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ABITE ch 27 vascular.doc

ABITE ch 27 vascular.doc

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Most common congenital hypercoagulaboe disorder Leiden factor (resistance to protein C) Most common aquired hypercoagulability disorder Smoking

Macrophages that have absorbed fat and lipids in the blood vessel wall Foam cells Exposure of collagen in vessel wall and eventual throbus formation Intimal disruption Atherosclerosis: layer that it effects Intima Hypertension: layer that it effects Media 3rd most common cause of death in US stroke amount of blood supply provided to brain by carotids 85% flow pattern of a normal internal carotid artery continuous forward flow normal flow pattern of the external carotid artery triphasic flow 1st branch of external carotid artery superior thyroid vessels that provide communication between internal carotid and external carotid (2) ophthalmic artery, internal maxillary artery most commonly diseased intracranial artery middle cerebral artery most common source of cerebral ischemic events arterial embolization from ICA symptoms associated with anterior cerebral artery events mental status changes, release, slowing symptoms associated with middle cerebral artery events contralateral motor and speech, face droop occlusion of ophthalmic branch of ICA causing transient visual effects amaurosis fugax candidates for CEA >= 70% stenosis and symptoms stump pressures requiring shunt during CEA >50 most commonly injured cranial nerve during CEA vagus

>5cm. dyspnea. voice changes. previous colon surgery. renal or leg ischemia. large size Artery perfusing spinal cord. dysarthria. inadequate flow to c olon . distal embolixation. back pain. >=6cm with Marfan�s. tinnitus. SMA stenosis.5cm/yr situations when IMA should be reimplanted during AAA repair backpressure <40mmHg.complications of CEA stroke. hypertension. persistent pain. incoordination. pseudoaneurysm. diameter 2X normal. compression of adjacent organs Rupture risk of AAA 5cm 15-20% 5-year rupture risk of AAA >8cm 100% 5-year indications for AAA repair (3) symptomatic. whose injury causes paraplegia if occluded during repair Artery of Adamkiewicz Symptoms of AAA Rupture. drop attack. MI signs of vertebrobasilar insufficiency (7) diplopia. rapid increase in size aneurysm classification for those with any ascending aortic involvement Class A Aneurysm classification for those with descending involvement only Class B DeBakey classification for aneurysms with ascending an descending involvement Type I DeBakey classification for aneurysms with ascending involvement only Type II DeBakey classification for aneurysms with descending involvement only Type III Layer of blood vessel where dissection occurs Media Ascending aortic dissections that need operative repair ALL of them Descending aortic dissections that need operative repair Visceral. growth >0. vertigo. dysphagia indications for repair of ascending aortic aneurysm (4) >=7cm. binocular vision loss tumor presenting as painless neck mass near bifurcation of carotid carotid body tumor symptoms of ascending aortic aneurysm aortic insufficiency.

E. B12 Yearly risk of gangrene and amputation with claudication 2%/year and 1%/year symptoms of aortoiliac occlusion buttock pain symptoms of external iliac occlusion midthigh claudication symptoms of common femoral or proximal superficial femoral artery occlusion calf claudication symptoms of distal SFA or popliteal disease foot claudication syndrome with a lesion at or above aortic bifurcation. resection of infected portion of aorta Organisms common in aortic graft infections (2) Staph. staph Treatment of mycotic aneurysm Extraanatomic bypass. anterior tibial artery Nerve in lateral compartment of the leg Superficial peroneal nerve Nerve and 2 vessels in the deep posterior compartment of the leg Tibial nerve. distal.bloody diarrhea after AAA: dx? Ischemic colitis Organisms common in mycotic aneurysms (2) Salmonella. impotence . buttock/thigh claudication. or through the stent Type I endoleak Endoleak that is persistent blood flow through lumbars or IMA Type II endoleak Nerve and vessel in anterior compartment of leg Deep peroneal nerve. then blood per rectum ~6mos after AAA Aortoenteric fistula Treatment of aortoenteric fistula Axillary bifem. graft resection Endoleak that is proximal. B6. posterior tibial and peroneal arteries Nerve in superficial posterior compartment of the leg Sural nerve Treatment of homocysteinuria Folate. bypass through noncontaminated field Herald bleed with hematemesis.coli Treatment of aortic graft infection Resect graft. causing lack of femoral p ulse.

