Vascular Surgery - Basics And Pvd

Front 1

what is atherosclerosis?

Back 1

diffuse disease process in arteries; atheromas containing cholesterol and lipid form w/in the intima and inner media, often accompanied by ulcerations and smooth muscle hyperplasia

Front 2

what is the common theory of how atherosclerosis is initiated?

Back 2

endothelial injury --> platelet adhere --> growth factors released --> smooth muscle hyperplasia/plaque deposition

Front 3

what are the risk factors for atherosclerosis?

Back 3

HTN, SMOKINT, diabetes mellitus, family hx, hypercholesterolemia, high LDL, obesity, sedentery lifestyle

Front 4

what are the common sites of plaque formation in arteries?

Back 4

branch points (carotid bifurcation), tethered sites (superficial femoral artery in hunter's canal in the left)

Front 5

what must be present for a successful arterial bypass operation?

Back 5

1. inflow (e.g., patent aorta). 2. outflow (e.g., open distal popliteal artery). 3. run off (e.g., patent trifurcation vessels down to the foot)

Front 6

what is the major principle of safe vascular surgery?

Back 6

get PROXIMAL and DISTAL control of the vessel to be worden on

Front 7

what does it mean to POTTS a vessel?

Back 7

place a vessel loop 2x around a vessel so that if you put tension on the vessel loop it will occlude the vessel

Front 8

what is the suture needle orientation through graft v. diseased artery in a graft to artery anastomosis?

Back 8

needle in-to-out of the lumen in diseased artery to help tack down the plaque and the needle out-to-in on the graft

Front 9

what are the 3 layers of an artery?

Back 9

intima, media, adventitia

Front 10

which arteries supply the blood vessel itself?

Back 10

vaso vasorum

Front 11

what is a true aneurysm? what is a false aneurysm (AKA pseudoaneurysm)

Back 11

true: dilation (>2x nl diameter) of all 3 layers of a vessel. false: dilation of artery not involving all 3 layers (e.g., hematoma w/fibrous covering), often connects w/vessel lumen and blood swirls inside the false aneurysm

Front 12

what is endovascular repair?

Back 12

placement of a catheter in artery and then deployment of a graft intraluminally

Front 13

what is the orientation of the lower exterior arteries below the knee on A-gram?

Back 13

LAMP: lateral - anterior tibial, medial - posterior tibial

Front 14

what is peripheral vascular disease?

Back 14

occlusive atherosclerotic disease in the lower extremities

Front 15

what is the most common site of arterial atherosclerotic occlusion in the lower extremities?

Back 15

occlusion of the SFA in hunter's canal

Front 16

what are the symptoms of PVD?

Back 16

intermittent claudication, rest pain, erectile dysfunction, sensorimotor impairment, tissue loss

Front 17

what is intermittent claudication?

Back 17

pain, cramping, or both of the lower extremity, usually the calf muscle, after walking a specific distance; then the pain/cramping resolves after stopping for a specific amt of time while standing; this pattern is reproducible

Front 18

what is rest pain?

Back 18

pain in the foot, usually over the distal metatarsals; this pain arises at rest (classically at night, waking up the patient)

Front 19

what classically resolves rest pain?

Back 19

hanging the foot over the side of the bed or standing; gravity affords extra flow to ischemic areas

Front 20

how can vascular causes of claudication be differentiated from nonvascular causes, such as neurogenic claudication or arthritis?

Back 20

history (in vast majority of patients) and noninvasive tests; remember, vascular claudication appears after a specific distance and resolves after a specific time of rest while standing (not so w/most other forms of claudication)

Front 21

what is the DDx of lower extremity claudication?

Back 21

neurogenic (e.g., nerve entrapment/discs), arthritis, coarcation of the aorta, popliteal artery syndrome, chronic compartment syndrome, neuromas, anemia, diabetic neuropathy pain

Front 22

what are the signs of PVD?

Back 22

absent pulses, bruits, muscular atrophy, decreased hair growth, thick toenails, tissue necrosis/ulcers/infection

Front 23

what is the site of a PVD ulcer v. a venous stasis ulcer?

Back 23

PVD arterial insufficiency ulcer - usually on toes/foot. venous stasis ulcer - medial malleolus (ankle).

Front 24

what is the ABI?

Back 24

ankle to brachial index --> ratio of systolic blood pressure at the ankle to systolic blood pressure at the arm (brahcial artery) A:B; ankle pressure taken w/doppler, ABI is noninvasive

Front 25

what ABIs are associated w/normals, claudicators, and rest pain?

