Vas 366 Final 1

Front 1

The ____________ is consulted in order to establish a ________ and to recommend or carry out appropriate ____________.

Back 1

- vascular surgeon
- dx
- tx

Front 2

The 3 goals of vascular intervention:

________ blood flow
Repair ______ or ___________
______________ occluded ________

Back 2

- Re-establish (vessel stenosis or blocked by thromboembolism)

- dilated
- damaged

- bypass
- vessels

Front 3

What are the 2 types of vascular intervention?

Back 3

- Vascular surgery

- Interventional Radiographic Procedure

Front 4

Vascular surgery is aided by what 3 things?

Back 4

- angiography

- vas tech (US image, Doppler, physiologic test)

- knowledge of anatomical location of human vasculature

Front 5

Interventional Radiographic Procedures are primarily _____________ procedures. They are performed by ____________.

What 3 things is it aided by?

Back 5

- endovascular
- cardiologists & interventional radiologists

- Angiography
- Vas technologist
- Fluroscopy during the endovascular procedure

Front 6

Candidates for vascular intervention are assessed by:

______________ exam
results of ______________
Consideration of pts ____________ or ___________

Back 6

- Hx & PA

- vascular & angiographic exams

- existing vascular
- organ-system diseases for the best procedure

Front 7

Factors that should be considered prior to the decision:

_______________ rates
Risk of _________________
______________________
consequences of ___________

Back 7

- Initial & long term success

- morbidity & mortality

- cost effectiveness

- failure

Front 8

Decisions are based on a combination of:

how each hospital/clinic lists its ______________.
_____________ consultation.
Available _______________ & _________________

Back 8

- own requirements (protocol) for vascular interventions

- physician/pt

- choices
- final outcome

Front 9

T or F:

How each hospital/clinic lists its protocol for vascular interventions is based on specificity

Back 9

FALSE

How each hospital/clinic lists its protocol for vascular interventions is based on SENSITIVITY

Front 10

Endovascular radiographic procedures are procedures where ____________ are placed w/in vessels to _____________.

PTA is _____________

Back 10

- catheters
- allow interventional technique

- Percutaneous Transluminal Angioplasty

Front 11

PTA:

____________ of the vessel
plaque is penetrated w/ _____________

Back 11

- dilatation & recanalization

- catheter tip

Front 12

T or F:

PTA is considered an endovascular surgery

Back 12

FALSE:

Originally considered endovascular surgery but NOW it is considered NON-SURGICAL

Front 13

PTA:

Double lumen balloon expands to ____________.
Employs a _________ used for balloon such as _________.
A balloon cath is also used to ____________ in arteries, veins and graft known as ___________

Back 13

- predetermined diameter

- flexible material
- polyethylene or polyurethane
- remove embolized thrombus
- thromboembolectomy (usually requires cut-down)

Front 14

PTA uses _____ lengths & ____________.

Careful consideration must be give to __________.
Balloon should approximate the ____________ and the ____________.

__________ is a big issue for stent placement

Back 14

- different
- expandable diameters

- size
- diameter of vessel
- length of the lesion

- intimal hyperplasia

Front 15

T or F:

The balloon should be 20-30% greater than the adjacent normal vessel diameter

Back 15

FALSE:

Balloon should be 10-20% greater than the adjacent normal vessel

Front 16

The balloon dilation is a _______________ technique where the plaque is ______________.

The non-diseased area of the artery _______ is ________.

The plaque is partially sheared from ___________ and _____________

Back 16

- controlled injury
- fx, split and compressed

- tunic media >>>> stretched
- its attachment
- pushed into the media

Front 17

T or F:

Usually no embolism occurs during PTA

Why or Why not?

Back 17

TRUE:

Plaque remains attached to media

* Net is still deployed w/carotid balloon angioplasty

Front 18

The media & adventitia undergo ___________ over a period of time as they respond to ____________.

How well is soft plaque tx w/balloon angioplasty?

Back 18

- further dilation
- hemodynamic demands

- Soft plaque responds the best

Front 19

T or F:

Hard and soft plaques respond well the PTA

Back 19

FALSE:

Soft plaque responds the BEST!
Densely calcified plaques, elongated plaques and lesions containing LG amounts of thrombus DO NOT fair as well by plain balloon angioplasty

Front 20

T or F:

PTA is considered technically successful if there is
< 35% residual stenosis after the procedure is completed

Back 20

FALSE:

< than a 30% residual stenosis

Front 21

What are the 5 possible angioplasty complications?

Back 21

- Arterial entry site
- Angioplasty site
- Angioplasty at bifurcation
- Distal to angioplasty site
- Systemically

Front 22

T or F:

Acute occlusion and possible hemorrhage from perforation of artery are both rare complications of arterial entry site

Back 22

FALSE: (Those are angioplasty site complications)

- HEMATOMA formation at puncture site
- THROMBUS formation in the vessel at puncture site
- PSEUDOANEURYSM or AV FISTULA formation

Front 23

What is a common arterial entry site complication?

In an angioplasty comp an acute occlusion is generally caused by what 3 things?

Back 23

- Hematoma formation at the puncture site

- thrombosis
- intimal tear
- local artery spams

Front 24

Angioplasty at a bifurcation can cause ____________.

how is this problem reduced?

this is known as _____________ because __________

Back 24

- fx of plaque into branch artery

- By placing 2 balloons, one on each branch of the bifurcation

- Kissing balloons
- they actually touch when inflated

Front 25

A complication distal to the angioplasty site is due to a poss _______________ or _____________

Back 25

- embolization of fresh thrombus

- balloon fragment embolization from rupture

Front 26

Systemically is die to ________________.

