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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