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101 Flashcards

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1
Q

What are the grades of blunt thoracic aortic trauma

A
  1. Intimal injury - medical management
  2. Mural hematoma
  3. Pseudoaneurysm
  4. Contained rupture
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2
Q

What is CREST 2

A

A trial comparing carotid endarterectomy to best medical management and carotid stenting to best medical management, and asymptomatic patients 

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3
Q

What are 4 exclusión criteria for EVAR

A

Widely accepted exclusion criteria for EVAR include:
1. proximal neck length less than 10 mm
2. proximal neck diameter greater than 32 mm
3. neck angulation greater than 60 degrees
4. external iliac diameter of less than 6mm

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4
Q

Velocity criteria for severe carotid stenosis

A

PSV Greater than 230
>50% plaque
Internal:common psv ratio >4
EDV > 100

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5
Q

Velocity criteria for moderate carotid stenosis 50-69%

A

ICA PSV 180-230
Plaque >50
ICA:CCA PSV Ratio 2-4
ICA EDV 40-100

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6
Q

Rutherford classification for chronic ischemia

A

Stage 0 - asx
Stage 1 - mild claudication
Stage 2- moderate claudication
Stage 3 - severe claudication
Stage 4 - rest pain
Stage 5 - minor tissue loss
Stage 6 - major tissue loss

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7
Q

Rutherford classification for acute limb ischemia

A

I. Intact sensory motor, Doppler signals present, cap refill intact

IIa. Loss of arterial Doppler signals. Mild sensory changes. Motor intact. Cap refill delayed. Urgent OR

IIb. Motor deficits. Worsening sensory deficits. Immediate OR

III. Paralysis and complete sensory loss. Loss of venous Doppler signals. No cap refill. Unsalvageable

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8
Q

Wifi classification

A
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9
Q

Reflux time for superficial and deep veins to be considered significant

A

Superficial greater than 0.5, deep greater than 1 second

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10
Q

Exclusion for TCAR

A

4/5/6
4mm internal, 5cm runway/5cm depth, 6mm common

  1. Distance between access site (common carotid above the clavicle) and lesion less than 5cm
  2. Diameter of CCA less than 6mm
  3. Access and occlusion sites with significant disease
  4. Visible Thrombus
  5. Circumferential plaque/calcification
  6. Tortuosity, small diameter ICA

Relative: neck radiation, tracheostomy

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11
Q

Best-CLI Trial

A

Prospective open label trial comparing two cohorts, NEJM December 2022
Cohort 1 was patients with suitable single segment of greater saphenous vein- in this group surgery was superior to endo (major adverse limb events/death)

Cohort 2 was patients without suitable single segment saphenous. In this group surgery and endo we’re equivalent

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12
Q

Adequate gsv diameter for bypass

A

3mm; 2-3 marginal

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13
Q

Timing of CEA after stroke

A

48hrs - 14 days

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14
Q

Popliteal artery aneurysm size threshold for repair

A

2cm

If there is thrombus and poor distal run off, can consider repairing at smaller size

If comorbid and no thrombus can wait until 3cm

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15
Q

Biochemical work up for carotid body tumor

A

Screen with serum metanephrines and serum dopamine if positive follow up with 24 hr urine metanephrines

(See email with Wachtel)

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16
Q

Describe the Voyager trial

A

RCT of Compass dose xarelto (2.5 bid) and Asa compared to Asa alone in PAD patients with revascularization with regards to composite outcome of ALI, major amputation, MI, stroke or death from CV causes. TIMI bleeding not significantly higher but ISHT major bleeding was

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17
Q

Describe the compass trial

A

In patients with stable atherosclerotic disease, three groups: asa 100mg, full strength rivaroxaban (xarelto), or low dose rovaroxaban (2.5 bid) AND asa 100mg were compared with respect to a composite outcome of cardiovascular death, MI or stroke. Combo low dose xarelto and asa had lower rates of primary outcome, higher rates of major bleeding than Asa alone. Xarelto alone had similar rates of primary outcome but higher rates of bleeding to Asa alone

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18
Q

CREST Trial

A

Symptomatic and asymptomatic patients comparing endarterectomy and stenting. Showed equivalent outcomes but in the periprocedural period CEA had more MI and CAS had more strokes. Decreased quality of life in stroke pts relative to MI pts. 2010

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19
Q

EMINENT Trial

A

Eluvia DES vs bare metal stents for SFA lesions, Eluvia with better long term latency at 1 year (85 vs 76)

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20
Q

ZILVER PTX Trial

A

Comparison of Zilver (paclitaxel DES) to angioplasty;

Acutely failed angioplasty randomized to DES vs BMS

Zilver less restenosis than either

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21
Q

BATTLE Trial

A

Zilver stents vs misago stents… showed no advantage to Zilver

Zilver is a non polymer DES so drug rapidly dissipates and is gone before ISR typically presents (60 days to dissipate, 1 year for ISR)

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22
Q

IMPERIAL Trial

A

Zilver vs Eluvia
Two year follow up
Eluvia significantly less TLR and significantly high primary patency