Diabetics have a _______ overall immunity and run the risk of septicemia if any pathogens are introduced __________

Back 26

- MI
- CVA
- Septicemia

- via angioplasty procedure

Front 27

Intravascular stents are ___________ designed to preserve ___________.

They are utilized when ______ from ________ or __________

Back 27

- metallic stents
- arterial or venous lumen

- vascular narrowing
- external compression
- inadequate PTA results

Front 28

T or F:

The stent is strong enough to fx the plaque

Back 28

FALSE:

Stent ALONE is not strong enough to fx plaque

Front 29

What are the 3 types of stents?

Back 29

- Balloon expandable

- self expanding

- Nitonol stents

Front 30

Balloon expandable:

The stent is _________________ prior to placement and then ________ when the _____________

Back 30

- collapsed around the deflated balloon

- expanded into place

- balloon is inflated

Front 31

Self expanding:

__________ allows __________ when stent is pushed out of a ___________.

What can be a problem w/this type of stent?

Back 31

- spring action

- expansion

- retaining tube sheath

- Difficult to length match w/lesion

Front 32

Nitonol stents:

Are ____ while _______ but ______ to ________ when _______

Back 32

- collapsed
- cool
- expand
- original size
- warmed to blood temperature

Front 33

IVUS is an ____________ that can be used to image the vessel ____________________.

Can be used to evaluate the success of __________ or ________.

Could also see an __________.

Back 33

- ultrasound tipped catheter
- from the inside and outward

- a balloon angioplasty
- a stent placement

- intimal tear

Front 34

What is a disadvantage of IVUS?

Back 34

Can't sterilize probe >>>have to throw away = expensive

Front 35

What are the 6 types of surgical interventions?

Back 35

- Profundaplasty
- Endarterectomy
- Semi closed
- Extraction
- Eversion
- Selective

Front 36

Profundaplasty is the surgical procedure of ________ to restore function as _______ to _________ or ________.

May prevent ___________.

May be only procedure available if ______________

Back 36

- profunda femoral artery
- collateral
- politeal or calf

- AK amp

- distal bypass not feasible

Front 37

T or F:

Profundaplasty is used when distal profunda is occluded along w/SFA

Back 37

FALSE:

Profundaplasty is used when PROXIMAL profunda is occluded w/SFA

Front 38

Endarterectomy is the _____________ of _____________.

What are the 5 specific technicques?

Which is the most common?

Back 38

-direct removal
- occlusive arterial lesions

- Open
- Semi-closed
- Extraction
- Eversion
- Selective

- open

Front 39

Open endarterectomy:

__________ arteriotomy.
_______ removed.
common for _____________.

Back 39

- longitudinal
- lesion

- carotid endarterectomy

Front 40

T or F:

Semi-closed is when retrograde or antegrade removal of lesion through single arteriotomy

Back 40

FALSE: (that's extraction)

Semi closed: Transverse or longitudinal arteriotomies at proximal and distal extent of lesion

Front 41

What is the advantage of a semi closed?

The lesion is detached and removed in ________ manner w/ ____________

Back 41

- can see the distal end of the atheroma

- retrograde
- loop stripper

Front 42

T or F:

Semi closed is used on thicker, harder and more calcified lesions

Back 42

FALSE:

Semi closed is used on thinner, softer and LESS calcified lesions

Front 43

Extraction is ___________ removal of lesion through ___________.

Performed by use of long jawed clamps and/or a ________.

Used on ____________

Back 43

- retrograde or antegrade
- single arteriotomy

- dural elevator
* Many times the clamp jaws serve as the dural elevator

- thicker, harder, more calcified lesions

Front 44

T or F:

Extraction uses a transverse or longitudinal arteriotomies

Back 44

FALSE:

Extraction uses ONLY ONE arteriotomy

Front 45

What is the disadvantage of extraction?

Back 45

- Distal end of the atheroma is not seen

Front 46

T or F:

Eversion require the proximal transection of artery beyond site of disease or can be used in an open endarterectomy w/a longitudinal arteriotomy

Back 46

FALSE:

Eversion require the DISTAL transection of artery beyond site of disease or can be used in an open endarterectomy w/a longitudinal arteriotomy

Front 47

In eversion the vessel is _________ or ____________ to ____________.

Once the atheroma is removed the vessel is ________ into __________ and _____________.

Back 47

- turned back
- peeled back
- separate the vessel wall from the atheroma

- folded back
- position
- sewn together

Front 48

T or F:

Selective is a modification of an open procedure

Back 48

FALSE:

Selective is a modification of the SEMI-CLOSED procedure

Front 49

Selective is used to remove __________ in arterial segments of branch.

_____ removal through ___________ w/ a ____________.

Performed w/in _____________________.

Back 49

- discontinuous lesions

- retrograde
- distal longitudinal arteriotomy
- loop stripper

- diseased arterial segment

Front 50

What are the two surgical assessment aides?

Both are used ______________.

___________ is an assessment too using radiographic contrast

Back 50

- Intraoperative arteriography

- Intraoperative duplex

- post vascular surgery

- Intraoperative arteriography

Front 51

A true aneurysm is a _________________ .

The two types are _______________ _______________

Back 51

- Dilation of all layers of the arterial wall

- fusiform
- saccular

Front 52

T or F:

Pseudoaneurysms contain arterial layers

Back 52

FALSE:

Pseudoaneurysms DO NOT contain arterial walls

* They are completely separate from the artery except for the communicating channel thru which the blood travels to reach it

Front 53

A pseudoaneurysm is also considered a _____________ and a ______________.

They are caused by ____________ _____________or _______.

They are located close to ____________ into _________.

