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37 Cards in this Set
- Front
- Back
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What are the 3 layers of the artery?
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Inner: Tunica intima
Middle: Tunica Media Outer: Tunica Adventitia |
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What is the main cause of chronic impairment of arterial blood flow to the extremities?
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Arthersclerosis (#1)
thromboangiitis Obliterans Homocysteinemia Non-infective: SLE, Kawasaki, Raynauds Giant -cell Temporal arteritis, Takayasu |
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Whicht are the Intrinsic causes of arterial Insufficiency and thrombosis? Which are Extrinsic?
__Embolism __A-Fib __Akinetic LV or Ventricular thrombus from MI __Vegetations from bacterial endocarditis __ Prosthetic cardiac valves __Long bone fracture __ Spinal cord injury __ Blunt or penetrating trauma __Secondary thrombosis from prolonged hypotension |
Intrinsic:
Embolism A-Fib Akinetic LV or Ventricular thrombus from MI Vegetations from bacterial endocarditis Prosthetic cardiac valves Extrinsic: __Long bone fracture __ Spinal cord injury __ Blunt or penetrating trauma __Secondary thrombosis from prolonged hypotension |
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Which arteries do 70% of the Peripheral emboli go to?
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The lower extremities:
-Bifurcation of common femoral artery -Iliac -Popliteal (15% go to UE--Brachial mostly, rest to cerebral and visceral) |
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Common causes of thrombosis?
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1. Hemorrhage
2. Enlargement of preexisting plaque 3. Trauma- compression or intimal dissection 4. Hypercoagulable states 5. Hypotension, dehydration, or cardiogenic shock. |
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What is the #1 reason (risk factor) for PVD needing surgical intervention?
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Smoking
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Signs and Symptoms of Acute Ischemia? (hint: 5P's)
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Pain
Paralysis Paresthesia Pallor Pulselessness |
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How long does it take for irreversible damage from arterial occlusion?
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4-6 hours
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What is the emboli progression for tissue damage? (ends w/ gangrene)
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emboli impaction
Thrombotic propagation Muscle necrosis Gangrene |
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An Imflammatory process of the wall and connective tissure surrounding the areteries and veins.
It is often associated with the thrombosis and occlusion that commonly result in gangrene. a. Tamponade b. diabetic thrombus c. thromboangiitis obliterans d. none of the above |
answer: c. Thromboangiitis obliterans
Hint: Young Jewish men (age 20-40) |
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________is pain that results from activation of local sensory receptors by accumulation of pain producing metabolites and lactate, when skeletal muscle O2 demand exceeds O2 blood supply during exercise.
a. Daily rest pain b. focal tissue necrosis c. absolute claudication d. intermittent claudication |
answer: d. intermittent claudication
.... symptoms do not occur until 75% of vessel lumen is occluded |
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What is the Ankle -brachial Index? What is considered normal?
What is considered severe? |
ABI: Ankle SBP/ Brachial SBP
1.00 - 1.29 = Normal 0.91- 0.99 = Borderline 0.41- 0.90 = Mild to moderate PAD 0.00- 0.40 = Severe PAD |
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What are the fontaine stages of PAD?
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stages of the PAD with
Stage 1 being asymptomatic, stage 2 is intermittent claudication, stage 3 is daily rest pain stage 4 is focal tissue necrosis (ulcers and gangrene) |
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Match the Pain with the Occlusion site:
1. Thigh & Calf Pain ___Aortoiliac occlusion 2. foot Pain ___Superficial femoral artery occlusion 3. calf pain ___Peroneal occlusion 4. Hip and buttock pain ___Iliofemoral occlusion |
1. Thigh & Calf Pain: Iliofemoral occlusion
2. foot Pain: Peroneal occlusion 3. calf pain: Superficial femoral artery occlusion 4. Hip and buttock pain : Aortoiliac occlusion |
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What kind of pain is considered Limb threatening ischemia?
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Pain at rest. (worse at toes and worse at night when recumbent)
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What is not a PAD indication for surgery?
1. claudication at rest, 2. ulcers, 3. gangrene 4. ischemia threatening the loss of limb 5. All of the above are indications |
5. all are indications for surgery: claudication at rest, ulcers, gangrene or ischemia threatening the loss of limb
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What are some of the non-artherosclerotic etiologies of arterial insufficiency?
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Thromboangiitis obliterans (Buerger's )
Giant Cell arteriitis Temporal arteritis Radiation arteritis Raynaud's phenomenon Kawasaki Disease Homocysteinemia |
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What disease is a recurrent acute and chronic inflammation and thrombosis of arteries of veins and hands; exacerbated by cigarette smoking; affects Jewish males 20-40; and is characterized by vasospasms, intermittent claudication and migratory thrombophlebitis?
a. Takayasu's A b. Kawasaki c. Thromboangiitis Obliterans(Buerger's) d. Homocysteinemia e. Temporal Arteritis |
c. Thromboangiitis Obliterans(Buerger's)
(emily's hint: young German, jewish smoking boys) |
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What disease is considered a pulseless disease, causing chronic inflammation of the aorta and it's main branches causing ocular disturbances; Lower BP and weak pulses in UE compared to LE; and affects young females prior to 40yrs?
a. Takayasu's A b. Kawasaki c. Thromboangiitis Obliterans(Buerger's) d. Homocysteinemia e. Temporal Arteritis |
a. Takayasu's Arteritis
(emily's hint: Kaya is a blind girl she knew who had bad pulses esp in arms) |
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What is considered the most common form of vasculitis; is acute and chronic inflammation of large arteries in head causing H/A, facial pain and tenderness, and jaw claudication?
a. Takayasu's A b. Kawasaki c. Thromboangiitis Obliterans(Buerger's) d. Homocysteinemia e. Temporal Arteritis |
e. Temporal Arteritis
(treatment is steroids not surgery) |
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What is not a PAD indication for surgery?
