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74 Cards in this Set
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- Back
- 3rd side (hint)
Leriche Syndrome |
Obstruction of the terminal aorta. Usually males. Fatigue in hips, thighs or calfs with exercise, absence of pulsation in femoral arteries, impotence, & often coldness/pallor of lower limbs.
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Blue Toe Syndrome
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May be caused by ulcerated and/or atherosclerotic lesions, embolization, arteritis, and some angiographic procedures.
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Most common location for a dissection aneurysm?
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Thoracic Aorta
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Buerger's Disease
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Most common arteritis. Heavy smoking, primary in men under 40, occlusions in distal arteries, rest pain & ischemic ulcerations occurs early on, often thrombosis, superficial thrombophlebitis is a secondary result, patchy ulcerations or gangrene, often associated with collagen vascular syndromes - rheumatoid arthritis and lupus.
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Coarctation of the Aorta
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Congenital anomalies of the arterial system. Narrowing/stricture of the thoracic aorta that may affect the abdominal aorta. Clinical findings: hypertension due to decreased kidney perfusion or manifestations of lower extremity ischemia ( decreased pulses, decreased segmental Doppler pressures).
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Buerger's Disease is also known as what?
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Thromboangiitis obliterans
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Raynaud's Syndrome
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Intermittent ischemia of fingers or toes in response to cold exposure or emotional stress. May be idiopathic or result from underlying disease or anatomic abnormality. 2 kinds
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Primary Raynaud's Phenomenon
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Aka Spastic Raynaud's Syndrome. Intermittent digital ischemia caused by digital arterial spasms. Common in young women & may be hereditary. Usually bilateral & long term history of symptoms w/o progression or underlying cause. Rather benign w/ excellent prognosis.
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Secondary Raynaud's
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Aka Obstructive Raynaud's Syndrome. Normal vasoconstrictive responses of the arterioles superimposed on a fixed arterial obstruction. Ischemia is constant. May be 1st manifestation of a collagen disorder, Buerger's Disease, anatomic abnormality or other underlying causes
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Popliteal Entrapment
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Compression of the popliteal artery by the medial head of the gastrocnemius muscle or fibrous bands. Commonly found in young men. Bilateral in 2/3's of cases.
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Livedo Reticularis
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Purple patches (similar to bruising) on the skin of the dorsum of the foot. Usually result of dilated capillaries and venule filling, not arterial obstruction.
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Pulse Grading
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0-4+
0 - None 1+ Weak 2+ Good 3+ Strong 4+ Bounding |
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Bruit Grading
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1+ - 3+
1+ Mild 2+ Moderate 3+ Severe |
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Doppler Shift
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Doppler Effect: When a wave is reflected from a moving target, the frequency of the wave received differs from that of the transmitted wave. The difference is known as the Doppler Shift.
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Analog Analysis
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Employs a zero-crossing frequency meter to display the signals graphically on a strip-chart recorder. Counts every time the input signal crosses the zero baseline within a specific time span. Because oscillation varies, the machine estimates the frequency. Drawbacks: noise, less sensitivity, underestimate high velocities & overestimate low velocities.
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Spectral Analysis
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Advantage of showing the amplitudes at all frequencies, but free of many analog drawbacks. More sensitive.
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Pulsatility Index (PI)
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Peak-Peak Frequency
---------------------------- Mean Frequency Ratio provides quantitative data. Applied to high-resistance beds. Index increases from central to peripheral arteries (CFA=5.5, PopA=8.0). CFA of 4.0='s proximal aortoiliac occlusive disease. If a distal occlusion, PI no longer works. |
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Inverse damping factor
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Ratio of distal PI to the proximal PI of an arterial segment. Indicates the degree to which a wave is dampened as it moves through an arterial segment.
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Acceleration Time
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Helps differentiate inflow from outflow disease. Arterial obstruction proximal to the site of the doppler probe lengthens the time between the onset of systolic flow to the point of maximum peak in waveform at the probe site. Acceleration time is not prolonged when disease is distal to the probe.
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What is a Sphygmomanometer?
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Blood Pressure Cuff
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Segmental Cuff Sizes
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4 Cuff- 12x40cm
3 Cuff- 19x40cm (thigh) & 12x 40cm |
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What will the toe pressure be with foot & toe ulcers that fail to heal?
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30mmHg or less
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Segmental Pressures Post-exercise results
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Normal- Elevated Pressures. Single Level- 2-6 min. Multi Level - 12 min or more
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Segmental Pressures Post-exercise
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Segmental Pressures Post Reactive Hyperemia Results
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Normal- 17%- 34% Drop. Single Level - < 50% drop. Multi Level - > 50% drop
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What is Laser Doppler used for?
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Determining the healing potential of a wound, ulcer or amputation.
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PBI Values
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Normal: >0.75. Marginal: 0.65-0.74. Abnormal: <0.65 vasculogenic impotence
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What is a Varicocele?
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An enlargement of the veins of the spermatic cord. A condition which occurs most often in young men and adolescents. It is most common on the left side.
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What is a characteristic of a Raynaud's PPG?