Back 53

- Peripheral arterial mass
- Pulsatile hematoma (active lumen active blood Q)

- trauma
- infection
- intervention

- entry site
- arterial lumen

Front 54

T or F:

Pseudoaneurysms are most commonly found at the brachial artery

Back 54

FALSE:

Most commonly found at the COMMON FEMORAL ARTERY but also at the brachial artery

Front 55

Pseudoaneurysms are connected to the lumen by ____________.

They may result due to ____________ following ________.

Back 55

- channel or neck

- poor compression
- removal of catheter

Front 56

T or F:

Arterial sticks below inguinal ligament increase chance of pseudoaneurysm

Back 56

FALSE:

Arterial sticks ABOVE inguinal ligament increase chance of pseudoaneurysm

Front 57

T or F:

Use of anticoagulants and small diameter catheters are risk factors of pseudoaneurysms

Back 57

FALSE:

Use of anticoagulants is, but use if LARGE DIAMETER catheters
* Increased diameter = increased risk

Front 58

T or F:

Superficial lying arteries due to body habitus tend to be a risk factor

Back 58

FALSE:

DEEP lying arteries due to body habitus tend to be a risk factor

Front 59

Duplex findings:

Blood in the __________ surrounded by a _____________.
_________ seen layered w/in pseudoaneurysm.

Back 59

- hematoma
- fibrous wall

- Thrombus

Front 60

T or F:

Duplex findings of a pseudoaneurysm demonstrates swirling high velocities that are seen w/color Q

Back 60

FALSE:

Duplex findings of a pseudoaneurysm demonstrates swirling LOW velocities that are seen w/color Q

Front 61

How is the neck of the pseudoaneurysm identified on Doppler WF?

Back 61

- "to and fro" pattern

Front 62

T or F:

During diastole, high velocity is detected flowing out of the native artery & into the contained rupture

Back 62

FALSE:

During SYSTOLE, high velocity is detected flowing out of the native artery into the contained rupture

Front 63

During diastole, flow ___________ to __________ and into the ___________.

You need to obtain measurements in _______ & _____.

There is a classic ________ sign w/pseudoaneurysm

Back 63

- returns back
- the native artery
- contained rupture

- aneurysm & neck
- "pepsi"

Front 64

5 complications of pseudoaneurysms:

____________ w/_____________.
_____________ thromboembolization.
______________ of the native artery.
Persistent _____________ & __________.

Back 64

- rupture
- severe hemorrhaging

- arterial
- extrinsic compression
- pain & lump

Front 65

During the physical assessment the tech should:

_____ pt for _____________

Feel ____________

Listen _____________

Back 65

- palpate
- lump or bump in groin

- pulsatility or thrill

- for bruit

Front 66

UGCR is _____________.

The pt is given ____________ for pain and in some cases w/ ____________ drug.

Irrigate groin w/ _______________.

Back 66

- Ultrasound Guided Compression Repair

- Demoral
- anti-anxiety

- 2% lidocaine

Front 67

UGCR procedure:

Visualize the _______ while ________ until ____________.
During ___________ evaluate ___________.

Back 67

- neck
- compressing
- flow is absent in the neck

- compression
- distal pulses

Front 68

UGCR procedure:

Utilize color to check adequate ____________.

Do not compress _________ because ____________.

Back 68

- vein Q

- aneurysm itself
- may force contents into arterial system

Front 69

6 pitfalls of UGCR:

A very ______________.
Procedure may take ____________.
Many times very ____________.
Can ___________.
It is not ____________.
Difficult on ___________.

Back 69

- long procedure (especially if pt is anticoagulated)

- more than one lab personnel

- painful for pt

- tie up lab space

- always successful

- LG pts

Front 70

A hematoma is a discrete collection of ___________.

May be the result of ___________.

Back 70

- blood

- previous catheter procedure

Front 71

T or F:

A hematoma is a palpable lump w/some pulsatility

Back 71

FALSE:

Hematoma is a palpable lump w/NO PULSATILITY

* No active arterial channel

Front 72

T or F:

A duplex evaluation of a hematoma will show some flow in lumen

Back 72

FALSE:

Duplex eval of a hematoma will show NO FLOW in lumen

Front 73

Hematomas can be ____________ or __________ formation due to ____________.

There are usually layers of ___________.

Back 73

- anechoic
- echogenic
- age of thrombus

- echogenicity

Front 74

T or F:

Hematomas are commonly treated

Back 74

FALSE:

NO TX needed for most

Front 75

The UE venous system is comprised of _______ & __________ veins.

Most veins in _______ system are accompanied by ________.

Q return is dependent on _____________ & ___________.

Back 75

- superficial
- deep

- deep
- artery of the same name

- gravity
- cardiac output generated pressure gradients

Front 76

T or F:

Like the LE, majority of flow return of the UE is through the superficial system

Back 76

FALSE:

UE is done through superficial
LE is done through deep system

Front 77

What are the 8 RF's of UE DVT?

Which is the most common?

Back 77

- Central venous catheter (PICC) *MOST COMMON
- cancer
- physical activity
- obesity
- drug abuse
- pregnancy
- IV placement superficial to deep

Front 78

DVT of UE caused by Central venous catheter is usually in _____________.

_____________ is harsh on cells & causes them to become irregular.
You would measure ______________.
Used for pts w/___________ as ____________.
Drug _____________.

Back 78

- Axillary-subclavian veins

- chemotherapy

- central venous pressure
- Gastrointestinal dysfunction >>> parenteral nutrition

- administration

Front 79

T or F:

Two common places of UE DVT are the Subclavian vein and Brachial veins

Back 79

FALSE:

Subclavian IS but Brachial veins ARE NOT

Front 80

What are the 4 most common locations of UE DVT?

Of these which is the most common?

