ABSITE Vascular
Describe the danger factors related to atherosclerosis: - ANSSmoking, diabetes,
hyperlipidemia, weight problems, HTN, sedentary lifestyle
Arterial ulcers vs venous ulcers - ANSArterial ulcers—painful and usually arise on feet or
foot
Venous ulcers—typically huge-based totally, shallow at medial malleolus
Claudication— - ANScramping ischemic muscle pain with exertion that occurs distal to
arterial stenosis, associated with 1% risk of limb loss and five% mortality.
Rest ache— - ANSdue to ischemia, arises with out exertion and classically wakes patients
from sleep (often over distal metatarsals). The pain may resolve with status or setting foot
over aspect of mattress (dependent position, gravity). >50% patients subsequently require
amputation.
Dry gangrene— - ANSnecrotic "mummified" tissue with out signs of infection—not a surgical
emergency
Wet gangrene— - ANSnecrotic tissue indicative of active infectious method—calls for
competitive debridement or amputation to keep away from sepsis
How are ankle brachial index/digital brachial index (ABIs/DBIs) and segmental pressures
measured? Pulse quantity recordings (PVRs)? What is their significance? - ANSNormal ABI
at relaxation: 1.Zero to one.2, moderate arterial insufficiency: 0.7 to zero.Nine, claudication:
0.5 to zero.7, relaxation pain and ultimately tissue necrosis: <zero.Four (falsely improved
ABIs can be seen in diabetic sufferers or people with chronic renal disease due to giant
vascular calcification).
PVRs analyze the waveforms at sequential websites along patient's leg—triphasic or
biphasic waveforms, suggests greater perfusion than monophasic.
What is the half of-life of heparin? Intraoperative healing dosing? How is it reversed? -
ANSHalf-existence is 60 to ninety mins. Intraoperative dosing is 70 to a hundred units/kg
(activating clotting time of 250 to 350 seconds if measured). Protamine sulfate: 1 mg/a
hundred devices of heparin.
What are the 5-year patencies of not unusual and external iliac percutaneous transluminal
angioplasty (PTA) without stenting? - ANSCommon iliac: 70% to eighty%
External iliac: 50% to 60%
What are the traditional signs and symptoms/signs and symptoms of acute arterial
occlusion? In what order do they gift? - ANSThe "6 P's" include: Paresthesias, Pain, Pallor,
Poikilothermia, Pulselessness, Paralysis
, What percentage of emboli originate in the coronary heart? First and second maximum
commonplace reasons? - ANS80% of peripheral emboli are due to cardiac etiology
(First—atrial fibrillation, Second—acute MI)
At what anatomic sites do atherosclerotic lesions most generally occlude? -
ANSAtherosclerosis paperwork at branch points consisting of carotid bifurcation, bends, and
tethered segments together with superficial femoral artery as it passes through Hunter canal
Emboli lodge at arterial bifurcation—that is, femoral bifurcation, brachial bifurcation
How can a peripheral venous embolus reason occlusion in the peripheral arterial move? -
ANSA "paradoxical embolus" happens whilst a peripheral venous thromboembolus crosses
into the peripheral arterial circulation thru a patent foramen ovale inside the coronary heart.
What is the hazard of limb loss related to acute thromboembolic ailment? What is the related
mortality? - ANSRisk of limb loss: eight% to 22%
Thromboembolic perioperative mortality: 10% to 17%
Name some of the indications to perform for peripheral arterial occlusive disease: -
ANSTissue necrosis, rest pain, infection, debilitating claudication refractory to nonoperative
management (Pentoxifylline, Aspirin, Cessation of smoking, Exercise—PACE pneumonic)
NOTE—claudication isn't an illustration for surgical procedure; it's far quality handled with
supervised exercise training.
What is 5-12 months patency price of Fem-Pop vein grafts versus prosthetic grafts -
ANS5-yr patency of an above-the-knee vein graft is 75% (no distinction among in situ or
reverse); prosthetic is 40% to 50%.
Five-yr patency of a beneath-the-knee vein graft is sixty five%, prosthetic is 30%.
What do early (<30 day), intermediate, and late (>2 year) skip graft disasters usually
represent? - ANSEarly—Use of small, terrible-satisfactory vein; anastomosis to inadequate
outflow artery or technical errors (kink/twist of graft; incomplete lysis of valves) on the time of
surgical procedure Intermediate—Intimal hyperplasia at anastomotic web sites or valve web
sites within the graft Late—Progression of atherosclerotic ailment in the inflow or outflow
vessels
Name the four calf cubicles so as of compartment syndrome probability: - ANSAnterior,
lateral, deep posterior, superficial posterior compartment
What is the first sign of compartment syndrome? How long after revascularization is finest
risk? - ANSNumbness of exquisite toe webbing is an early signal of compartment syndrome
because of deep peroneal nerve compression (anterior). Greatest threat occurs four to 6
hours after revascularization in conjunction with release of intracellular
ions/proteins/enzymes from damaged sarcolemma.
