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58 Cards in this Set
- Front
- Back
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What are the risk factors for AAA?
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Atherosclerosis, HTN, smoking, male, age
Inheritance- Marfan's, Ehler's Danlos Common underlying defect is vessel wall weakness 2ry to elastin/collagen degradation |
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what is the role of ultrasound in AAA?
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best screening tool.
can assess x-sectional screening tool and diameter to 95% accuracy used to follow diameter over time |
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What is the role of PEX in AAA?
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first step in feeling an abdominal mass
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What is the definition of a AAA?
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>1.5-2.0 cm with all three layers involved
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What is the role of CT/MRI in AAA?
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helps get better precision on a AAA.
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what is the role of angiography in AAA?
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- largely replaced by MRI
- limitation- size may not be accurate due to thrombus - best way to evaluate lumen patency, iliac and renal involvement |
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what is the role of plain film in AAA?
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shows calcifications. not used for work-up
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what is the law of laplace?
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tension is directly proportional to intra-luminal pressure. inversely related to wall thickness.
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what is the difference between big aneurysms and small aneurysms in relation to diameter and risk of rupture?
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4% annual risk for < 5 cm
7% risk for 5-7 cm 20% risk for > 7 cm |
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what are independent risk factors for AAA rupture?
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recent expansion
HTN COPD abdom/back pain near site |
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when should one operate on a AAA?
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when rupture risk is greater than surgery risk:
- diameter 5-5.5 cm or greater - the triad: severe ab/back pain, pulsatile ab mass, hypotension - symptomatic aneurysm |
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Describe the technique of an open surgery for AAA.
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dissection
proximal and diststal arteries are isolated - heparin - clamp, aneurysm incised. Prosthetic graft is sewn in place and covered w/ the residual aneurysm sac. |
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Infrarenal risk?
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less than 5%.
Involvement of the iliac arteries or more proximal portions of the abdominal or thoracic aorta are technically more challenging. |
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what are some serious complications of AAA treatment?
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renal impairment
MI extremity amputation CVA colonic ischemia, distal emboli, and hemorrhage |
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what are the long-term complications of AAA treatment?
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graft infection, graft thrombosis, pseudoaneurysm.
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what are the advantages to an open procedure
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lower morbidity/mortality
durable better option in those that can tolerate it. |
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what are the disadvantages to a open procedure?
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not tolerated in frail pts
- CAD contraindicates |
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what is the procedure for endovascular repair of a AAA?
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Placement of stents via the femoral artery. catheters
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what are the advantages of endovascular AAA repair?
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no CVRR or GI distress from lack of clamping.
shorter hospital stay |
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what are the disadvantages of endovascular AAA repair?
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higher post-op failure rate
requires wide open vessels for access. |
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what are common locations of peripheral aneurysms?
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palpiteal artery- presents bilaterally, presents with distal emboli, thrombosis "blue toe syndrome"; total occlusion is a 50% amputation risk.
Iliac- resection if >3cm; common iliac-> aortofem bypass; hypogastric-> pulsatile mass on DRE. Femoral- uncommon, local pain, venous obstruction, embolism/thrombosis; resect if >2.5cm |
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Where is an aneurysm found in syphilis?
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ascending aorta
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where is an aneurysm typically found in marfan's?
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descending thoracic aorta
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where is mycotic aneurysms found?
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anywhere
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where are pseudoaneurysms found?
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trauma or surgical anastomosis site
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what are the five Ps of acute ischemia?
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pallor
pulselessness pain paresthesia paralysis Poikilothermia emergency- paralysis, paresthesia |
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what are the major sources of emboli in acute ischemia?
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1. left side of heart- afib, acute mi
2. aneurysm- stasis for clot Other- - ventricular aneurysm - mitral stenosis - popiteal or other arterial emboli - bacterial endocarditis - paradoxical embolis- rare, venous, needs shunt |
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what are the sources of thrombus in acute ischemia?
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- atherosclerotic plaque rupture
- aneurysm - trauma - posterior knee dislocation - supracondylar humerus fracture- may entrap the brachial. Volkman's- compartment syndrome - hypercoaguable state |
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what is rest pain in chronic ischemia?
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pain in the toes and metatarsals, relieved with walking.