Back 80

- Subclavian vein
- Internal Jugular Vein
- Axillary Vein
- ASVT - Axillary-Subclavian vein *** MOST COMMON

Front 81

ASVT is commonly due to ____________ also known as ____________.

This condition is caused by ___________ of ___________ while in ____________.

Back 81

- Effort thrombus
- Paget Schroetter Syndrome

- excessive use
- shoulder or arm
- unusual position
*EX: drywall installer

Front 82

T or F:

Primary subclavian-axillary vein thrombosis is the result of multiple iatrogenic factors

Back 82

FALSE:

Primary subclavian-axillary vein thrombosis has NO DIRECT CAUSE that is obvious on initial evaluation

Front 83

Primary subclavian-axillary vein thrombosis is ______________ and the most common victim is ___________.

_____________ snydrome.

Back 83

- effort induced ("effort thrombosis")

- young males
* Heavily associated w/occupation

- Paget-Schroetter

Front 84

Secondary subclavian-axillary vein thromobsis is the result of _______________ and/or ___________.

What are the 6 poss etiologies?

Which is the most common cause?

Back 84

- multiple etiologic
- iatrogenic factors

- Malignancy
- Heart failure
- Infection
- Polycythemia
- Estrogens
- PICC line, IV line or other catheters ***most common

Front 85

T or F:

UE DVT is more common in female than male

Back 85

FALSE:

More common in MEN than female

2:1 ratio

Front 86

T or F:

UE DVT often leads to PE

Back 86

FALSE:

Can lead to PE BUT NOT OFTEN

0-28% of the time according to Rutherford

Front 87

UE clinical features:

____________ swelling of _________ .
Arm ______ or ___________.
HX of ___________ or _____________.
Swelling may __________ from_______ into ________.
______ & _______ possible.

Back 87

- abrupt onset
- one arm

- heaviness/tingling/ache

- recent
- unusual trauma

- spread
- arm >>>> hand

- tenderness
- pain

Front 88

UE DVT is usually obvious from ____________.

Must rule out other causes for swelling such as ____________.

Perform ___________.

Back 88

- clinical presentation

- insect bites, allergies, burns

- Duplex exam

Front 89

T or F:

UE DVT is more common in males in the L arm

Back 89

FALSE:

More common in males in the RIGHT arm than the L

* 3:1 ratio
* Dominant extremity involved 60-80%

Front 90

3 RF's for superficial thrombophlebitis:

Recent ___________
_______ use
_____________

Back 90

- IV
- drug
- trauma

Front 91

What are the 3 poss location of SVT?

Which is the most common?

Back 91

- Cephalic vein ****(most common)
- Basilic vein
- Median cubital vein

Front 92

5 clinical features of UE SVT:

__________
__________ over area
_________
_________ to touch
___________ or ___________

Back 92

- swelling

- tenderness

- redness (erythema)

- warm

- palpable bump or lump

Front 93

T or F:

The dx of SVT is difficult to make

Back 93

FALSE:

Usually OBVIOUS from palpation

* duplex exam

Front 94

T or F:

Normal UE venous Q is spontaneous, phasic and hyperemic

Back 94

FALSE:

Normal: Spontaneous, respiratory phasicity and pulsatility proximally
* NOT HYPEREMIC/CONTINUOUS

Front 95

T or F:

Like the LE, in UE flow increases w/expiration as the intrathoracic pressure decreases

Back 95

FALSE: (OPPOSITE OF LE)

UE:
- Q decreases w/expiration
- intrathoracic pressure increases

Front 96

UE venous Q:

Q ___________ w/ expiration
Intrathoracic pressure __________

Q ___________ w/ inspiration
Intrathoracic pressure _____________

Back 96

- decreases
- increases

- increases
- decreases

Front 97

T or F:

An abnormal venous signal can demonstrate absent, hyperemic or diminished Q

Back 97

TRUE

Front 98

In a duplex eval of UE DVT, the tech is looking for:

Visible ________
____________ of vessel
____________ of veins

Back 98

- thrombus
- non-compressibility
- Dilation

Front 99

T or F:

Compression is demonstrated the same for all veins of the UE

Back 99

FALSE:

All EXCEPT SUBCLAVIAN VEIN

* Must do sniff test or Doppler

Front 100

Tx of UE DVT:

________ infusion followed by ____________.
________ of arm in _______ supported by _______.

Back 100

- IV Heparin
- oral Warfarin

- elevation
- forward or extended position
- pillow

Front 101

UE DVT can also be tx using _____________.

What are 3 examples?

Back 101

- thrombolysis

- streptokinase
- urokinase
- tPA (tissue plasminogen activator)

Front 102

T or F:

Tx options for SVT include: Heparin, anti-inflammatory drug, or thrombolysis

Back 102

FALSE:

SVT: Heparin (possible anticoagulant), anti-inflammatory drug but NOT THROMBOLYSIS

Front 103

T or F:

SVT is always tx

Back 103

FALSE:

May do nothing and rescan in 1-2 days

Front 104

A poss surgical tx of SVT is __________.

This is best performed ________ and most successful w/___________ pts.

Back 104

- Thrombectomy

- early
- effort thrombosis

Front 105

_____________ are used when other tx fail.

They must _____________.

Considered a ____________ procedure

Back 105

- stents

- maintain patent lumen

- interventional

Front 106

Endovascular aneurysm repair or ____________ w/_____________.

Back 106

- endograft repair
- stent-grafts

Front 107

T or F:

Asymptomatic aneurysms > 4 cm in diameter are an indication for placement

Back 107

FALSE:

Asymptomatic aneurysms > 5 CM in diameter

Front 108

Indications for placement:

All _______ & ___________.