Back 25

normal ABI >=1.0, claudicator ABI <0.6, rest pain ABI <0.4

Front 26

who gets false ABI readings?

Back 26

patients w/calcified arteries, especially those w/diabetes

Front 27

what are PVRs?

Back 27

pulse volume recordings --> pulse wave forms are recorded from lower extremities representing volume of blood per heart beat at sequential sites down leg; large wave form means good collateral blood flow (noninvasive using pressure cuffs)

Front 28

prior to surgery for chronic PVD, what diagnostic test will every patient receive?

Back 28

a-gram (arteriogram: dye in vessel and x-rays) maps disease and allows for best treatment option (i.e., angioplasty v. surgical bypass v. endarterectomy); gold-standard for diagnosing PVD

Front 29

what is the bedside management of a patient w/PVD?

Back 29

1. sheep skin (easy on the heels). 2. foot cradles (keeps sheets/blankets off feet). 3. skin lotion to avoid further cracks in the skin that can go on to form a fissure and then an ulcer

Front 30

what are the indications for surgical treatment in PVD?

Back 30

STIR: severe claudication refractory to conservative tx that affects quality of life/livelihood, tissue necrosis, infection, rest pain

Front 31

how does aspirin work for PVD tx?

Back 31

inhibits platelets (inhibits cyclooxygenase and platelet aggregation)

Front 32

how does trental (pentoxifylline) work?

Back 32

results in increased RBC deformity and flexibility

Front 33

what is the treatment of claudication?

Back 33

for the vast majority, conservative treatment, including exercise, smoking cessation, treatment of HTN, diet, aspirin, w/ or w/o Trental (pentoxifylline). (remember PACE: pentoxifylline, aspirin, cessation of smoking, exercise)

Front 34

what is the risk of limb loss w/claudication? w/rest pain?

Back 34

w/claudication: 5% limb loss at 5 yrs, 10% at 10 yrs. w/rest pain: >50% of patients will have amputation of limb at some point.

Front 35

in the patient w/PVD, what is the main postop concern?

Back 35

cardiac status, b/c most patients w/PVD ahve coronary artery disease, ~20% have an AAA. MI is the most common cause of postop death after a PVD operation

Front 36

what is leriche's syndrome?

Back 36

buttock claudication, impotence (erectile dysfunction, and leg muscle atrophy from occlusive disease of the iliacs/distal aorta (CIA)

Front 37

what are the tx options for severe PVD?

Back 37

1. surgical graft bypass 2. angioplasty - balloon dilation 3. endarterectomy - remove diseased intima and media 4. surgical patch angioplasty (place patch over stenosis)

Front 38

what is a FEM-POP bypass?

Back 38

bypass SFA occlusion w/a graft from the femoral artery to the popliteal artery

Front 39

what is a FEM-DISTAL bypass?

Back 39

bypass from the femoral artery to a distal artery (peroneal artery, anterior tibial artery, or posterior tibial artery)

Front 40

what graft material has the longest patency rate?

Back 40

autologous vein graft

Front 41

what is an in situ vein graft?

Back 41

saphenous vein is more or less left in place, all branches are ligated, and the vein valves are broken w/a small hook or cut out; a vein can also be used if reversed so that the valves do not cause a problem

Front 42

what type of graft is used for above the knee FEM-POP bypass?

Back 42

either vein or gortex graft; vein still has better patency

Front 43

what type of graft is used for below the knee FEM-POP or FEM-DISTAL bypass?

Back 43

must use vein graft; prosthetic grafts have a prohibitive thrombosis rate?

Front 44

what is dry gangrene? wet gangrene?

Back 44

dry gangrene: dry necrosis of tissue w/o signs of infection (mummified tissue). wet gangrene: moist necrotic tissue w/signs of infection?

Front 45

what is blue toe syndrome?

Back 45

intermittent painful blue toes (or gingers) due to microemboli from a proximal arterial plaque

Front 46

what are the indications for lower extremity amputations?

Back 46

irreversible tissue ischemia (no hope for revascularization bypass) and necrotic tissue, severe infection, severe pain w/no bypassable vessels, or if patient is not interested in a bypass procedure

Front 47

what are the level of lower extremity amputations?

Back 47

above the knee (AKA), below the knee (BKA), symes amputation (ankle), transmetatarsal amputation, toe amputation

Front 48

what is a ray amputation?

Back 48

removal of toe and head of metatarsal