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200 Cards in this Set
- Front
- Back
The ____________ is consulted in order to establish a ________ and to recommend or carry out appropriate ____________. |
- vascular surgeon
- dx - tx |
|
The 3 goals of vascular intervention:
________ blood flow Repair ______ or ___________ ______________ occluded ________ |
- Re-establish (vessel stenosis or blocked by thromboembolism)
- dilated - damaged - bypass - vessels |
|
What are the 2 types of vascular intervention?
|
- Vascular surgery
- Interventional Radiographic Procedure |
|
Vascular surgery is aided by what 3 things?
|
- angiography
- vas tech (US image, Doppler, physiologic test) - knowledge of anatomical location of human vasculature |
|
Interventional Radiographic Procedures are primarily _____________ procedures. They are performed by ____________.
What 3 things is it aided by? |
- endovascular
- cardiologists & interventional radiologists - Angiography - Vas technologist - Fluroscopy during the endovascular procedure |
|
Candidates for vascular intervention are assessed by:
______________ exam results of ______________ Consideration of pts ____________ or ___________ |
- Hx & PA
- vascular & angiographic exams - existing vascular - organ-system diseases for the best procedure |
|
Factors that should be considered prior to the decision:
_______________ rates Risk of _________________ ______________________ consequences of ___________ |
- Initial & long term success
- morbidity & mortality - cost effectiveness - failure |
|
Decisions are based on a combination of:
how each hospital/clinic lists its ______________. _____________ consultation. Available _______________ & _________________ |
- own requirements (protocol) for vascular interventions
- physician/pt - choices - final outcome |
|
T or F:
How each hospital/clinic lists its protocol for vascular interventions is based on specificity |
FALSE
How each hospital/clinic lists its protocol for vascular interventions is based on SENSITIVITY |
|
Endovascular radiographic procedures are procedures where ____________ are placed w/in vessels to _____________.
PTA is _____________ |
- catheters
- allow interventional technique - Percutaneous Transluminal Angioplasty |
|
PTA:
____________ of the vessel plaque is penetrated w/ _____________ |
- dilatation & recanalization
- catheter tip |
|
T or F:
PTA is considered an endovascular surgery |
FALSE:
Originally considered endovascular surgery but NOW it is considered NON-SURGICAL |
|
PTA:
Double lumen balloon expands to ____________. Employs a _________ used for balloon such as _________. A balloon cath is also used to ____________ in arteries, veins and graft known as ___________ |
- predetermined diameter
- flexible material - polyethylene or polyurethane - remove embolized thrombus - thromboembolectomy (usually requires cut-down) |
|
PTA uses _____ lengths & ____________.
Careful consideration must be give to __________. Balloon should approximate the ____________ and the ____________. __________ is a big issue for stent placement |
- different
- expandable diameters - size - diameter of vessel - length of the lesion - intimal hyperplasia |
|
T or F:
The balloon should be 20-30% greater than the adjacent normal vessel diameter |
FALSE:
Balloon should be 10-20% greater than the adjacent normal vessel |
|
The balloon dilation is a _______________ technique where the plaque is ______________.
The non-diseased area of the artery _______ is ________. The plaque is partially sheared from ___________ and _____________ |
- controlled injury
- fx, split and compressed - tunic media >>>> stretched - its attachment - pushed into the media |
|
T or F:
Usually no embolism occurs during PTA Why or Why not? |
TRUE:
Plaque remains attached to media * Net is still deployed w/carotid balloon angioplasty |
|
The media & adventitia undergo ___________ over a period of time as they respond to ____________.