Usually for pts who are at high risk for ___________

Back 108

- symptomatic & ruptured aneurysms

- conventional open repair

Front 109

Have to decide if the endograft fails will the pt die due to ___________ and/or the ______ to replace the ________ w/ a ______________

Back 109

- endograft failure
- open repair
- endograft
- conventional graft

Front 110

T or :

According to Rutherford, w/improvements in technology and increasing experience the conversion of endovascular to open operation is falling

Back 110

TRUE

Front 111

High risk pts have been defined by the Endovascular Graft Committee as:

pts w/ ______, _______ aneurysms whose operative risk is __________.

Example: if the operative risk is in excess of _______ on the basis of _______ ________ or ________ disease or previous __________ or ________.

Back 111

- LG
- life-threatening
- excessive

- 3-4 times normal
- heart
-lung
- liver
- abdominal scarring
- infection

Front 112

T or F:

The first generation of endografts was developed in which the fabric is supported throughout by a contiguous metal frame

Back 112

FALSE:

1st generation EMPLOYED A TAPERED TUBULAR FABRIC GRAFT W/BALLOON DEPLOYED OR SELF EXPANDING STENTS AT EA END

Front 113

T or F:

2nd generation endografts had either hooks or barbs to help prevent graft migration

Back 113

FALSE: (1st generation DID)

2nd generation: This type of graft REMAINS IN PLACE W/MINIMAL OR NO ANCHORING DEVICES

Front 114

The 2nd generation of endografts was developed in which the _______ is supported throughout by a ____________.

This ____________ hes to add __________ & prevent _______.

Back 114

- fabric
- contiguous metal frame

- metal modular frame
- column strength
- kinking

Front 115

Most endografts have a _______ w/_______ to extend into the ___________.

Typically the _____ & ____ are contiguous. Access for this main piece of the endograft is therefore typically through the _____________.

Back 115

- trunk (aortic body)
- bifurcated legs
- common iliac

- trunk
- R iliac leg
- R CFA

Front 116

Because the inside diameter of the delivery system (sheath) is usually 21 French (7mm or 3/8") the ___________ is ___________.

Back 116

- CFA
- surgically exposed

Front 117

T or F:

The distal end is placed infrarenally

Back 117

FALSE:

The PROXIMAL end is placed infrarenally

Front 118

Surgeons must consider the distance from the _____________ to the point where the endograft ___________.

Endograft ________ must be ___________ to __________

Back 118

- proximal placement

- bifurcates

- bifurcation
- proximal
- native aortic bifurcation

Front 119

The sheath is withdrawn and the ___________ endograft is deployed throughout the __________ and ___________.

The single piece of left iliac leg is placed by access thru the ___________.

The left iliac leg is inserted slightly (overlapping) into the _______ of the ____________.

Back 119

- self-expanding
- distal aorta
- R CIA

- L CFA

- left bifurcation branch
- main trunk endograft

Front 120

Closure occurs when the entire endograft is ____________ under flouroscopy and _____________ then the ________ are closed and the ___________ closed.

Back 120

-placed satisfactorally

- Q well established

- arteriotomies
- incision sites

Front 121

Endoleak is a condition association w/ _______________ defined by the persistence of blood Q __________ of the endoluminal graft but __________ or _____________ being tx by the graft.

Back 121

- endoluminar vascular grafts

- outside the lumen

- aneurysm sac

- adjacent vascular segment

Front 122

Type I Endoleak:

Occurs when a persistent channel of blood Q develops due to ______ or ___________ at the ________.

This type of leak is usually present _________ in the course of tx but may also be encountered ______ when _________ thru a __________ around the area of ________ to the ___________.

Back 122

- inadequate
- ineffective
- graft ends

- early
- late
- blood erodes
- blood clot seat
- device fixation
- aortic wall

Front 123

T or F:

Type II Endoleak is a antegrade type of leak

Back 123

FALSE:

Type II Endoleak is a RETROGRADE type of endoleak

Front 124

Type II Endoleak;

Occurs when there is persistent blood Q ________ due to _________ blood Q from ________, ______ or ____________.

In some cases where there are two or more patent vessels a situation of ______ and ___ develops creating an ______ w/in a channel created w/in ________.

Back 124

- into the aneurysm sac
- retrograde
- patent lumbar arteries
- inferior mesenteric artery
- other collateral cessels

- inflow
- outflow
- active blood Q
- aneurysm sac

Front 125

Type III Endoleak:

Related to ________ or ________ at the _________ between segments of __________ or ________ of the graft fabric

This type may be develop _____ due to __________ or ______ in the course of the tx when there is _______ of one of the ___________ due to ________ or ________.

Back 125

- inadequate
- ineffective seal
- graft joint
- overlapping graft segment
- rupture

- early
- technical problems
- late
- displacement
-extensions
- aneurysm retraction
- device breakdown

Front 126

Type IV Endoleak:

Related to the ________ & ___________ of blood thru the ___________.

Back 126

- porosity
- passage
- fabric of the graft

Front 127

T or F:

Since the grafts used in endovascular devices are preclotted most fabrics will not initially leak through

Back 127

FALSE:

Grafts used in endovascular devices ARE NOT PRECLOTTED---most fabrics WILL initially leak through

Front 128

With the development of thinner graft materials, which type of endoleak is becoming more common?

Back 128

Type IV Endoleak

Front 129

T or F;

UE arterial disease is as common as in the LE, rarely life threatening and there are several disease processes or conditions

Back 129

FALSE:

UE arterial disease is NOT AS COMMON as LE disease, rarely life threatening and there are several disease processes or conditions

Front 130

T or F:

Distal subclavian is the most common arterial occlusive disease

Back 130

FALSE:

PROXIMAL subclavian is the most common arterial occlusive disease

Front 131

Arterial occlusive disease;

Often _________.
may have ___________ which could result in ___________.
Poss ___________ in _________.

