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115 Cards in this Set

  • Front
  • Back
MC congenital hypercoagulable disorder
resistance to activated protein C (Leiden factor)
MC acquired hypercoagulable disorder
3 stages of atherosclerosis
1st - foam cells
2nd - smooth mm proliferation
3rd - intimal disruption
Atherosclerosis is disease of
HTN is disease of
1st branch of external carotid artery
superior thyroid artery
communication b/n ICA and ECA
ophthalmic artery and internal maxillary artery
MC diseased intracranial artery
etiology of most strokes
arterial embolization
Management of carotid traumatic injury with major fixed deficit
do not fix if occluded
indications for CEA in symptomatic vs asymptomatic pts
>70% vs >80%
When do you shunt in CEA
stump pressures<50
Equal b/l stenosis; which side to fix first
dominant side first
CEA complications
CN injury
HTN (20%) give nipride
MC M&M s/p CEA
MC CN injury
vagus nerve
Rate of stenosis after CEA
vertebrobasilar insufficiency
drop attacks
management and presentation of carotid body tumors
painless neck mass
Thoracic aortic transection mechanism
usually decel injury
fix other life threatening injuries first
@ ligamentum arteriosum
left heart bypass with repair mediastinal widening (from bridging veins not aorta itself)
Ascending aortic aneurysms etiology
connective tissue disorder
MC cystic medial necrosi
different presentations of ascending AA
back pain
voice changes
transverse aortic arch aneurysm etiology
Descending aortic aneurysms
2/2 atherosclerosis
5-10% paraplegia
reimplant intercostal vessels below T8
Indications to repair ascending aortic aneurysm
acute symptomatic
>6 with marfan's
2x >nl diameter
rapid growth
RF for aortic dissection
severe HTN
prior coarctation repair
What layer of blood vessel does dissection usually occur
dissection is a/w aortic
insufficiency 70%
death from dissection usually 2/2
cardiac failure
when to operate in dissection
all ascending
descending with visceral, renal, leg ischemia; persistent pain or large size
abd AA
2/2 atherosclerosis
medial degeneration
old HTN male smokers
most likely location of rupture in AAA
left posterolateral 2-4 cm below renal
more likely AAA rupture with what comorbidities
diastolic HTN
%mortality w. ruptured AAA
Repair AAA if
growth >0.5cm/year
when to reimplant IMA?
backpressure <40
prior colon surgery
stenotic SMA
Major vein injury with proximal cross clamp
retroaortic renal vein
complications of AAA repair
impotence 33%
#1 cause of acute death s/p AAA repair
#1 cause of late death s/p AAA repair
renal failure
MC late complication after aortic graft
atherosclerotic occlusion
rate of graft infection and pseudoaneurysm
1% for both
Inflammatory aneurysms
10% AAA
adhesions to 3/4 duodenum
ureteral entrapment (25%)
not from INFECTION
bugs in mycotic aneurysms
#1 salmonella
#2 Staph
(infect plaque causing aneurysm)
Management of mycotic aneurysm
ax-bifem bypass and resect infrarenal aorta
Aortic graft infections bugs
#1 Staph
#2 Ecoli
resect graft and bypass via noncontaminated field
Aortoenteric fistula timing and presentation
>6 months after surgery
herald bleed with hematemesis then BRBPR
aortobifem bypass
Type 1-4 endoleaks
1) @ proximal/distal attachment sites
2) collaterals (lumbar)
3) fabric tears/graft interfaces
4) porosity <24h; transient
Dimensions needed for stent tube grafts
proximal and distal neck >1.5 cm in length & <3cm diameter
Anterior leg compartment contains
deep peroneal nerve
anterior tib artery
lateral leg compartment
superficial peroneal nerve (eversion lateral foot)
deep posterior leg compartment
tibial nerve (plantarflexion)
posterior tibial artery
peroneal artery
superficial posterior
sural nerve
signs of PVD
hair loss
dependent rubor
abnl nail growth
slow cap refill
% of gangrene and amputation
2 vs 1%
Leriche Syndrome
No fem pulses
butt/thigh claudication
lesion @ aortic bifurcation
MC site of atherosclerotic occlusion
hunter's canal
ABI for claudication, rest pain, ulcers, gangrene
0.9, 0.6, 0.5, 0.3
management of isolated iliac lesions
angioplasty with stent is 1st choice
5 year patency of fem-pop grafts
5 year patency rate of fem-distal graft
#1 and #2 cause of leg swelling after bypass
DVT and edema from reperfusion
#1 cause of late and early failure of RSVG
atherosclerosis and technical
Location and tx of malperforans ulcer
@ metatarsal head
2nd mTP MC
Debridement of metatarsal head (remove cartilage)
pseudoaneurysm after arteriography
thrombin injection with u/s
u/s duplex best first test
compartment pressures
>20-30 ----> fasciotomy
40M with loss of pulses with plantarflexion
popliteal entrapment syndrome
loss of pulses with active plantarflexion/passive dorsi
medial deviation of artery around medial head of gastrocnemius
management of popliteal entrapment syndrome
resect medial head of gastroc
Adventitial cystic dz
popliteal usually (b/l)
intermittent claudication
dx with angio
tx: vein graft if occluded if not just resect cyst
Most common sit of peripheral obstruction of emboli?
