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48 Cards in this Set
- Front
- Back
what is atherosclerosis?
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diffuse disease process in arteries; atheromas containing cholesterol and lipid form w/in the intima and inner media, often accompanied by ulcerations and smooth muscle hyperplasia
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what is the common theory of how atherosclerosis is initiated?
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endothelial injury --> platelet adhere --> growth factors released --> smooth muscle hyperplasia/plaque deposition
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what are the risk factors for atherosclerosis?
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HTN, SMOKINT, diabetes mellitus, family hx, hypercholesterolemia, high LDL, obesity, sedentery lifestyle
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what are the common sites of plaque formation in arteries?
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branch points (carotid bifurcation), tethered sites (superficial femoral artery in hunter's canal in the left)
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what must be present for a successful arterial bypass operation?
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1. inflow (e.g., patent aorta). 2. outflow (e.g., open distal popliteal artery). 3. run off (e.g., patent trifurcation vessels down to the foot)
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what is the major principle of safe vascular surgery?
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get PROXIMAL and DISTAL control of the vessel to be worden on
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what does it mean to POTTS a vessel?
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place a vessel loop 2x around a vessel so that if you put tension on the vessel loop it will occlude the vessel
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what is the suture needle orientation through graft v. diseased artery in a graft to artery anastomosis?
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needle in-to-out of the lumen in diseased artery to help tack down the plaque and the needle out-to-in on the graft
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what are the 3 layers of an artery?
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intima, media, adventitia
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which arteries supply the blood vessel itself?
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vaso vasorum
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what is a true aneurysm? what is a false aneurysm (AKA pseudoaneurysm)
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true: dilation (>2x nl diameter) of all 3 layers of a vessel. false: dilation of artery not involving all 3 layers (e.g., hematoma w/fibrous covering), often connects w/vessel lumen and blood swirls inside the false aneurysm
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what is endovascular repair?
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placement of a catheter in artery and then deployment of a graft intraluminally
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what is the orientation of the lower exterior arteries below the knee on A-gram?
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LAMP: lateral - anterior tibial, medial - posterior tibial
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what is peripheral vascular disease?
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occlusive atherosclerotic disease in the lower extremities
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what is the most common site of arterial atherosclerotic occlusion in the lower extremities?
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occlusion of the SFA in hunter's canal
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what are the symptoms of PVD?
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intermittent claudication, rest pain, erectile dysfunction, sensorimotor impairment, tissue loss
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what is intermittent claudication?
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pain, cramping, or both of the lower extremity, usually the calf muscle, after walking a specific distance; then the pain/cramping resolves after stopping for a specific amt of time while standing; this pattern is reproducible
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what is rest pain?
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pain in the foot, usually over the distal metatarsals; this pain arises at rest (classically at night, waking up the patient)
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what classically resolves rest pain?
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hanging the foot over the side of the bed or standing; gravity affords extra flow to ischemic areas
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how can vascular causes of claudication be differentiated from nonvascular causes, such as neurogenic claudication or arthritis?
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history (in vast majority of patients) and noninvasive tests; remember, vascular claudication appears after a specific distance and resolves after a specific time of rest while standing (not so w/most other forms of claudication)
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what is the DDx of lower extremity claudication?
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neurogenic (e.g., nerve entrapment/discs), arthritis, coarcation of the aorta, popliteal artery syndrome, chronic compartment syndrome, neuromas, anemia, diabetic neuropathy pain
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what are the signs of PVD?
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absent pulses, bruits, muscular atrophy, decreased hair growth, thick toenails, tissue necrosis/ulcers/infection
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what is the site of a PVD ulcer v. a venous stasis ulcer?
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PVD arterial insufficiency ulcer - usually on toes/foot. venous stasis ulcer - medial malleolus (ankle).
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what is the ABI?
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ankle to brachial index --> ratio of systolic blood pressure at the ankle to systolic blood pressure at the arm (brahcial artery) A:B; ankle pressure taken w/doppler, ABI is noninvasive
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what ABIs are associated w/normals, claudicators, and rest pain?