What is the maximum common iatrogenic injury at some stage in anterior compartment
fasciotomy? - ANSInjury to the lateral peroneal nerve inside the superior factor of the
incision
Describe the danger factors related to atherosclerosis: - ANSSmoking, diabetes,
hyperlipidemia, weight problems, HTN, sedentary lifestyle
Arterial ulcers vs venous ulcers - ANSArterial ulcers—painful and usually arise on feet or
foot
Venous ulcers—typically huge-based totally, shallow at medial malleolus
Claudication— - ANScramping ischemic muscle pain with exertion that occurs distal to
arterial stenosis, associated with 1% risk of limb loss and five% mortality.
Rest ache— - ANSdue to ischemia, arises with out exertion and classically wakes patients
from sleep (often over distal metatarsals). The pain may resolve with status or setting foot
over aspect of mattress (dependent position, gravity). >50% patients subsequently require
amputation.
Dry gangrene— - ANSnecrotic "mummified" tissue with out signs of infection—not a surgical
emergency
Wet gangrene— - ANSnecrotic tissue indicative of active infectious method—calls for
competitive debridement or amputation to keep away from sepsis
How are ankle brachial index/digital brachial index (ABIs/DBIs) and segmental pressures
measured? Pulse quantity recordings (PVRs)? What is their significance? - ANSNormal ABI
at relaxation: 1.Zero to one.2, moderate arterial insufficiency: 0.7 to zero.Nine, claudication:
0.5 to zero.7, relaxation pain and ultimately tissue necrosis: <zero.Four (falsely improved
ABIs can be seen in diabetic sufferers or people with chronic renal disease due to giant
vascular calcification).
PVRs analyze the waveforms at sequential websites along patient's leg—triphasic or
biphasic waveforms, suggests greater perfusion than monophasic.
What is the half of-life of heparin? Intraoperative healing dosing? How is it reversed? -
ANSHalf-existence is 60 to ninety mins. Intraoperative dosing is 70 to a hundred units/kg
(activating clotting time of 250 to 350 seconds if measured). Protamine sulfate: 1 mg/a
hundred devices of heparin.
What are the 5-year patencies of not unusual and external iliac percutaneous transluminal
angioplasty (PTA) without stenting? - ANSCommon iliac: 70% to eighty%
External iliac: 50% to 60%
What are the traditional signs and symptoms/signs and symptoms of acute arterial
occlusion? In what order do they gift? - ANSThe "6 P's" include: Paresthesias, Pain, Pallor,
Poikilothermia, Pulselessness, Paralysis
, What percentage of emboli originate in the coronary heart? First and second maximum
commonplace reasons? - ANS80% of peripheral emboli are due to cardiac etiology
(First—atrial fibrillation, Second—acute MI)
At what anatomic sites do atherosclerotic lesions most generally occlude? -
ANSAtherosclerosis paperwork at branch points consisting of carotid bifurcation, bends, and
tethered segments together with superficial femoral artery as it passes through Hunter canal
Emboli lodge at arterial bifurcation—that is, femoral bifurcation, brachial bifurcation
How can a peripheral venous embolus reason occlusion in the peripheral arterial move? -
ANSA "paradoxical embolus" happens whilst a peripheral venous thromboembolus crosses
into the peripheral arterial circulation thru a patent foramen ovale inside the coronary heart.
What is the hazard of limb loss related to acute thromboembolic ailment? What is the related
mortality? - ANSRisk of limb loss: eight% to 22%
Thromboembolic perioperative mortality: 10% to 17%
Name some of the indications to perform for peripheral arterial occlusive disease: -
ANSTissue necrosis, rest pain, infection, debilitating claudication refractory to nonoperative
management (Pentoxifylline, Aspirin, Cessation of smoking, Exercise—PACE pneumonic)
NOTE—claudication isn't an illustration for surgical procedure; it's far quality handled with
supervised exercise training.
What is 5-12 months patency price of Fem-Pop vein grafts versus prosthetic grafts -
ANS5-yr patency of an above-the-knee vein graft is 75% (no distinction among in situ or
reverse); prosthetic is 40% to 50%.
Five-yr patency of a beneath-the-knee vein graft is sixty five%, prosthetic is 30%.
What do early (<30 day), intermediate, and late (>2 year) skip graft disasters usually
represent? - ANSEarly—Use of small, terrible-satisfactory vein; anastomosis to inadequate
outflow artery or technical errors (kink/twist of graft; incomplete lysis of valves) on the time of
surgical procedure Intermediate—Intimal hyperplasia at anastomotic web sites or valve web
sites within the graft Late—Progression of atherosclerotic ailment in the inflow or outflow
vessels
Name the four calf cubicles so as of compartment syndrome probability: - ANSAnterior,
lateral, deep posterior, superficial posterior compartment
What is the first sign of compartment syndrome? How long after revascularization is finest
risk? - ANSNumbness of exquisite toe webbing is an early signal of compartment syndrome
because of deep peroneal nerve compression (anterior). Greatest threat occurs four to 6
hours after revascularization in conjunction with release of intracellular
ions/proteins/enzymes from damaged sarcolemma.
What is the maximum common iatrogenic injury at some stage in anterior compartment
fasciotomy? - ANSInjury to the lateral peroneal nerve inside the superior factor of the
incision