MC involved in atheroma embolism
Blue toe syndrome
good distal pulses
aortoiliac disease most common source
NEED CT chest/abd/pelvis and ECHO
thrombosed PTFE graft
thrombolytics and a/c or OR if limb is threatened
Path of right renal artery
posterior to IVC
Renal atherosclerosis vs fibromuscular dysplasia
left, proximal 1/3, men vs right, distal 1/3, women
same management: PTA stent
Renal artery stenosis
bruits, DBP>115, drug resistant HTN
PTA with stent
indications for nephrectomy with renal HTN
atrophic kidney <6cm and minimal collaterals with persistently high renin
MC site of upper ext. occlusive dz
subclavian steal syndrome
operate if symptomatic
carotid to SC bypass
brachial plexus irritation
2/2 thoracic outlet syndrome
nl neuro exam
Ulnar nerve (C8-T1) MC
operation for thoracic outlet syndrome
resect cervical rib, divided ant/middle scalenes, +/- 1st rb resection`
absent radial pulse with maximal arm abduction
subclavian artery occlusion from ant scalene hypertrophy
Paget-von Schrotter dz tx
effort induced SC vein thrombosis
thrombolytics, a/c
4 MC reasons
#1) embolic
#2) thrombosis
#3) low flow
#4) venous thrombosis
SMA embolism
#1 source is heart
SMA thrombosis
food fear
weight loss
chronic history
thrombectomy +/- SMA bypass
SMV thrombosis
history of vasculitis or portal HTN
Median arcuate ligament syndrome
celiac compression
epigastric bruit
chronic pain & diarrhea, weight loss
resect ligament
chronic mesenteric angina
weigh loss
food fear
30 mins after eating --> pain
PTA? bypass?
obtain lateral visceral aorthgraphy
important collateral between SMA and celiac
arc of riolan
above vs below inguinal ligament complications of aneurysm
rupture vs thrombo/emboli
indications for repair of splanchnic aneurysms
all except splenic
MC visceral aneurysm
2% rupture
MC in women
indications to repair splenic artery
women of childbearing age
repair for most visceral aneurysms
exclusion and bypass
Indications to repair iliac aneurysm
>3cm (2.5cm for femoral, 2cm for popliteal)
exclude and bypass
MC peripheral aneurysm
1/2 b/l and have asstd aneurysms
surgery if sx, >2cm, mycotic
surgery for popliteal aneurysm
exclude and bypass
femoral pseudoaneurysm
repair of flow remains in pseudoaneurysm or @ suture site
if not u/s thrombin
when to operate on renal aneurysm
>1.5 cm
women who want pregnancy
recon with vein patch, nephrectomy if ruptures
treatment of hypersensitivity angiitis
MC failure of AVF
venous obstruction 2/2 intimal hyperplasia
superficial vs suppurative thrombophlebitis
NSAIDs vs resecting vein
DVTs are more common on what side?
left due to longer left iliac vein compressed by right iliac artery
Virchows triad
venous stasis
venous wall injury
phlegmasia alba dolens
white, edema, tender
need heparin
phlegmasia cerulea dolens
blue, massive edema, tender
need heparin
treatment duration for 1st, 2nd, 3rd DVT
6 vs 12 vs lifetime coumadin
IVC filter
PE while on coumadin
free floating iliofemoral thrombi
after pulm. embolectomy
lifetime coumadin
5 places that don't have lymphatics
MC infection in lymphedema
congenital L>R
Stewart-Treves syndrome
lymphangiosarcoma after breast axillary dissection
Dx/Tx of lymphangiectasia
dilation of preexisting lymphatic channels
s/p groin dissection
clear fluid leake
injecting blue dye into foot to ID channels and resect if alrge or symptomatic