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23
Q

BASIL Trial

A

Bypass vs Angioplasty
No difference

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24
Q

NASCET

A

Narrowest area of stenosis / normal ICA diameter distal to lesion

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25
TASCA
aortoiliac: stenosis (not occlusion!) short (3cm) and single, unilateral or bilateral Fempop- single stenosis less than 10cm or occlusion less than 5cm
26
TASC B
Aortoiliac: -short infrarenal stenosis -unilateral common iliac occlusion -external iliac stenosis: multiple or greater than 3cm but less than 10 and not extending into CFA -external iliac occlusion: unilateral, not involving CFA or internal Fempop: - multiple lesions all less than 5cm - single stenosis or occlusions less than 15, not involving infrageniculate pop - heavily calcified occlusion less than 5cm - single popliteal stenosis
27
4 compartments of lower leg
Deep and superficial posterior Anterior Lateral
28
Indications for concomitant carotid/CABG
—symptomatic carotid stenosis —bilateral 80-99% stenosis —unilateral 70-99% stenosis with contralateral occlusion
29
CEAP classes
Class 1: telangiectasias/reticular veins Class 2: varicose veins Class 3: Edema Class 4: venous stasis skin changes Class 5: healed ulcer Class 6: active ulcer
30
Name and describe all the collateral pathways in the visceral circulation
Arc of buhler- variant direct connection between celiac and sma Arc of riolan- anastomosis between middle colic and left colic (first branch of IMA) Marginal artery of Drummond GDA- pancreatico duodenal arcades - inferior pancreatioduodenal artery - SMA Internal iliac - middle hemorrhoidal - superior hemorrhoidal - ima
31
Crawford classification for thoracoabdominal aneurysms
Extent 1: Distal to LSCA, proximal to renals (isolated DTA) Extent 2: Distal to LSCA, and including some or all of the abdominal aorta Extent 3: Distal to 6th intercostal space, some or all of the abdominal aorta Extent 4: Distal to diaphragm, all of the abdominal aorta (Extent 5: distal to 6th intercostal space, proximal to renals; like a focal distal extent 1)
32
Arc of Buhler
Variant embryologic remnant direct connection between celiac and sma
33
Arc of riolan
Connection between middle colic (SMA) and left colic (IMA)
34
Extent I TAAA
From LSCA to renals
35
Extent II
LSCA to iliac Bifurcation
36
Extent III
Extent 3: Distal to 6th intercostal space, some or all of the abdominal aorta
37
Extent IV
Distal to diaphragm, all of the abdominal aorta
38
COBEST Trial
Covered vs bare stents for iliac lesions Covered stents superior
39
Lateral superior most branch of CFA
Superficial circumflex iliac artery Lateral distal External iliac branch: Deep circumflex iliac artery
40
Medial superior most branch of CFA
Superficial epigastric artery - really more anterior The most distal medial branch of the external iliac is the inferior epigastric
41
Arterial branches of the arm
Axillary artery becomes brachial at lateral border or teres major Brachial gives off a deep brachial branch Brachial bifurcation Ulnar gives off common interosseous -anterior and posterior divisions
42
Name and origin of 3rd major forearm artery
Common interosseous artery, comes off ulnar and then has anterior and posterior divisions
43
PPI
Profunda - popliteal index (AKSP – BKSP) / AKSP Use to evaluate effectiveness of geniculate collaterals to decide between inflow only vs inflow and other procedures
44
Describe appearance of acute thrombus in a vein on B mode imaging
Anechoic to hypo-echoic. Enlarged vein Incompressible. On color flow, absence of flow
45
Chronic DVT appearance
Increased echogenicity Decreased size Wall thickening Fibrosis and synechia
46
Size threshold for descending thoracic aneurysm
5.5cm or more than 0.5 cm/ year
47
Size threshold for iliac artery aneurysm
3cm, realistically could wait until 3.5 or 4
48
Size threshold for splenic artery aneurysm
3cm All aneurysms in women of childbearing age
49
Size threshold for renal artery aneurysm
3cm And women of child bearing age
50
Resistive Indices
PSV - EDV / PSV
51
Markers of chronically ischemic unsalvageable kidney
-Size less than 8cm - resistive indices 0.8 or greater
52
Vascular Causes of Horner’s syndrome?
1) FMD 2) carotid artery dissection [ 3) vertebral artery transposition surgery]
53
What respiratory maneuver worsens MALS
End Expiration Exacerbation during End Expiration
54
Giacomini vein
Posterior thigh tributary/ trunk projection off the SSV, present in 56-86% of limbs and may increase the effective length of SSV for use as a bypass conduit
55
Peroneus magnus
56
Where do most lower extremity venous thrombi originate
The soleal sinuses
57
Size threshold hepatic artery aneurysms
2cm
58
Size threshold celiac artery aneurysms
2cm
59
Size threshold SMA artery aneurysms
All aneurysms regardless of size
60
Jejunal and ileal artery aneurysms
2cm
61
Gastric and gastro epiploic artery aneurysms
Repair all regardless of size
62
PDA/gda aneurysm size threshold
Repair all regardless of soze
63
Popliteal entrapment
64
Persistent sciatic artery
65
8 High Risk Features for TBAD
-Refractory pain -Refractory HTN -Bloody pleural effusion -Aortic diameter >40 -Radiographic-only malperfusion -Readmission -Entry tear on lesser curve -False lumen diameter >22mm
66
Levels of mid foot amputation
SCL Symes Chopart Lis Frank
67
Coral Trial
-“ Drive by renal stenting” -CKD or HTN on 2 or more agents with greater than 60% RAS -randomized to best medical vs. renal artery stenting - 2014 NEJM
68
ACAS Trial
“Endarterectomy for Asymptomatic Carotid Stenosis” Jama 1995 (1987-1993) 60% stenosis CEA and Asa vs. Asa alone 5% stroke vs. 11% stroke
69
ACST trial
70
Basil 2
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