Vascular Surgery by Emi > Venous > Flashcards

Venous Flashcards

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1
Q

normal PPG refil time

A

> 20 seconds

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2
Q

reflux PPG refill time

A

<20 seconds

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3
Q

what indicates superficial vein reflux ONLY

A

PPG <20 seconds without a tourniquet but >20 seconds with a tourniquet

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4
Q

normal venous flow on duplex

A

less than or equal to 0.5 seconds

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5
Q

reflux venous flow on duplex

A

More than 0.5 seconds

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6
Q

C in CEAP classification

A
  1. teleangiectasia <3mm
  2. reticular veins >3mm
  3. edema
  4. skin changes - discoloration
  5. healed ulcer
  6. active ulcer
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7
Q

E in CEAP

A

etiology
c - congenital
p - primary
s - secondary

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8
Q

A in CEAP

A

anatomy
s - superficial
d - depp
p - perforator

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9
Q

P in CEAP

A

patophysiology
r - reflux
o - obstruction
r,o - both

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10
Q

direction of venous flow in upper extremity

A

UP with INSPIRATION
down with expiration
(augmented with negative pressure in the chest)

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11
Q

direction of venous flow in lower extremity

A

down with INSPIRATION

UP with expiration

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12
Q

indication for suprarenal IVC filter

A
  1. duplicated IVC
  2. malposition of the IVC filter
  3. pregnancy
  4. ovarian vein thrombosis
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13
Q

common femoral vein size

A

10mm

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14
Q

saphenous vein size

A

5mm`

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15
Q

what is the point of origin for lower extremity venosu thrombus

A

soleal sinus

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16
Q

how do you perform venous PPG

A

patient does dorsiflexio / plantarflexion while sitting wihich activates the calf muscle pump. Upon cessation, time required to refill the calf compartments is measured.

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17
Q

what are characteristics of deep venous reflux?

A

on PPG <20 seconds regardless of turniquet

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18
Q

how do you perform venous insufficiency study (doppler)

A

inflate pressure cuff around calf to 80-100mHg reduces calf muscle blood volume. With rapid deflation in normal person valve closure limits pop venous flow reversal to less than 0.5sec

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19
Q

What does it mean if Valsalva generates reflux in a vein

A

there are no competent valves between that vein and diaphragm

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20
Q

ACCP recommendations for treatment of acute DVT in lower extremity

A

LMWH or fundaparineux rather than unfractionated heparin
daily LMWH is preferred
may be treated at home
may walk

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21
Q

what is the association of brachial, axillary and subclavian DVT with complications

A

5% PE
20% post thrombotic syndrome
8% recurrence

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22
Q

ACCP recommendations for treatment of upper extremity DVT

A
  1. central line association - if line is needed, leave and anticoagulate for the time line is in and 3 months
  2. axillary and proximal - full anticoagulation with LMWH or fundaparineux; selective thrombolysis
  3. isolated brachial vein - full anticoagulation if symptomatic, + cancer and + TLC (for 3 months)
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23
Q

Anatomical anomalies of IVC

A
  1. retroaortic or circumaortic left renal vein 5-7%
  2. IVC transposition 0.2-0.5%
  3. IVC duplication 0.2-0.3%
  4. IVC agenesis
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24
Q

