arm.
Sclerotic, atretic or occluded radial artery.
Incomplete palmar arch in hand. |
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Term
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Definition
Obtain bilateral brachial pressures to R/O Subclavian disease.
Scan radial artery for: Arterial stenosis. Artery occlusion. Vessel atresia. Regions of wall calcification.
Note any anatomy variations . |
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Term
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Definition
| Average inside diameter of the distal radial artery: 2.8 mm for men, 2.4 mm for women. |
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Term
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Definition
Palmar arch patency. Compress radial
and ulnar arteries. Exsanguinate
hand. Release ulnar compression. Repeat w/radial compression. |
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Term
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Definition
PPG sensors are placed on thumb or index finger & 5th digit.
Radial Artery is compressed.
Observe/record changes in the PPG trace of the two digits.
There should be no, or little, drop in the PPG amplitudes. Repeat w/ulnar compression. |
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Term
| Types of Interventional Procedures: Lower Extremities |
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Definition
Bypass Graft
Synthetic: Polytetrafluoroethylene (PTFE),Dacron.
Autogenous Vein Grafts: Reversed, In situ.
Percutaneous angioplasty (PTA)
Stents |
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Term
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Definition
| The entire graft, as well as inflow & outflow, should be evaluated for stenosis. Careful attention should be given to the anastomotic sites looking for graft failure & infection. |
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Term
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Definition
Used in CFA to distal SFA or proximal popliteal a.
Newer flexible fabrication may allow placement to extend below knee. |
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Term
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Definition
Often used for fem-fem, & iliac grafts.
Advances in Dacron now allow femoral-distal bypass grafts. |
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Term
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Definition
Used to bypass fem-pop occlusion.
Graft often extended from CFA to distal tibial artery (aka, fem-distal graft). Vein grafts appear to have better patency rates than synthetic grafts in legs. Uses GSV in it’s native bed, not removed. Valve leaflets are excised with a valvulatome. Perforators / tributaries are ligated. Proximal & distal ends of vein are connected to artery. |
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Term
| In Situ Graft Complication |
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Definition
| A-V fistula due to a non-ligated perforator vein. Can’t happen in a reverse vein bypass. |
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Term
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Definition
Veins & arteries harvested from cadavers.
SSV is used for small segments or for graft revisions.
Cephalic or basilic veins in arm may be used for small graft extensions or revisions. |
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Term
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Definition
Perforating veins & tributaries are ligated & cut. GSV is removed.
Vein is reversed & implanted as bypass.
Valves are not excised. Can be used in contralateral leg. |
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Term
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Definition
Graft inflow, outflow & anastomosis.
Entire graft for: Stenosis, Wall irregularity, Aneurysm, Pseudoaneurysm,
A-V in non-ligated perforators (in situ only). Partially excised valve leaflets. |
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Term
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Definition
Proximal to, at & distal to a stenotic segment. Artery segment proximal to graft. Within the graft:Proximal graft,
Mid graft, Distal graft segments. Artery segment distal to the graft. |
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Term
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Definition
Velocities should be >40 cm/sec.
Velocities in normal reversed vein grafts will decrease distally as diameter becomes larger.
> 50% graft stenosis : Focal velocity acceleration followed by post stenotic turbulence.
PSV ≥150 cm/sec and velocity ratio of ≥ 2.0.
If velocity ratios are ≥ 3.5 & PSVs exceed 300 cm/sec, stenosis is unlikely to regress & intervention is recommended to prolong graft patency. |
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Term
| Stent Sites: Peripheral Vascular |
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Definition
| Aorta, Renals, Iliacs, Fem-Pop. |
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Term
| Peripheral Stent Criteria |
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Definition
| Obtain post operative velocity within stent. Use this as a reference during follow-up exams. |
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Term
| Endoluminal AAA Repair (EVAR) |
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Definition
Complications include: Graft infection.
Vessel rupture during deployment. Distal embolization. Endoleak. |
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Term
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Definition
| ABI. Assess Aorta from diaphragm to bifurcation of iliac arteries, & to CFA bilaterally. Measure aneurysm outside diameter, its length, & residual lumen. Does aneurysm extend above the renal arteries? Measure diameter of aorta proximal to aneurysm, & if possible, the distance between left renal artery & aneurysm. To allow for proper stent anchoring, there should be at least 1 cm of normal aorta between the left RA & aneurysm. Measure the diameter of the iliac arteries. Measurements of proximal & distal anchoring sites enable correct size selection of stent. |
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Term
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Definition
ABIs. Monitor for patency. Same position or has it moved proximally or distally? Look for low velocity endoleaks. Look for retroperitoneal fluid that may represent a leak outside of aorta. Measure diameter of aorta.
DO NOT OBTAIN SEGMENTAL PRESSURE WITH CUFF OVER A FEMORAL, POPLITEAL OR TIBIAL STENT. |
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