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49 Cards in this Set

  • Front
  • Back
Risk factors for atherosclerosis?
family history
high LDL
sedentary lifestyle
How is atherosclerosis initiated?
a. endothelial injury
b. platelets adhere
c. growth factors released
d. smooth muscle hyperplasia/plaque deposit
What is atherosclerosis?
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
Most common sites for plaque formations in arteries?
a. branch points (carotid bifurcation)
b. tethered sites (superficial femoral artery [SFA] in Hunter's canal in leg
What do you need for a successful arterial bypass operation?
1. inflow (eg. patent aorta)
2. outflow (eg. open distal pop. artery)
3. run off (eg. patent trifurcation vessels down to foot)
Major principle of safe vascular surgery?
get proximal and distal control of vessel to be worked on
What is to "POTTS" a vessel?
vessel loop placed 2x around a vessel, so that pulling the loop will occlude the vessel
Orientation of suture needle in diseased vessel during graft to artery anastomosis?
needle 'in to out' of lumen of diseased artery to tack down plaque; needle is 'out to in' on the graft
Layers of the artery?
1. Intima
2. Media
3. Adventitia
What arteries supply blood to blood vessels itself?
What is a true aneurysm?
dilation (>2x nl diameter) of ALL three layers of a vessel
What is a false (pseudo) aneurysm?
dilation of artery NOT involving all 3 layers (eg. hematoma w. fibrous covering)

often connects with vessel lumen and blood swirls inside false aneurysm
How are the lower extremity arteries oriented below the knee on an A-gram?

Lateral Anterior tibial
Medial Posterior tibial
What is peripheral vascular disease (PVD)?
occlusive atherosclerotic disease in LE
Most common site of arterial atherosclerotic occlusion in LE?
occlusion of SFA in Hunter's Canal
Sx of PVD?
a. intermittent claudication
b. rest pain
c. erectile dysfunction
d. sensorimotor impairment
e. tissue loss
What is intermittent claudication?
a reproducible pattern of pain and/or cramping in LE after walking a specific distance, with resolution after rest
What is (no) rest pain?
pain in foot, usually over distal metatarsals, which arises at night and awakes patient
What classically resolves rest pain?
hanging foot over bed or standing
How is vascular intermittent claudication different from pain from non-vascular causes?
a specific pattern
What is the differential dx of LE claudication?
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
Clinical signs that the doctor can appreciate in PVD?
a. absent pulses
b. bruits
c. muscular atrophy
d. decreased hair growth
e. thick toenails
g. tissue necrosis/ulcers/infx
What is the ABI?
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
What is normal ABI?
Claudicator ABI?
Rest pain ABI?
normal >= 1.0
claudicator < 0.6
rest pain < 0.4
When can pts. get false ABI readings?
calcified arteries, esp. those w. diabetes
What are PVRs?
Pulse Volume Recordings: pulse wave forms are recorded from LE; represent volume of blood flow per heart beat at sequential sites down leg
Prior to surg. for chronic PVD, what dx test will every pt. receive?
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
What is the gold standard for dx PVD?
A-gram (arteriogram)
What is bedside mgmt. of pt. with PVD?
1. sheep skin (easy on heels)
2. foot cradle (keeps sheet and blankets off feet)
3. skin lotion (to avoid cracks and ulcers)
What are indications for surg. tx of PVD?
1. rest pain
2. tissue necrosis
3. infx
4. severe claudication refractory to conservative tx
What is tx of claudication?
conservative tx: exercise, stop smoking, treat HTN, diet, aspirin, w. or w/o pentoxifylline
Mnemonic for conservative tx of claudication?

Cut out smoking
How does aspirin work?
inhibits cyclo-oxygenase, inhibiting platelets
How does pentoxifylline (Trental) work?
increases RBC deformity

pentoXifylline increases
fleXibility of RBC
Risk of limb loss with rest pain?
50% of pts. with rest pain will lose the limb
What is main post-op concern in pt. with PVD?
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
What is Leriche's syndrome?

Ass atrophy

(impotence, buttock claudication, gluteus muscle atrophy from occlusive disease of iliacs/distal aorta)
What are tx options for severe PVD?
1. surg. graft bypass
2. angioplasty
3. endarterectomy (remove diseased intima and media)
4. surgical patch angioplasty (patch over stenosis)
What is a FEM DISTAL bypass?
bypass from femoral artery to a distal artery (peroneal artery, anterior tibial artery, or posterior tibial artery)
What graft material has the longest patency rate?
autologous vein graft
What type of graft is used for above the knee FEM POP bypass?
either vein or Gortex
What type of graft is used for a below-the-knee FEM POP or FEM distal bypass?
MUST use vein graft due to risk of thrombosis in Gortex
How many mm in diameter is a 12 French Fogarty catheter?
divide French by pi (3.14), so a 12 French is about 4mm
What should you look for post-op after limb reperfusion?
compartment syndrome, hyperkalemia, renal failure from myoglobinuria, MI
What is compartment syndrome?
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
Can pulses be present in compartment syndrome?
What is the tx of compartment syndrome?
bilateral calf incision to open compartments, fasciotomies of all 4 compartments in the calf
What are signs and sx of comPartment syndrome?
pain after passive flexion/extension of foot, paralysis,
How much pressure is needed for the sydrome?
30 mmHg