1. claudication at rest, 2. ulcers, 3. gangrene 4. ischemia threatening the loss of limb 5. All of the above are indications |
5. all are indications for surgery: claudication at rest, ulcers, gangrene or ischemia threatening the loss of limb
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What are some of the non-artherosclerotic etiologies of arterial insufficiency?
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Thromboangiitis obliterans (Buerger's )
Giant Cell arteriitis Temporal arteritis Radiation arteritis Raynaud's phenomenon Kawasaki Disease Homocysteinemia |
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What disease is a recurrent acute and chronic inflammation and thrombosis of arteries of veins and hands; exacerbated by cigarette smoking; affects Jewish males 20-40; and is characterized by vasospasms, intermittent claudication and migratory thrombophlebitis?
a. Takayasu's A b. Kawasaki c. Thromboangiitis Obliterans(Buerger's) d. Homocysteinemia e. Temporal Arteritis |
c. Thromboangiitis Obliterans(Buerger's)
(emily's hint: young German, jewish smoking boys) |
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What disease is considered a pulseless disease, causing chronic inflammation of the aorta and it's main branches causing ocular disturbances; Lower BP and weak pulses in UE compared to LE; and affects young females prior to 40yrs?
a. Takayasu's A b. Kawasaki c. Thromboangiitis Obliterans(Buerger's) d. Homocysteinemia e. Temporal Arteritis |
a. Takayasu's Arteritis
(emily's hint: Kaya is a blind girl she knew who had bad pulses esp in arms) |
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What is considered the most common form of vasculitis; is acute and chronic inflammation of large arteries in head causing H/A, facial pain and tenderness, and jaw claudication?
a. Takayasu's A b. Kawasaki c. Thromboangiitis Obliterans(Buerger's) d. Homocysteinemia e. Temporal Arteritis |
e. Temporal Arteritis
(treatment is steroids not surgery) |
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What is an inborn error of metabolism that causes endothelial cell injury and cell detachment that initiates the development of artheriosclerosis?
a. Takayasu's A b. Kawasaki c. Thromboangiitis Obliterans(Buerger's) d. Homocysteinemia e. Temporal Arteritis |
d. Homocysteinemia
(treatment is folic acid and graft surgery) |
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What disease is characterized by mucocutaneous lymph node syndrome usually affecting children <4yrs; involves coronary arteries and is the leading cause of acquired heart disease in children.
a. Takayasu's A b. Kawasaki c. Thromboangiitis Obliterans(Buerger's) d. Homocysteinemia e. Temporal Arteritis |
b. Kawasaki
(increased risk of intraoperative MI, arrythmias, and sudden death) |
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Which syndrome is the occlusion of the subclavian or innominate artery by artherosclerosis proximal to the origin of the vertebral artery that may result in reversal of blood flow from the brain, leading to syncopal episodes?
a. subclavian-steal syndrome b. coronary-subclavian steal syndrome c. none of the above |
a. subclavian-steal syndrome
... s/sx: CNS ischemia, syncope, ataxia, hemiplegia, absent or dim. peripheral pulses, SBP is lower on affected side. (Nagelhaut says ~ 10mmHg) |
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This syndrome occus when incomplete stenosis of the left subclavian artery leads to reversal of blood flow, and the patient presents with post- CABG angina affecting the IMA graft.
a. subclavian-steal syndrome b. coronary-subclavian steal syndrome c. none of the above |
b. coronary-subclavian steal syndrome s/sx: SBP is lower on affected side. (Nagelhaut says ~ 20mmHg)
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Advantages of using General anesthesia for Vascular cases?
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1. Good for long cases
2. CV stability with higher dose opiods 3. Good if there are coagulation concerns ( Disadvantages: N/V, Post-op pain) |
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Advantages of using Regional anesthesia for vascular cases?
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1. Vasodialtion is desirable for surgeons
2. Postop pain management is better 3. decreased hypercoagulability (disadvantaes are hypotension, bradycardia, postop fluid shifts and heparin use by surgeon) |
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Definition of inflow reconstruction?
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Bypass the obstruction in aortoiliac segment - Aortofemoral bypass.
* more stressfull procedure requiring cross-clamping of aorta. |
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Definition of outflow reconstruction?
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Performed Distal to inguinal ligament for bypass of femoropopliteal or distal obstruction. Reversed saphenous vein, in situ or prosthetic graft.
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What is Virchows triad?
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It is the conditions that create increased risk of DVT's:
1. Venous stasis 2. Hypercoagulable states 3. Vascular wall injury |
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Describe the reversed saphenous graft for outlflow reconstruction?
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1. Saphaneous vein is exposed and removed.
2. Branches are ligated 3. Vein is reversed to permit flow due to valves 4. Tunnelled and anastomosed to the arteries (long cases) |
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Describe the saphaneous graft in situ?
Why is this preferred? |
1. vein remains in bed
2. valves are excised with valvulotome 3. Proximal vein is attaced to proximal artery and the smaller distal end of vein attaches to smaller distal artery ** Preferred because there is less kinking ,twisting or trauma. |
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What are other options for vein grafts?
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1. Human umbilical ven
2. Dacron 3. Gore-tex Advantages: 1. faster procedures with less dissection. 2. long term patency rates. |