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A sharp, anacrotic notch is present high on the wave.
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What does a Transcutaneous Oximetry (tcPO2) do?
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Helps determine wound and amputation healing. Reflects tissue PO2, which depends on the balence between oxygen consumption and oxygen supply.
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Other names for Volume Plethysmographic Waveforms?
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Pulse Volume Recordings (PVR)
Volume Pulse Recordings (VPR) Pulse Contour Recordings (PCR) |
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Brescia-Cimino Fistula involves which vessels?
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Radial Artery & Cephalic Vein
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When evaluating a Hemodialysis Access Graft what should you look for?
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Aneurysms, Pseudoaneurysms, Puncture Sites, Perigraft Fluid & Thrombus.
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Steal Syndrome
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Distal arterial (high pressure) blood flow is reversed into the low-resistance (low pressure) venous circulation.
Symptoms: Pain distal, pallor and coolness of the skin Often seen with grafts. |
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Brachial Artery Reactivity Testing. What is it?
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Assesses the ability of the endothelium to regulate vasodilation by measuring the degree to which the brachial artery dilates in response to reactive hyperemia.
Pt fasting & relaxed. Inflate cuff to 250mmHg for 4.5-5min. Measure diameter of Brachial Artery: >10% Upper Arm-Normal, >6% Forearm- Normal. |
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Renal-to-Aortic Ratio
RAR |
Renal Artery PSV
---------------------- Aortic PSV Normal: <3.5 Abnormal: >3.5, 60% or greater diameter reduction |
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End Diastolic Ratio EDR or
Parenchymal Resistance Ratio PRR |
End Diastolic Velocity
---------------------------- Peak Systolic Velocity Normal: >0.2 Abnormal: <0.2 Increased resistance with in the kidney parenchyma. |
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Pourcelot's Ratio/resistivity Index RI
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PSV - EDV
------------ PSV Normal: <0.7 Abnormal: >0.7 |
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Acceleration Time AT
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Time interval from the onset of systole to the initial peak.
Reported in milliseconds (msec) AT > 100 msec = Proximal >60% diameter reduction. |
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Mesenteric ischemia is also know as?
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Mesenteric angina
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Postprandial high-resistance blood flow in the SMA or IMA means what?
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Distal mesenteric ischemia, distal obstruction.
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Hyperemia
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Decreased arterial resistance in SMA circulation in response to eating.
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Explain celiac compression
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Extrinsic compression of the celiac artery origin by the median arcuate ligament of the diaphragm. Fairly common among young, athletic women.
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If the celiac artery were occluded what might you see?
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Retrograde flow of the Hepatic Artery.
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B-mode signs of Kidney rejection include:
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Increased renal transplant size,
Increased cortical echogenicity, Hypoechoic regions in the parenchyma. |
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What is Watershed Area?
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Small branches of both the Deep Superior Epigastric Artery & the Deep Inferior Epigastric Artery anastomose in this region. It is located midway between the superior and inferior epigastric arteries.
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TRAM flap
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Transverse Rectus Abdominis Myocutaneous (TRAM) flap.
Used in autogenous breast reconstruction. |
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What is another name for the Internal Mammary Artery and where is it located?
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Internal Thoracic Artery
Arises from the arch of the subclavian artery, descends along the posterior sides of the cartilage of the upper 6 ribs, about 1cm from the sternum. |
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Why look at the Internal Mammary Artery
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Evaluate for recipient site for TRAM flap in breast reconstruction or as a graft to the left anterior descending (LAD) artery.
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Arteriovenous Fistulae AVF
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Congenital or traumatic. Abnormal connection b/t high-pressure arterial & low-pressure venous system. Close to the heart increase CHF, peripherally more ischemia. Diameter & length predict the resistance.
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Flow patterns in a AVF
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Prox Artery: Greatly increased, especially during diastole.
Flow in AVF: Elevated peak and end diastolic with spectral broadening, often bidirectional. Distal Artery: Flows become normal, may reduce blood pressure. Prox Venous: Elevated velocities, more pulsatile. Distal Venous: Elevated velocities throughout. Phasicity and increased pulsatility bc mixed venous & arterial flow Lg AVF: may have retrograde flow in the distal vein, valves become incompetent. |
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Compartment Syndromes
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Caused by swelling within the osteofascial compartments of leg or arm. Intercompartmental pressure increases to the point where it exceeds capillary perfusion pressure, decreasing vascular perfusion and compromising nutritive blood flow to tissue. Nerves most susceptible to ischemia, muscle necrosis later. Most commonly occurs following revascularization to correct prolonged ischemia caused by embolic, traumatic or less common condition. Can be spontaneous or result of bleeding within a compartment.
Paresthesias, Pain, Muscle weakness, Tension of compartment. |
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Treatment for Compartment Syndromes
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Fasciotomy
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Cystic Adventitial Disease
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Cystic fluid accumulates in the wall of the peripheral artery. Can cause narrowing or occlusion of vessel.
