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49 Cards in this Set
- Front
- Back
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Risk factors for atherosclerosis?
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HTN
smoking DM family history hypercholesterolemia high LDL obesity sedentary lifestyle |
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How is atherosclerosis initiated?
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a. endothelial injury
b. platelets adhere c. growth factors released d. smooth muscle hyperplasia/plaque deposit |
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What is atherosclerosis?
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a. diffuse disease process in arteries
b. atheromas containing cholesterol and lipid form within the intima and inner media c. often accompanied by ulcerations and smooth muscle hyperplasia |
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Most common sites for plaque formations in arteries?
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a. branch points (carotid bifurcation)
b. tethered sites (superficial femoral artery [SFA] in Hunter's canal in leg |
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What do you need for a successful arterial bypass operation?
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1. inflow (eg. patent aorta)
2. outflow (eg. open distal pop. artery) 3. run off (eg. patent trifurcation vessels down to foot) |
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Major principle of safe vascular surgery?
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get proximal and distal control of vessel to be worked on
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What is to "POTTS" a vessel?
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vessel loop placed 2x around a vessel, so that pulling the loop will occlude the vessel
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Orientation of suture needle in diseased vessel during graft to artery anastomosis?
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needle 'in to out' of lumen of diseased artery to tack down plaque; needle is 'out to in' on the graft
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Layers of the artery?
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1. Intima
2. Media 3. Adventitia |
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What arteries supply blood to blood vessels itself?
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vasovasorum
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What is a true aneurysm?
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dilation (>2x nl diameter) of ALL three layers of a vessel
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What is a false (pseudo) aneurysm?
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dilation of artery NOT involving all 3 layers (eg. hematoma w. fibrous covering)
often connects with vessel lumen and blood swirls inside false aneurysm |
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How are the lower extremity arteries oriented below the knee on an A-gram?
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L.A.M.P.
Lateral Anterior tibial Medial Posterior tibial |
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What is peripheral vascular disease (PVD)?
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occlusive atherosclerotic disease in LE
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Most common site of arterial atherosclerotic occlusion in LE?
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occlusion of SFA in Hunter's Canal
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Sx of PVD?
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a. intermittent claudication
b. rest pain c. erectile dysfunction d. sensorimotor impairment e. tissue loss |
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What is intermittent claudication?
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a reproducible pattern of pain and/or cramping in LE after walking a specific distance, with resolution after rest
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What is (no) rest pain?
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pain in foot, usually over distal metatarsals, which arises at night and awakes patient
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What classically resolves rest pain?
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hanging foot over bed or standing
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How is vascular intermittent claudication different from pain from non-vascular causes?
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a specific pattern
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What is the differential dx of LE claudication?
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a. neurogenic (eg. nerve entrapment)
b. arthritis c. coarctation of aorta d. popliteal artery syndrome e. chronic compartment syndrome f. neuroma g. anemia h. diabetic neuropathy |
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Clinical signs that the doctor can appreciate in PVD?
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a. absent pulses
b. bruits c. muscular atrophy d. decreased hair growth e. thick toenails g. tissue necrosis/ulcers/infx |
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What is the ABI?
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Ankle to Brachial Index: ratio of systolic BP at ankle to sys. BP at the arm (brachial artery)
ankle BP is taken w. doppler, the ABI is non-invasive |
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What is normal ABI?
Claudicator ABI? Rest pain ABI? |
normal >= 1.0
claudicator < 0.6 rest pain < 0.4 |
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When can pts. get false ABI readings?
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calcified arteries, esp. those w. diabetes
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What are PVRs?
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Pulse Volume Recordings: pulse wave forms are recorded from LE; represent volume of blood flow per heart beat at sequential sites down leg
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Prior to surg. for chronic PVD, what dx test will every pt. receive?
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A-gram (arteriogram: dye in vessel and x-rays), which maps disease and lets decide best tx option
this is the gold standard for dx PVD |
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What is the gold standard for dx PVD?
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A-gram (arteriogram)
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What is bedside mgmt. of pt. with PVD?
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1. sheep skin (easy on heels)
2. foot cradle (keeps sheet and blankets off feet) 3. skin lotion (to avoid cracks and ulcers) |
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What are indications for surg. tx of PVD?
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1. rest pain
2. tissue necrosis 3. infx 4. severe claudication refractory to conservative tx |
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What is tx of claudication?
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conservative tx: exercise, stop smoking, treat HTN, diet, aspirin, w. or w/o pentoxifylline
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Mnemonic for conservative tx of claudication?
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PACE
Pentoxifylline Aspirin Cut out smoking Exercise |
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How does aspirin work?
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inhibits cyclo-oxygenase, inhibiting platelets
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How does pentoxifylline (Trental) work?
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increases RBC deformity
pentoXifylline increases fleXibility of RBC |
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Risk of limb loss with rest pain?
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50% of pts. with rest pain will lose the limb
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What is main post-op concern in pt. with PVD?
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1. cardiac status, b/c most pts with PVD have coronary artery disease (20% have AAA)
2. MI is the most common cause of post-op death after PVD operation |
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What is Leriche's syndrome?
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CIA
Claudication Impotence Ass atrophy (impotence, buttock claudication, gluteus muscle atrophy from occlusive disease of iliacs/distal aorta) |
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What are tx options for severe PVD?
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1. surg. graft bypass
2. angioplasty 3. endarterectomy (remove diseased intima and media) 4. surgical patch angioplasty (patch over stenosis) |
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What is a FEM DISTAL bypass?
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bypass from femoral artery to a distal artery (peroneal artery, anterior tibial artery, or posterior tibial artery)
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What graft material has the longest patency rate?
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autologous vein graft
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What type of graft is used for above the knee FEM POP bypass?
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either vein or Gortex
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What type of graft is used for a below-the-knee FEM POP or FEM distal bypass?
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MUST use vein graft due to risk of thrombosis in Gortex
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How many mm in diameter is a 12 French Fogarty catheter?
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divide French by pi (3.14), so a 12 French is about 4mm
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What should you look for post-op after limb reperfusion?
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compartment syndrome, hyperkalemia, renal failure from myoglobinuria, MI
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What is compartment syndrome?
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tissue swelling from reperfusion increases intracompartmental pressure, decreasing capillary flow and leading to ischemia and myonecrosis;
myonecrosis can occur after intracompartment pressure reaches 30 mmHg |
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Can pulses be present in compartment syndrome?
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YES!
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What is the tx of compartment syndrome?
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bilateral calf incision to open compartments, fasciotomies of all 4 compartments in the calf
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What are signs and sx of comPartment syndrome?
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pain after passive flexion/extension of foot, paralysis,
paresthesia, pallor |
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How much pressure is needed for the sydrome?
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30 mmHg
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