VASCULAR Flashcards Preview

A ORAL BOARDS 2016 > VASCULAR > Flashcards

Flashcards in VASCULAR Deck (129)
Loading flashcards...
1

Normal toe pressure

110

2

First step in bypassing for vascular occlusion

Find distal target first!

If there is no target then you are done with the case.

3

Steps of bypass for vascular occlusion

Find distal target first!

Then evaluate proximal inflow (may have todo endarterectomy)

if SFA is too calcified - need to go to profunda patch

Harvest Vein 20-30 % more than you need.
Reverse the vein.

Tunnel

Heparinize

prox anast

mark for orientation

Distal anast.

4

Medications for vascular path

Beta blocker
Statin
Lipitor

5

Contraindications for cilostazol

this is pletal

no if in cardiac failure

6

Treatment for lesion just proximal to aortic bifurcation

Angioplasty

(not enough room for stance- they would set timer for 30 minutes just running to each other)

7

Trial of asymptomatic carotid disease

ACS

60 % angio (80% by duplex) occlusion

11% risk of CEA on meds

5% risk of stroke with CEA

8

Trial of symptomatic carotid disease

Symptomatic

70% stenosis of angio or duplex

26% stroke risk meds

9% stroke risk with CEA

9

CEA

vericle incision along SCM
retract lateral
enter carotid sheath
find IJ
facial vein ligate and divide
btw IJ and common carotid is vagus nerve - this is protected

encircle with vessel loops
common
Internal
external

watch hypoglossal

Heparnize
Verify with ACT

Order of clamping:

ICE
is
NICE

Inertnal
Common
External

If no change on neuromonitor EEG or awake and fine- then no need to shunt

Ateriotmy
endarterectomy : feather, tack as needed
patch

Release clamps:

Temp open each clamp

External - fills with blood
Common carotid
Internal

10

What is white clot

probably HIT

11

Super celiac aortic control

Vertical Midline incision

Opened gastrohepatic ligament (pars facida)

(watch replaced left heptic)

Take down triangular ligament - retract left lateral lobe of liver) to the right

Grab the OG and move esophagus to patient's LEFT

compress aorta against spine (wait for anesthesia to catch up - then can place clamp)

12


What is a argyle shot made out of

vinyl

13

What is alternative to argyle shunt

foley
chest tube

14

Alternative proximal just to control technique

Balloon occlusion

Pruitt balloon

(you can also inject heparin through this baloon)

15

Imaging for a ruptured AAA

Noncontrast CT scan

Permissive hypotension systolic in the 90s

16

Initial step in managing acute mesenteric ischemia

Heparin

17

Where it is in black usually lodge in the SMA

Distal to the middle colic take off

18

Management of chronic mesenteric ischemia

Usually open operation(because stenting is associated with higher the operation rate)

19

Bypass option for chronic mesenteric ischemia SMA

common illiac

external illiac

infrarenal illiac

supra celiac aorta

from the chest

stent via open approach retrograde

(can just bypass one artery)

20

when to reimplant IMA

NO flow

21

Aortoenteric fistula stable patient

Stable post herold bleed

Ax bifem

Super celiac
Aortic proximal control

Iliac distal control

Take out the graft

Repair the duodenum

22

Aortoenteric fistula unstable patient

Endograft seals whole

then ax bifem

take out graft and stent

---

Super celiac control
Iliac control

Resect repair duodenum

If doing well then do
ax bifem

if not doing well:
oversew stump of aorta and

If not doing well

23

types of vascular shunts

Argyle - vinyl conduit
Pruitt–Inahara shunt - double balloon
Pruite
Bard Javid Carotid Bypas Shunt - T - SHUNT WITH

24

treatment of SMV thrombosus

Hep!

lysis is not standard of care - but people do it and this can be mentioned

25

Claudication numbers and presentation

ABI above .5
no ulcers

26

Medical managemnt of claudicant

1 ASA
2 Statin LDL goal

27

Occlution at bifurcation of Aorta

Bypass
Aorto bi illiac - graft open

or

Ax bifem

or

stent one side then do fem-fem

28

Steps of thrombectomy and possible bypass for Acute limb ischemia - oclusion of below knee pop

Prep - groin to toes
Heparin
ABx
Angio
Duples saphenous in lower calf

Medial incision to finger bredth posterior to proximal tibia

expose posterior compartment

Retract gastroc muscle down

this exposes bundle of nerve artery and vien

mobalize vein - to expose below knee popliteal artery

then inferiroly reflect the soleus from periostium - this exposes the trifurcation

This exposes anterior tibial vein - mobilize to expose the anterior tibial artery

encircle anterior tibial trunk

transverse arteriotomy for emolectomy just proximal to trifurcation - this allows cannulation of AT, PT, and peroneal with fogarty

run retrograde

check for signals at the foot

POSSIBLE fasciotomy:

the superficail posterior compartment is already done having exposed the trifurcation

to release the complete DEEP posterior compartment release - you must release the entire solus off of the tibia (this is done if true compartment syndrome


Lateral incision just anterior to fibula
transferse superfical entrance of facia
release mets pointed away from septurm fascia anterior to intermuscular septum knee to ankle (careful of superficial peroneal n can have variable course not in its normal position posterior to septum)

Then release posterior to intermuscular septum sissors pointed away from septum.

29

Reperfusion syndrom

massive hyper K
acidotic
hypo vol

(may need to reocclude)

(may have to pull off first liter of blood)

30

lysis therapy

first choice thrombectomy

if too sick:
lysis takes time and may get neuro - motor def