Back 131

- silent
- steal syndrome
- cerebral ischemia
- reversal of Q >>>> vertebral

Front 132

T or F:

Arterial occlusive disease is more common the R UE in middle aged patients

Back 132

FALSE:

More common in the LEFT ARM and is usually in OLDER PTS

Front 133

T or F;

35 mmHG or more difference between brachial pressure in arms is indicative of arterial disease

Back 133

FALSE:

30 mmHG or more difference between brachial pressure

Front 134

If bilateral, may have _______ difference or more

Poss ____________

Severe cased pt may have ___________ ___________ ______

Back 134

15 - 20 mmHG

- bruits

- rest pain
- skin ulcer
- gangrene

Front 135

T or F:

Claudication is common in UE Arterial disease

Back 135

FALSE:

Claudication is RARE due to collateral flow

* vertebral

Front 136

Takayasus Arteritis affects primarily the _____________ which typically results in ______ or _______.

It actually damages the __________ and is more common in _________.

Etiology is ________, it is similar to ___________.

Back 136

- aorta & its main branches
- stenosis or occlusion

- intima
- Women than in men

- unknown
- giant cell arteritis

Front 137

T or F:

Takayasu's Arteritis can affect the axillary or brachial arteries

Back 137

FALSE:

can affect SUBCLAVIAN or AXILLARY ARTERIES

Front 138

T or F:

Steal is common in takayasus

Why or why not?

Back 138

FALSE:

Steal is RARE---disease affects both the prox & distal segments of the subclavian artery

Front 139

T or F:

Claudication is not possible as vertebral can act as a collateral

Back 139

FALSE:

Claudication IS POSSIBLE as vertebral artery CANNOT ACT as a collateral

Front 140

___________ is common in UE arterial.

It is important to check pts hx for ______________.

sxs are ___________ , ____________ or ______________

Back 140

- emboli

- Heart disease/conditions

- cold sensitivity
- gangrene
- purplish digits

Front 141

T or F:

Clot usually from heart or a distal aneurysm

Back 141

FALSE:

Clot usually from heart of a PROXIMAL ANEURYSM

Front 142

T or F:

Typically affects larger vessels

Back 142

FALSE:

Typically affects SMALLER VESSELS -- usually digits

Front 143

Buerger's disease or ______________ is a condition in which ______________ are _____________.

The etiology ___________ and affects ___________ most commonly.

May go undetected until _____ involve __________.

Back 143

- Thromboangitis obliterans
- all 3 layers of the arterial wall
- inflammed

- unknown
- young male smokers

- lesions
- forearm arteries

Front 144

T or F:

Buerger's Disease causes occlusion of medium and large arteries in hand & digits

Back 144

FALSE:

Buerger's disease causes occlusion of SMALL & MEDIUM arteries in hand and digits

Front 145

7 sx of Buergers Disease:

______ in hands/fingers
_____________
__________ changes
skin ____________
________ pain
_____________ ____________
Fingers _____ & ___________

Back 145

- coldness
- paresthesias
- skin color (purplish-red)
- lesions
- rest
- intermittent claudication
- cold / damp

Front 146

Buerger's disease may result in _________ or __________ and lead to _________ of ___________.

____________ of _______ may be necessary.
____________ usually halts progression of the disease.

Back 146

- digital gangrene
- ulceration
- amputation
- fingers or parts of

- debridement
- necrotic tissue

- cessation of smoking

Front 147

T or F:

Arterial reconstruction is always possible in thromboangitis obliterans

Back 147

FALSE:

Arterial reconstruction NOT ALWAYS POSSIBLE IF MULTIPLE ARTERIES INVOLVED

Front 148

Trauma can be a cause of UE arterial disease:

_______ & ___________ wounds.
__________ mechanisms.
Improperly _________ or _______ in ___________.
________ forces.
May have diminished ___________

Back 148

- gunshot / knife

- penetrating
- fitted shoulder harness or gear
- subclavian region
- compression
- distal pulses

Front 149

Occupational problems:

__________ force to _______ or ___________.

White finger syndrome is _____ induced __________. This can be caused by ________ or _______ and the pts feels ___________ or __________.

It can also progress to ___________.

Back 149

- excessive
- shoulder
- hand

- vibration
- vasospasm
- pneumatic drills
- jackhammers
- numbness or tingling

- Raynaud's

Front 150

T or F:

Hypothenar Hammer Syndrome is using hand as hammer and can lead to occlusion of radial artery

Back 150

FALSE:

Hypothenar Hammer Syndrome is using hand as a hammer and can lead to occlusion of ULNAR ARTERY

Front 151

T or F:

TOS is more commonly caused by a venous issue

Back 151

FALSE:

TOS is more commonly a NEUROLOGIC issue

* Neurogenic TOS: 95%
* Venous TOS: 1-3%
* Arterial TOS: 1%

Front 152

Neurologic TOS involves __________ at lowest trunk of ___________.

There is __________ & _________ of ___________ & _______.

Back 152

- nerve compression
- brachial plexus

- numbness
- tingling
- hands
- fingers

Front 153

Vascular TOS is due to ________ of ______ or ________ at the __________.

Typically causes compression of __________ first.

Back 153

- compression
- subclavian artery
- subclavian vein
- thoracic outlet

- brachial plexus

Front 154

T or F:

Car accidents are the most common cause of vascular TOS

Back 154

FALSE:

CONGENITAL BONY ABNORMALITIES are MOST COMMON CAUSE but also common after car accidents

Front 155

Vascular TOS can also be caused by skeletal or soft tissue:

Skeletal from ___________ _______ or _________.
Soft tissue from ____________ or ____________.