Symptoms may be claudication with bruit, may be loss of distal pulses during flexion of foot or hand. Most common in males 40-50yrs old. May include congenital abnormality exacerbated by repetive trauma associated with regions of joint connection or be related to development of a ganglion. |
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Popliteal Artery Entrapment Syndrome
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Compression by the medial head of the gastrocnemius muscle or fibrous bands. Mostly seen in young men and bilateral in 1/3 of cases. Repeated trauma by result in aneurysm, thrombosis, atherosclerosis and emboli. Diminished flow with flexion.
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Thoracic Outlet Syndrome (TOS)
Arterial Component |
Neurovascular bundle compression by the shoulder structures (cervical rib, costoclavicular, scalene muscle).
Neurogenic compression of the brachial plexus when the arm is in certain positions. Small percent are result of venous or arterial compression. Symptoms: Numbness, tingling and pain, 25-30% asymptomatic. |
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TOS Positions
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Arm at 90 degree angle is same plane as torso
Arm at 180 degree angle in same plane as torso Exaggerated military stance (patient sitting) Right & Left Adson Maneuver: Exaggerated military stance (shoulders back) with head turned sharply toward the arm being tested Causative position described by patient. |
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Treatment for TOS
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Shoulder exercises
Surgical: resecting 1st rib with/without scalene muscle splitting. |
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Arteriography
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2 types: Intraarterial injection & Intravenous digital technology
Puncture of an artery and insertion of a very thin catheter (Seldinger technique). Most common arteries: CFA, axillary or brachial. Liquid contrast agent injected. Image arterial lumen but not the arterial walls. Rapid film changer used to picture as contrast moves. Using fluoroscopy the examiner may obtain and store digital info for later manipulation and interpretation. After, patient supine and 6-8 hours with possible sandbags. Interpretation based on how much of the artery does not fill with contrast agent. |
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How does atherosclerotic plaque appear on arteriography?
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Irregular or smooth negative images, where ever the plaque displaces the contrast agent.
Common locations: Origins of the great vessels at the aortic arch, bifurcations and the adductor canal. Collaterals are seen with long-standing occlusions. |
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How do aneurysms appear on arteriography?
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Dilation of the artery.
Thrombus may develop along the dilated wall, creating the appearance of a straight tube on arteriography. Possibly lack of branches where you would expect to see them. |
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How does vasospasm appear on arteriography?
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Severe narrowing of the arterial lumen, usually without occlusion.
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How does Fibromuscular Dysplasia FMD appear on arteriography?
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Multiple arterial stenosis, caused by medial hyperplasia which looks like a "string of beads". Poststenotic dilatation also may be present.
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What patients cannot undergo arteriography?
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Allergic to contrast agent (iodine).
Kidney failure. |
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Endarterectomy
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Surgical removal of atherosclerotic material and usually a portion of the intimal lining from the arterial lumen.
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Common Bypass Grafts
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Aorta to both iliac arteries
Aorta to bifemoral Femoral to popliteal Femoral to PTA, ATA or Pero A Axillary to femoral Axillary to bifemoral Femoral to femoral |
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Sympathectomy
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Surgical interruption of part of the sympathetic nervous pathway to help treat severe arterial occlusive disease by producing vasodilation and thereby enhancing blood flow to an extremity. No longer commonly performed.
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Angioplasty
PTA Percutaneous Transluminal Angioplasty |
Used to dilate precisely that segment of a vessel that contains a focal atherosclerotic lesion.
Balloon-tipped catheter used under fluoroscopic guidance and small amounts of contrast agent. Once positioned within the stenotic lesion the balloon is slowly inflated, pushing the plaque against the walls, dilating the vessel and opening up flow. Done on larger vessels: iliac, fem, popA and renals. Not usually used for smaller vessels. |
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Subintimal Angioplasty
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Under ultrasound guidance a wire is passed within the wall of the blood vessel into the subintimal space rather than through the occluded true lumen from above to below the occlusion. Balloon is inflated to open a new pathway. A stent may also be used.
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3 major types of stents?
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Balloon-expandable
Self-expandable Thermal expanding (not in wide use) |
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Stent grafts
What are they used for? What are they main types? |
Aneurysmal disease, especially in the aorta.
Tube grafts Bifurcated grafts Aortoiliac grafts |
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Complications with stents
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Intimal hyperplasia, stent migration, twisting, dislodgment and leaks.
Endoleaks, graft stenosis or thrombosis, disection lower extremity ischemia secondary to embolization, graft infection, delayed rupture of the aortic aneurysm, bleeding, pseudoaneurysm at the insertion site and hematoma. |
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Types of Endoleaks
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Type I: Attachment @ prox/dist sites
Type II: Branch leaks Type III: Modular connect leak Type IV: Transgraft endoleaks Type V: Endotension |
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Thrombectomy/Embolectomy
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Procedure used to extract embolus from the affected arterial segment.
Balloon catheter is inserted past the area of thromboembolism, inflated and withdrawn with the thromboembolus. |
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Atherectomy
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Cuts through or pulverizes the plaque with a rotational device at the end of the catheter.
Problems: heat generation, susceptible to puncture, & microembolization or pulverized particles. Advantage: Reduced risk of peripheral emboli and intimal dissection. |
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