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normal ABI >=1.0, claudicator ABI <0.6, rest pain ABI <0.4
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who gets false ABI readings?
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patients w/calcified arteries, especially those w/diabetes
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what are PVRs?
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pulse volume recordings --> pulse wave forms are recorded from lower extremities representing volume of blood per heart beat at sequential sites down leg; large wave form means good collateral blood flow (noninvasive using pressure cuffs)
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prior to surgery for chronic PVD, what diagnostic test will every patient receive?
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a-gram (arteriogram: dye in vessel and x-rays) maps disease and allows for best treatment option (i.e., angioplasty v. surgical bypass v. endarterectomy); gold-standard for diagnosing PVD
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what is the bedside management of a patient w/PVD?
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1. sheep skin (easy on the heels). 2. foot cradles (keeps sheets/blankets off feet). 3. skin lotion to avoid further cracks in the skin that can go on to form a fissure and then an ulcer
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what are the indications for surgical treatment in PVD?
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STIR: severe claudication refractory to conservative tx that affects quality of life/livelihood, tissue necrosis, infection, rest pain
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how does aspirin work for PVD tx?
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inhibits platelets (inhibits cyclooxygenase and platelet aggregation)
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how does trental (pentoxifylline) work?
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results in increased RBC deformity and flexibility
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what is the treatment of claudication?
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for the vast majority, conservative treatment, including exercise, smoking cessation, treatment of HTN, diet, aspirin, w/ or w/o Trental (pentoxifylline). (remember PACE: pentoxifylline, aspirin, cessation of smoking, exercise)
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what is the risk of limb loss w/claudication? w/rest pain?
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w/claudication: 5% limb loss at 5 yrs, 10% at 10 yrs. w/rest pain: >50% of patients will have amputation of limb at some point.
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in the patient w/PVD, what is the main postop concern?
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cardiac status, b/c most patients w/PVD ahve coronary artery disease, ~20% have an AAA. MI is the most common cause of postop death after a PVD operation
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what is leriche's syndrome?
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buttock claudication, impotence (erectile dysfunction, and leg muscle atrophy from occlusive disease of the iliacs/distal aorta (CIA)
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what are the tx options for severe PVD?
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1. surgical graft bypass 2. angioplasty - balloon dilation 3. endarterectomy - remove diseased intima and media 4. surgical patch angioplasty (place patch over stenosis)
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what is a FEM-POP bypass?
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bypass SFA occlusion w/a graft from the femoral artery to the popliteal artery
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what is a FEM-DISTAL bypass?
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bypass from the femoral artery to a distal artery (peroneal artery, anterior tibial artery, or posterior tibial artery)
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what graft material has the longest patency rate?
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autologous vein graft
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what is an in situ vein graft?
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saphenous vein is more or less left in place, all branches are ligated, and the vein valves are broken w/a small hook or cut out; a vein can also be used if reversed so that the valves do not cause a problem
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what type of graft is used for above the knee FEM-POP bypass?
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either vein or gortex graft; vein still has better patency
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what type of graft is used for below the knee FEM-POP or FEM-DISTAL bypass?
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must use vein graft; prosthetic grafts have a prohibitive thrombosis rate?
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what is dry gangrene? wet gangrene?
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dry gangrene: dry necrosis of tissue w/o signs of infection (mummified tissue). wet gangrene: moist necrotic tissue w/signs of infection?
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what is blue toe syndrome?
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intermittent painful blue toes (or gingers) due to microemboli from a proximal arterial plaque
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what are the indications for lower extremity amputations?
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irreversible tissue ischemia (no hope for revascularization bypass) and necrotic tissue, severe infection, severe pain w/no bypassable vessels, or if patient is not interested in a bypass procedure
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what are the level of lower extremity amputations?
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above the knee (AKA), below the knee (BKA), symes amputation (ankle), transmetatarsal amputation, toe amputation
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what is a ray amputation?
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removal of toe and head of metatarsal
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