Back 155

- cervical
- rib
- clavicle (costo clavicular)

- fibromuscular bands
- scalene muscle

Front 156

Vascular TOS compression produces a ___________.

Why?
________ formation occurs over time.
____________ lesions.
Artery ________ which usually forms as a result of ______.
______________ of thrombi

Back 156

- subclavian artery stenosis
- Because at the 1st rib

- aneurysm
- intimal
- thrombosis
- the intimal lesion
- embolization

Front 157

T or F:

In vascular TOS, pts may complain of Raynaud's sxs

Why or why not?

Back 157

TRUE:

Vasoconstriction is restricting blood Q so can mimick Raynaud's

Front 158

T or F:

A coronary catheter may be done using the Cephalic vein

Back 158

FALSE:

A coronary catheter may be done using the BRACHIAL ARTERY

Front 159

Complications post catheterization may be:

__________
__________
_______ damage which may include ______ or _______.
Arterial ___________

Back 159

- Hematomas
- Pseudoaneurysms

- arterial wall
- AV fistulae
- wall dissection
- thrombosis

Front 160

Sxs of catheterization problems may be:

Pain in area of ____________.
___________ ____________.
________ at puncture site.
_____________ as a result of _____________.

Back 160

- puncture

- palpable lump

- pulsatile mass

- Digit ischemia
- thromboembolus

Front 161

T or F:

It is normal for hand & finger blood Q to increase in response to cold or emotions

Back 161

FALSE:

It is normal for hand & finger blood Q to DECREASE in response to cold or emotions

Front 162

____________ of __________resulting in cessation of digital artery Q is abnormal.

When this occurs the stereotypical sxs are known as ________.

Back 162

- spastic closure

- digital arteries

- Raynaud's syndrome

Front 163

Raynaud's syndrome can also be described as a condition that exists when sx of intermittent ________ of the __________ or __________ occur in response to ____________ as well as ___________ ___________.

Back 163

- ischemia

- fingers
- toes

- cold exposure
- emotional stress

Front 164

Syndrome are _____ & _____ that occur together and characterize a particular ____________.

Signs & sxs are produced by a ____________ __________.

Back 164

- signs
- sxs
- abnormality

- root abnormality

Front 165

The root abnormality or disease is the ___________ of the _______.

A phenomenon is an observable _____ or ________.

Back 165

- abnormal vasospastic closure
- digital arteries

- fact
- event

Front 166

Same signs & sxs produced by fact or event other than the ____________.

__________ + ____________.

If recognized, the other fact or event can b recognized as the __________ and can become a _______ in itself

Back 166

- root abnormality
- vasoconstructive
- atherosclerotic induced ischemia

- root abnormality
- syndrome
* miracle of evolution

Front 167

Raynaud's disease is also known as __________ & ___________.

It is due to abnormal ___________ of ___________.

Back 167

- Raynaud's syndrome
- Vasospastic Raynaud's Syndrome

- spastic closure
- digital arterial Q

Front 168

T or F:

Raynaud's syndrome stereotypical sxs include observable color changes of red to white to blue

Back 168

FALSE:

WHITE >>> BLUE >>>> RED

Front 169

Vasospasm completely ___________ near the digits causing a ___________ of one or more fingers or toes

Back 169

- restricts arterial Q
- white waxy

Front 170

T or F:

The first returning arterial blood is rapidly saturdated w/O2 and produces a redness or rubor

Back 170

FALSE:

The first retuning arterial blood is rapidly DESATURATED w/O2 and produces CYANOSIS or BLUENESS

* W/relaxation of the vasospasm

Front 171

As blood Q ____________ the __________ condition replaces cyanosis w/ _________________.

Back 171

- increases

- hyperemic

- rubor or redness

Front 172

Primary Raynaud's Disease is also known as _________ or ___________.

The arteries _______ due to ___________ ________.

Regarded as ____________

Back 172

- Vasospastic Raynaud's Syndrome
- True Raynaud's Syndrome

- close
- abnormal vasospasm

- a disease

Front 173

Unlike the digital arteries of normal individuals which are relatively ________ to cold, the pts w/primary Raynauds Disease display a remarkable ability to ________ w/complete ________ occurring when the skin temperature ___________ a _____________.

Back 173

- unresponsive

- constrict
- closure
- falls below
- threshold level

Front 174

Secondary Raynaud's Phenomenon is also known as __________.

Arteries are __________ or _________ due to a ________, ___________ or ________________ or ___________ __________ from ___________.

Back 174

- Obstructive Raynaud's Syndrome

- occluded
- nearly occluded
- fixed vasculitis
- thrombus
- atherosclerosis
- extrinsic compression >>> vasocontriction

Front 175

In Obstructive Raynaud's Syndrome there is a ____________ lesion.

When this fixed ________ lesion is combined w/the normal vasoconstriction near the digits, Q to the digits ____________ or ______.

Back 175

- Q limiting

- Q restricting
- ceases
- nearly ceases

Front 176

Arteriolar constriction is usually ____________, but when it is ________ on a substrate of fixed _______ ________, previously adequately perfused fingers may become _____________.

This is the mechanism principally responsible for the appearance of _______________.

Back 176

- tolerated well

- arterial obstruction

- ischemic

- raynaud's phenomenon

Front 177

Primary Raynaud's Disease etiology is ___________ whereas Secondary Raynaud's Phenomenon etiology is ______________.