Leriche syndroma Most common atherosclerotic occlusion in lower extremities Hunter�s canal (exit of SFA) ABI where claudication starts <0. myoglobinuria. atheromatous embolixati on Graft material good for aorta and large vessels Dacron Typeical repair for aortoiliac disease Aortobifemoral repair 5-year patency of femoropopliteal grafts 75% 5-year patency of femoral-distal grafts 50% complications of reperfusion of ischemic tissue (4) lactic acidosis.6 ABI where ulcers start (usually on toes) <0. short segments tx for pseudoaneurysm after arteriography thrombin injection (u/s guided) most common compartment of leg to get compartment syndrome anterior .9 ABI where rest pain starts <0. compartment syndrome tx for patients with heel ulceration to bone amputation tx for patients with dry gangrene allow to autoamputate tx for wet gangrene amputation to remove infected necrotic tissue + antibiotics (surgical emergency) good lesions for PCTA common iliac lesions. lifestyle limitation.5 ABI where gangrene starts <0. hyperkalemia. ulceration or gangrene.3 studies to find significant occlusion and at what level PVRs (peripheral vascular resistance studies Gold standard for vascular imaging to detect occlusion Angiogram Surgical indications for PVD (4) Rest pain.

anticoagulation source of most renal emboli heart most common location for renal atherosclerosis Left proximal 1/3. more in men Most common location for renal fibromuscular dysplasia Right distal 1/3. OR for thrombectomy (if limb threatened). angio for thrombolytics (if l imb not threatened) treatment of thrombosed PTFE graft thrombolytics. more in women Diagnostic study for renal artery stenosis Renal angiogram Tx of renal artery stenosis PTA with stent Indications for nephrectomy with renal HTN Atrophic kidney <6cm with persistently elevated rennin level . good distal p ulses blue toe syndrome treatment of acute arterial thrombosis heparin. resection of cyst 3-year mortality after BKA or AKA 50% % of patients who walk again after BKA 70 % of people who walk again after AKA 30% most common cause of acute arterial emboli atrial fibrillation most common site of peripheral obstruction from emboli common femoral artery flaking of atherosclerotic emboli off abdominal aorta or branches. primary symptom is loss of puls es with plantarflexion popliteal entrapment syndrome treatment for popliteal entrapment syndrome resection of medial head of gastroc intermittent claudication with changes in symptoms with knee flexion and extensi on adventitial cystic disease tx of adventitial cystic disease vein graft if occluded.pressures requiring fasciotomies >20-30 mild intermittent claudication in med in their 40�s.

heparin Treatment of SMA thrombus Thrombectomy. scalene and clavicle Vein passes over 1st rib anterior to anterior scalene. low-flow states. vascular occlusion Most common cause of visceral ischemia Acute embolic occlusion (50%) Causes of visceral ischemia (4) Embolus. embolectomy. sc alene and clavicle Artery passes over 1st rib posterior to anterior scalene and anterior to middle scalene Test looking at radial pulse with head turned to the ipsilateral side Adson�s test Location of ulnar nerve on brachial plexus (superior. then behind clavicle Normal position of subclavian artery and brachial plexus in relation to ribs. middle. or inferior) Inferior portion Location of radial nerve on brachial plexus (superior. intramural gas. portal venous air. Poss ible 1st rib resection Effort induced thrombosis of subclavian vein Paget von Schrotter disease CT findings that suggest intestinal ischemia Bowel wall thickening. SMA bypass. thrombectomy if diagnosed early Nonocclusive mesenteric ischemia: definition low cardiac output state to visceral vessels caused by spasm.Most common site of upper extremity stenosis Subclavian Proximal subclavian artery stenosis resulting in reversal of flow through ipsila teral vertebral artery into subclavian Subclavian steal syndrome Treatment of subclavian steal syndrome Carotid to subclavian bypass or PTA Normal position of subclavian vein in relation to ribs. division of anterior scalenes and middle scalenes. venous thrombosis Most common source of SMA embolus Heart Treatment of SMA embolus Resuscitation. resection. thrombolytics. middle or inferior) Superior portion Treatment of thoracic outlet syndrome Cervical rib resection. antibiotics. o r hypovolemia . thrombotic occlusion. low flow state. resection. heparin Treatment of mesenteric vein thrombosis Heparin.

