Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
52 Cards in this Set
- Front
- Back
PAD which is narrowing of the peripheral arteries is most commonly found in the?
|
pelvis and leg
|
|
What is the most common cause of limb loss?
|
PAD
|
|
PAD typically displays a ____distribution
|
segmental
|
|
What is Buerger's sign?
|
dependent rubor. When you lift up the foot it gets white and when you put it downwards i gets red again.
|
|
Describe how to do an ABI
|
ankel-brachial index
Lay patient in supine. Assess systolic pressure at both the arm (brachial) and ankle (posterior tibial artery). Divide the ankle by the the arm pressure. Should give you a number between .9 and 1 if normal .7 - .89 suggest mild to moderate PAD (asymptomatic or intermittent claudication) <0.7 suggests moderate to sever PAD (intermittent claudication and rest pain <0.5 = limb threatening ishcemia |
|
what is the gold standard for defining intra-arterial lesion? dx?
|
angiography
|
|
50% of patients with Stage II intermittent claudictaion, will improve with what treatment?
|
exercise and smoking cessation!!!
|
|
aortoiliac occlusion classically causes ______ syndrome. Defined by impotence, absense of femoral pulses, lower extremity claudication and mm wasting of the buttocks.
|
Leriche syndrome
|
|
the most common cause of acute ischemia is?
|
emboli
|
|
what are the top 4 sites for emboli to lodge themselves?
|
1. femoral artery bifurcation (43%)
2. iliac arteries 3. aorta 4. popliteal arteries |
|
what are the 5 Ps of acute ischemia?
|
1. pain
2. pallor 3. Pulselessness 4. parasthesias 5. paralysis Pulseless, painful, paralysis = surgery |
|
what are physical exam findings for PAD?
|
1. bruits
2. decreased or absent pulses/doppler signal 3. decreased skin temp 4. Dependent rubor (Buerger's sign) 5. dystrophic nails 6. shiny, hairless skin 7. ulceration of toes 8. dry or wet gangrene 9. "blue toe" or "trash foot" syndrome 10. Livedo reticularis (mottled skin, purple, lacey) |
|
what is the definition of an aneurysm?
|
focal dilation of an artery of more than 1.5 times normal diameter
|
|
an increase in aortic diameter by greater than 50% of normal is known as? or aortic diameter of greater than 3 cm diameter
|
AAA
|
|
what is the most common location for an AAA
|
infrarenal - less collagen, less vasa vasorum (weakest area)
|
|
what law?
the larger it grows the thinner it grows, the higher the wall stress |
Laplace's law
|
|
the risk of AAA rupture is directly proportional to what?
|
the size of the aneurysm
|
|
If AAA left untreated, how many will expand?
|
80% and 20% of those will expand quickly
|
|
when do you decide to repair an AAA?
|
when its bigger than 5.5 cm
|
|
how do most people with AAA die?
|
from an unrelated cause!
|
|
overall, how many AAA ruputre?
|
15%
|
|
what are operative indications for AAA?
|
1. if greater than or equal to 5.5cm
2. if grows more than .5 cm in 6 months 3. if the patient is symptomatic, regardless of size 4. if the AAA ruptures (at this point only 50% survivial) |
|
what is the triad for ruptured AAA presentation?
|
1. pulsatile abdominal mass
2. back pain 3. hypotension |
|
what is the MC type of endovascular graft leakage. (endoleaks)
|
TYPE 2 - backfeeding from lumbar arteries
|
|
what is the MC perioperative complication of open or EVAR AAA repair?
|
MI - 2-5% because of hemodynamic reasons
|
|
what is another name of the anterior spinal artery?
|
Artery of Adamkiewicz
|
|
Any patient having a bowel movement on the table or immediately after aortic surgery NEEDS TO BE EVALUATED FOR
|
colonic ischemia
|
|
Transmural colonic necrosis undergoes colonic resection this is known as?
|
hartman's procedure
|
|
what is virchow's triad for DVTs?
|
1. venous stasis
2. endothelial injury 3. hypercoaguable state |
|
what is the MC inherited thrombophilia in the US?
|
Factor V leiden
|
|
pain on passive dorsilexion of the ankle. a non-specific sgin
|
Homan's sign
|
|
dome-shaped, pleurally-based opacification in the lung due to PE
|
Hampton's hump
|
|
squamous cell carcinoma arising at sites of chronic inflammation is known as?
|
Marjolin's Ulcer
|
|
Daily rest pain. what Fontaine stage?
|
Stage 3
|
|
What is FOntaine stage 1?
|
usually asymptomatic, intermittant claudication minimal pain (min. lower ABI)
Ankle-Brachial Index < 0.9 Decreased distal pulses |
|
what is fontaine stage II?
|
Intermittent claudication, severe pain
|
|
no previous claudication, absent bruits, contralateral leg pulses are present what type of occlusion and how do we dx and tx it?
|
embolus -- acute
Dx clinical tx with embolectomy and warfarin |
|
what is the medication for claudication?
|
cilostazol
|
|
in what Fontaine stage do we see rest pain? what is it caused by?
|
Stage 4 -caused by nerve ischemia
|
|
risk factors for AAA include
|
smoking, hypertension and family hx
|
|
people with this disorder hace increased matrix metalloproteinase (MMP) activity which favor degradation of collagen and elastin
|
AAA
|
|
who do we screen for AAA?
|
males greater than 65 years old who have a smoking history
if detected screen every 6 months |
|
what are the early complications of AAA repair?
|
PaGe DR or Pa-C MEG
Paraplegia Graft infection Death Renal failure Pneumonia Colon ischemia* MI* Graft occlusion |
|
any patient having a bowel mvmt on tale or immediately after aortic surgery needs to be evaluate for?
|
colonic ischemia
|
|
what is a late complicato of AA reapair
|
bowel obstruction
amuputation from majore arterial occlusion impotence in males (ED >30%)!!!! Paresthesias in things from femoral exposure Lymphocele in groin Aorto-enteric fistula*** (patient can present with massive UGIB) Incisional hernia |
|
you may see a herald bleed or melena or hematochezia when this occurs after AAA surgery
|
Aortoenteric fistula
|
|
aortic dissection is associated with what?
|
age 50-70
HTN, marfan's and bicuspid aortic valve hx of recent trauma |
|
tearing chest pain radiating to the back or epigastrium
asymmetric reduced or absent pulses wide mediastinum syncome new murmur |
aortic dissection
|
|
Which type, A or B is treated medically in disseting aortic aneurysm?
|
Type B medically
Type A surgically! |
|
what are the deep veins in venous disease?
|
FEmoral, popliteal
AT/PT veins |
|
what is the MC inherited thrombophilia in the US?
|
factor V leiden
|
|
what is a common complication of DCS in abdominal trauma?
|
Intra-abdominal abscess
|