Back 177

- unknown
- digital or palmar arteries are occluded or nearly occluded

Front 178

T or F:

Primary Raynaud's disease is due to vasospasm only

Back 178

TRUE;

Not from secondary causes

Front 179

T or F:

There is occlusive disease in Secondary Raynaud's Phenomenon and Primary Raynaud's Disease

Back 179

FALSE:

There is in Secondary Raynaud's Phenomenon but NO OCCLUSIVE DISEASE IN PRIMARY RAYNAUDS

Front 180

In Primary Raynaud's Disease the arteries ______ or _______ causing complete __________ during _______.

It is initiated by ________ to ___________ or increase in _____________.

Back 180

- constrict
- spasm
- closure
- spasm

- hypersensitivity
- cold exposure
- sympathetic nerve stimulation

Front 181

T or F:

Primary Raynaud's Disease is more common in males ages 11-45

Back 181

FALSE:

Primary Raynaud's Disease is more commin in WOMEN ages 11-45
4:1 ratio

Front 182

Although Primary Raynaud's Disease is more common in women it is common among ________ who have _____________ involving ____________ or ____________

Back 182

- men
- occupations
- use of jackhammers
- other vibratory equipment

Front 183

Secondary Raynaud's Phenomenon sxs are secondary to other medical conditions:

_________ disorders.
____________ disorders.
Drugs, __________ & ___________.
Traumatic ___________.
__________ disease.

Back 183

- connective tissue

- hematologic

- neoplasms, toxins

- arteritis

- Buerger's

Front 184

In dx of Raynaud's Syndrome ____________, __________ and __________ or _____________ readings are obtained.

PPG readings on a normal digit will demonstrate a ______________.

Back 184

- segmental pressures
- finger pressures
- PVR
- PPG

- normal waveform contour

Front 185

T or F:

A PPG reading demonstrating a flattened, slow to rise (tardus-parvus) waveform indicates Secondary RS pt and a cold tolerance test is not needed

Back 185

TRUE

Front 186

T or F:

PPG readings on a secondary RS pt will demonstrate a peaked waveform contour

Back 186

FALSE:

PPG readings on PRIMARY RS PT will demonstrate a peaked waveform contour

Front 187

For the cold tolerance test for RS the pt is _______ in lab for several minutes. Baseline studies performed w/________, __________, and/or ____________.

Hands are immersed into ice water for a ________ minimum and ________ maximum.

Back 187

- warmed
- PVR
- PPG
- pressure measurements of digits

- 2 minute
- 5 minute

Front 188

The test is repeated after ________ room temperature should return to normal baseline waveforms.

If not, ___________ has occurred.

If PPG flatlines or the color phase appears further evidence of ___________ is added to this test.

Back 188

- 5 minutes

- Primary vasospasm

- RS

Front 189

T or F:

If pt has secondary RS the test is normal at baseline and cold tolerance test is needed

Back 189

FALSE:

If pt has secondary RS the test is ABNORMAL AT BASELINE and cold tolerance is of LITTLE VALUE

Front 190

Dx of TOS:

Always do _____ study.
Can do ________ will do Duplex of _______ in _______ position.
Obtain Doppler signals and begin abducting arms w/head rotated ____ from ____ which is known as the ____________ __________.

Back 190

- bilateral
- PVR
- Subclavian artery
- normal resting
- away
- arm
- Addson's maneuver

Front 191

Compression of the artery may be at one of what three sites?
Level of __________
Level of ________
Level of ___________
The signal is either ______ or ________ w/maneuvers.

Back 191

- first rib
- scalene muscle
- mid-clavicle (artery crosses here)

- decreased
- absent

Front 192

What test is used to dx palmar arch obstruction?

An incomplete arch is indicated when CW Q significantly _______ or _________.

Back 192

- Allens test

- decreases
- obliterates

Front 193

Allens test:

Have pt make ________.
Compress ______________ arteries.
After ______ pt opens hand revealing ____ of palm w/arteries __________.
Release one _______ at a time observing ______.

Back 193

- fists

- radial & ulnar

- 1 minute
- pallor
- still compressed

- artery
- color change

Front 194

Duplex exam UE TOS:

Isonate & visualize arteries beginning w/ ___________.
Should observe _______________.
Velocity ranges vary:
Subclavian: ____________
Brachial: _______________
Radial/Ulnar: ____________.

Back 194

- subclavian
- triphasic waveforms

Subclavian: 80-120 cm/s
Brachial: 60-80 cm/s
Radial & Ulnar: 40-60 cm/s

Front 195

Velocities vary from ________ & ____________.

There is a __________ in resistance during ________ or _______.

Back 195

- vessel size
- skin temperature

- decrease
- exercise
- heat

Front 196

For tx of emboli & thrombi _________ therapy is used.

For Buerger's disease & vibratory trauma:
_______ drugs
_____________ _______ dilates peripheral arteries.
__________ controls fatty acids that stimulate contractility of smooth muscle which promotes ________.
____________ agents which affect viscosity

Back 196

- thrombolytic

- vasodilatory

- calcium channel blockers

- Prostaglandins
- Vasodilation
*Decrease BP & controls permeability

- hemorrheologic

Front 197

T or F:

There is no non-pharmalogic way to tx Buerger's

Back 197

FALSE:

Cessation of smoking

Front 198

Other tx options of Raynaud's are ________ sympathetcomy or _____________ sympathectomy.

_______________ is the procedure done to disrupt sympathetic nerve supply to the upper nerve connections.

___________ is a blockade of sympathetic nerve supply by chemicals.

Back 198

- surgical
- chemical

- surgical
- chemical

Front 199

Primary Raynaud's may respond to ___________ & _____________ for temporary relief.

___________ are a must.

Back 199

- sympathectomy
- calcium channel blockers
- vasodilators

Front 200

Arterial occlusive disease is tx w/ ________ or _______.

Back 200

- bypass

- endarterectomy