myalgia. mycotic Indications for surgery for femoral aneurysm Symptomatic.most vulnerable areas for nonocclusive mesenteric ischemia (2) Griffiths and Sudak�s points Celiac compression causing chronic abdominal pain. severe rest pain with bilateral ulceration Buerger�s disease Type I collagen defect causing retinal detachment. aortic root dilatiation Marfan�s syndrome Collagen defect resulting in easy bruising. >2. arthralgia. anore xia (common in women >55) Temporal arteritis Large artery arteritis causing fever. hypermobile joints. >3cm. weight loss. visual changes.5cm. iliac and femoral aneurysm Exclusion and bypass graft Indications for surgery for iliac aneurysm Symptomatic. mycotic Most common peripheral aneurysm Popliteal % of people with popliteal aneurysm who have another aneurysm 50% surgical indications for popliteal aneurysm symptomatic. pregnancy. weight loss due to food fear Chronic mesenteric ischemia Most common complication of aneurysms above inguinal ligament Rupture Most common complication of aneurysms below inguinal ligament Thrombus/emboli Most common visceral aneurysm in women Splenic Indications for splenic artery aneurysm repair Symptomatic. arterial rupture Ehlers-Danlos syndrome Large artery arteritis causing fever. >2cm. diarrhea Median arcuate ligament syndrome Visceral angina 30 min after meals. arthralgia. mycotic collection of blood in continuity with arterial system but unenclosed by all 3 l ayers of arterial wall femoral pseudoaneurysm disease with string of beads appearance on angiogram fibromuscular dysplasia gangrene of fingers>toes. and anorexia (common . myalgia. women of childbearing age Treatment of visceral.

kawasaki�s disease Small vessel arteritis. swollen legs and night cramps. severe varicosities Disease secondary to venous incompetence Venous ulcers Treatment of venous ulcers Unna boot. pallor and edema of lower extremity Phlegmasia alba dolens Tenderness. venous wall injury Tenderness. increased ATIII and tPA. often secondary to drug/tumor antigens Hypersensitivity angitis Vasculitis of young women with subsequent vasoconstriction and cyanotic extremit ies Raynaud�s disease Most common failure of AV grafts for dialysis Venous obstruction secondary to intimal hyperplasia Indications for surgical treatment of varicose veins Symptomatic. vein stripping Trendelenburg test Test of venous insufficiency: elevate leg. cyanosis and massive edema of lower extremity Phlegmasia cerulea dolens Source of PE when a DVT filter is in place (3) . then lower leg to see how rapid the refilling of the vein is Disease with achy. recurrent ulcers.in women <35) Takayasu�s arteritis Treatment of large vessel arteritis Steroids. hypercoaguability. ligate perforators. occlude greater saphenous. increased fibrinolysis Leg more commonly affected by DVT Left (longer iliac vein compressed by iliac artery) Virchows triad Venous stasis. bypass Medium vessel arteritis (2) Polyarteritis nodosa. as well as brawny edema Venous insufficiency Nonbacterial inflammation of superficial veins Superficial thrombophlebitis Bacterial infection of superficial veins Suppurative thrombophletibis Self-limiting thrombophlebitis of the breast Mondor�s disease Methods by which SCD�s prevent clots (3) Decreased venous stasis.

brain. muscle. tendon. cornea Lymphangiosarcoma associated with breast axillary dissection Stewart-Treves syndrome Dilation of preexisting lymphatic channels Lymphangiectasia . upper extremities Treatment of 1st DVT Coumadin 6 months Treatment of 2nd DVT Coumadin 12 months Treatment of 3rd DVT or PE Lifetime Coumadin ABG changes of PE Dec pO2. IVC superior to filter.Ovarian veins. cartilage. respiratory alkalosis Tissue types with no lymphatics (6) Bone. dec pCO2.

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