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Arterial foot ulcers:
what are common causes? What are the symptoms? Where are they seen? What do they look like? What are associated findings? |
cuases- atherosclerosis, diabetes
symps- painful (not in DM), heavy, weak, fatigued legs where- bony prominences, toes, heals, top of foot. appearance- punched out, gray necrotic bases. |
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Venous foot ulcers:
what is the etiology? What are the symptoms? Where are they seen? What do they look like? What are associated findings? |
Venous Hypertension-> capilarry leaks-> edema (protein to skin)-> inhibbed oxygen, nutrients-> skin breakdown
symps- edema, achiness, stasis, (red-brown pigmentation), dermatitis, atrophie blanche (white spots) Location- above the ankle, below the knee appearance- irregular borders, granulating base. findings- vericose veins, venous thrombosis, phlebitis, post-thrombotic syndrome |
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neuropathic foot ulcers:
what is the etiology? What are the symptoms? Where are they seen? What do they look like? What are associated findings? |
areas of pressure have decreased flow, go unnoticed.
symps- painless, may have burning, shooting pains, hyperesthesia, parasthesia location- areas of pressure, lateral and plantar parts of foot, heel, toes, metatarsal appearance- formed boarders, deep; pale, gray, black base, surrounded by callous associated findings- dry, hyperkeratotic skin; deformed foot; infections, neuropathic edema, stunted deep tendon reflexes, and joint position senses; arterial ischemia |
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What are the indications for surgical bypass?
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claudication
Rest Pain Gangrene (wet- with purulent discharge; dry- dead, black) non-healing ulcers, sores in lower extremity |
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What is a normal ABI?
When is there claudication? When is there rest pain? when is there gangrene? when are they incompressible? |
normal .9-1.2
rest pain .5-.8 gangrene <.2 incompressable >1.2 |
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What PEX findings can be found in a patient experiencing claudication?
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hair loss
muscle atrophy color changes ulcers gangrene Buerger's sign- (dependant rubor) |
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What are the Rx options for claudication?
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1. Exercise program- walk for 30-45 min 6 days a week. Conditions muscles and develops collaterals
2. Stop smoking 3. angioplasty/stenting 4. Endarterectomy - used in bifurcation 5. bipass 6. amputation |
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What are the variables in angioplasty results?
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a. location- lower leg only has 40-50% patency after 1 year
b. length c. degree of occlusion d. amount of calcification e. tortuosity |
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what are the reasons for amputation in PVD?
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severe rest pain, gangrene
site chosen for best wound healing. Knees are attempted to be spared. |
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what is Virchow's triad? risks for clotting.
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i. venous endothelial injury
ii. stasis iii. hypercoag state other risks- birth control, pregs, history of DVT, surgery, sepsis, obesity |
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what is triphasic, biphasic, and monophasic wave forms?
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triphasic- normal
biphasic- mild ischemia monophasic- progressive occulsion |
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What does high velocity on a duplex mean?
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means stenosis
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what are signs of corotid occulsive disease?
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Amarousis Fugax- transient monocular blindness
TIA- neurodeficit for < 24 hrs CVA- neuro lasting > 24 hrs dizziness, headache, syncopeare not symps |
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what are the indications for an endarterectomy?
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stenosis > 50%, symps, 70-90% stenosis w/ symps showed benefit for endarderectomy Nascat.
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what are the risks of carotid endarterectomy?
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stroke- 3-5% risk
MI death (caused by above) nerve injury |
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what nerves are at risk in carotid surgery?
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Hypoglossal
Vagus- posterior posterior auricular Glossopharyngeal Marginal Mandibular |
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what is the role of Pentoxifylline in claudication?
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improves abnl erythrocyte deformability, reduces blood viscosity, decreases platelet activity
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what is the role of Cilostazol in claudication?
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type III posphodiesterase inhibitor, possesses an anti-platelet and vasodilating properties
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What are the signs of a PE?
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pleuritic chest pain
dyspnea, tachycardia, cough, hemoptisis |
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what tests are used to diagnose a PE?
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spiral ct
chest xray d-dimer pulm angiogram V/Q scan |
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how is heparin used in PE treatment?
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IV infusion
till PTT is double normal. |
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what are the indications for placement of a vena cava filter? (Greenfield filter)
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pt with LE venous thrombis, but contraindicated to anti-coag. or with symps while anti-coagulated.
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What is post phlebetic syndrome?
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weeks after a DVT, pain, redness, thickness, glossy skin.
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What is an UNNA boot?
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gauze bandage covered with ointments
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What are the risks for developing vericose veins?
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family Hx
obesity pregnancy the pill work that requires standing for a long time. |
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what is the role of sclerotherapy in vericose veins?
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dilute sclerosing agent is injected into the skin. vein irritation-> occlusion
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What is the gold standard for treating spider veins?
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sclerotherapy
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what is a common comorbidity of vericose veins?
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DVTs in 25%
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What is the trendelenberg test?
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pt. lies flat, leg is elevated, Tie tourniquet at thigh, w/out competent valve, sudden filling when tourniquet removed
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