Greater saphenous vein tributaries

A
  1. inferior epigastric vein
  2. superficial circumflex iliac vein
  3. lateral accessory saphenous vein
  4. medial accessory saphenous vein
  5. deep external pudendal vein
  6. superficial external pudendal vein
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25
size of teleangiectasia
0.1 - 1 mm
26
methods of femoral vein valve reconstruction
1. internal valvuloplasty 2. external valvuloplasty 3. external banding 4. valve transposition 5. valve transplantation
27
Indications for iliac vein stenting
C0-2 limbs with severe diffuse venous limb pain not relieved by compression C3-6 limbs failing compression
28
Treatment algorithm for postthrombotic venous insufficiency
Treat saphenous reflux first, provided gsv is at least 5mm in size Treat perforator reflux underneath the ulcer if larger than 3.5 mm and reflux in >500ms Correct obstruction next Correct reflux if all of the above fails
29
How do you size stents for veins
CIV normal size is 16 mm, oversize 2mm —> 18 mm stet EIV normal size 14mm, —> 16 stent CFV normal size 12mm, —> 12 stent
30
Stent patency in nonthrombotic venous obstruction
79% primary 100% primary assistant Thrombosis extremely rare
31
Patency if venous stent for recanalization thrombotic occlusion
54% for primary, 68% for primary assisted 74% secondary
32
What does lack of femoral venous respiratory variation mean
Iliofemora occlusion
33
Phasicity
Cyclic vartiation with respiration
34
Augmentation
Produced by distal compression or release of proximal compression
35
Valvular competence in venous duplex
Presence or absence of reverse flow in response to proximal compression or Valsalva maneuver Flow reversal >0.5sec abnormal
36
Characteristics of acute DVT on duplex
Echolucent, spongy / incompressible, dilated vein, homogenous vein, smooth luminal surface, absent collateral, confluent flow channel, +/- present free floating rail
37
Chronic DVT duplex characteristics
``` Echogenic Firm vein Contracted vein Heterogenous inside of vein Irregular luminal surface Present collaterals Multiple flow channels Absent free floating tail ```
38
What increases VTE risk 10 fold
Antithrombin deficiency | Protein C and S deficiency
39
How much does factor V Laiden increase VTE risk
5 fold for heterozygotws | 50 fold for honozygotes
40
Classification of the antiphospholipid syndrome
Clinical criteria: 1. Vascular thrombosis (one or more episodes of arterial, venous or small Vassell thrombosis within any tissue or organ) 2. Unexplained death of a normal fetus >10 week gestation 3. Premature birth or normal neonates less than 34 weeks gestation due to eclampsia, preeclampsia, placenta insufficiency 4. 3 or more spontaneous abortions less than 10 week gestation Laboratory criteria 1. Lupus anticoagulant two or more occasions more than 12 weeks apart 2. Anticardiolipin igg or igm on two or more occasions more than 12 weeks apart 3. Anti beta 2 GP1 IGG or IGM on two or more occasions more than 12 weeks apart
41
Secondary theomboprophylwxis with antiphospholipid syndrome
1 venous event - indifinite with INR 2-3 Arterial event - indefinite with INR 3-4 and ASA Recurrent events - indefinite with INR 3-4 or lovenox
42
Malignancy associated with arterial thrombosis
``` Leukemia Myeloproliferarive disorder (JAK2 mutation) Multiple myeloma Neurofibromatosia Lung Transitional cell Breast Ovarian Colorectal Unknown primary ```
43
Vascular complications associated with l- asparinginase
CVA
44
Vascular complications associated with cis platinum
CVA, peripheral arterial events, aortic thrombosis
45
Vascular complications associated with fluorouracil
Coronary vasospasm mediated ischemia
46
Vascular complications associated with bevacizumab
Coronary thrombosis mediated ischemia, CVA
47
Vascular complications associated with gembotabine
Digital ischemia, thrombotic microangiopathy
48
Vascular complications associated with thalidomide
Arterial thrombosis
49
Vascular complications associated with sorafenib, sunitinib
Myocardial infarction, CVA
50
Clinics criteria for HIT
Unexplained thrombocytopenia (less than 100) Or decrease in platelet count more than 30-50% Positive assays for HAABs (platelet aggregation teat, 2point platelet aggregation assay, C14-serotonin release assay) Positive ELISA (40% discordance vs platelet aggregation, IGG, IGM) Arterial and o venous thrombus
51
Purpose of tumescent infiltration in endogenous ablation
Helps uniformly compression vein around heating element Creates fluid cushion to exanguinatr treatment vein Create depth between skin surface and anterior vein wall Acts as heat sink to protect perivenous tissue from thermal injury
52
EHIT levels
1. Before the branches to GSV around the SFJ 2. Past inferior epigastric vein branch but still in GSV 3. At the GSV deep vein junction, not extending into CFV 4. Extending into CFV <50% 5. Extending into CFV >50% 6. Occluding CFV
53
EHIT treatment
Level 1-2 no treatment Level 3 surgeons choice Level 4-5 lovenox until the clot retracts to level 3 Level 6 lovenox abd warfarin for 3 months
54
What is May - Husni procedure
Popliteo - femoral venous bypass using GSV
55
Palma procedure
Femoral femoral venous bypass with GSV
56
PEIHO trial
Randomized double blinded Patients with intermediate risk PE TEnecteplase vs heparin Endpoint: death, hemodynamic collapse Statistically lower primary outcome and hemodynamic collaps in lysis group but higher (much) stroke rate and major bleeding Patients received therapeutic heparin during lysis
57
Recommended treatment for superficial thrombophlebitis
In those with SVT >5cm use prophylactic dose fundapsrinha or LMWH for 45 days
58
Contraindication to endovascular venous ablation
Absolute: active superficial vein thrombosis GSV close to the skin Relative: pacemaker, arterial insufficiency, GSV less than 5mm (or 2?) and over than 15mm and tortuous GSV
59
Cyaniacrylate vein closure
VeClose shows noninferioriry with EVLA Closure rates are comparable CAE does not require anesthesia Decrease post op ecchymosis No other difference
60
What’s a superficial accessory great saphenous vein
Any venous segment ascending parallel to the GSV and located more superficially above saphenous faascia both in the leg and in the thigh
61
What is anterior accessory great saphenous vein
Any venous segment ascending parallel to GSV and located anteriorly both in the leg and in the thigh
62
What is vein of Giacomini
Cranial extension of the SSV that communicates with the GSV via posterior thigh circumflex vein
63
whats the energy delivery in EVLA over length
withdraw the catheter to deliver 30-50 joules/cm
64
Speed of withdrawal for EVLA
1-2mm/sec for first 10 seconds, followed by 2-3mm for the remainder
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