How well is soft plaque tx w/balloon angioplasty? |
- further dilation
- hemodynamic demands - Soft plaque responds the best |
|
T or F:
Hard and soft plaques respond well the PTA |
FALSE:
Soft plaque responds the BEST! Densely calcified plaques, elongated plaques and lesions containing LG amounts of thrombus DO NOT fair as well by plain balloon angioplasty |
|
T or F:
PTA is considered technically successful if there is < 35% residual stenosis after the procedure is completed |
FALSE:
< than a 30% residual stenosis |
|
What are the 5 possible angioplasty complications?
|
- Arterial entry site
- Angioplasty site - Angioplasty at bifurcation - Distal to angioplasty site - Systemically |
|
T or F:
Acute occlusion and possible hemorrhage from perforation of artery are both rare complications of arterial entry site |
FALSE: (Those are angioplasty site complications)
- HEMATOMA formation at puncture site - THROMBUS formation in the vessel at puncture site - PSEUDOANEURYSM or AV FISTULA formation |
|
What is a common arterial entry site complication?
In an angioplasty comp an acute occlusion is generally caused by what 3 things? |
- Hematoma formation at the puncture site
- thrombosis - intimal tear - local artery spams |
|
Angioplasty at a bifurcation can cause ____________.
how is this problem reduced? this is known as _____________ because __________ |
- fx of plaque into branch artery
- By placing 2 balloons, one on each branch of the bifurcation - Kissing balloons - they actually touch when inflated |
|
A complication distal to the angioplasty site is due to a poss _______________ or _____________
|
- embolization of fresh thrombus
- balloon fragment embolization from rupture |
|
Systemically is die to ________________.
Diabetics have a _______ overall immunity and run the risk of septicemia if any pathogens are introduced __________ |
- MI
- CVA - Septicemia - via angioplasty procedure |
|
Intravascular stents are ___________ designed to preserve ___________.
They are utilized when ______ from ________ or __________ |
- metallic stents
- arterial or venous lumen - vascular narrowing - external compression - inadequate PTA results |
|
T or F:
The stent is strong enough to fx the plaque |
FALSE:
Stent ALONE is not strong enough to fx plaque |
|
What are the 3 types of stents?
|
- Balloon expandable
- self expanding - Nitonol stents |
|
Balloon expandable:
The stent is _________________ prior to placement and then ________ when the _____________ |
- collapsed around the deflated balloon
- expanded into place - balloon is inflated |
|
Self expanding:
__________ allows __________ when stent is pushed out of a ___________. What can be a problem w/this type of stent? |
- spring action
- expansion - retaining tube sheath - Difficult to length match w/lesion |
|
Nitonol stents:
Are ____ while _______ but ______ to ________ when _______ |
- collapsed
- cool - expand - original size - warmed to blood temperature |
|
IVUS is an ____________ that can be used to image the vessel ____________________.
Can be used to evaluate the success of __________ or ________. Could also see an __________. |
- ultrasound tipped catheter
- from the inside and outward - a balloon angioplasty - a stent placement - intimal tear |
|
What is a disadvantage of IVUS?
|
Can't sterilize probe >>>have to throw away = expensive
|
|
What are the 6 types of surgical interventions?
|
- Profundaplasty
- Endarterectomy - Semi closed - Extraction - Eversion - Selective |
|
Profundaplasty is the surgical procedure of ________ to restore function as _______ to _________ or ________.
May prevent ___________. May be only procedure available if ______________ |
- profunda femoral artery
- collateral - politeal or calf - AK amp - distal bypass not feasible |
|
T or F:
Profundaplasty is used when distal profunda is occluded along w/SFA |
FALSE:
Profundaplasty is used when PROXIMAL profunda is occluded w/SFA |
|
Endarterectomy is the _____________ of _____________.
What are the 5 specific technicques? Which is the most common? |
-direct removal
- occlusive arterial lesions - Open - Semi-closed - Extraction - Eversion - Selective - open |
|
Open endarterectomy:
__________ arteriotomy. _______ removed. common for _____________. |
- longitudinal
- lesion - carotid endarterectomy |
|
T or F:
Semi-closed is when retrograde or antegrade removal of lesion through single arteriotomy |
FALSE: (that's extraction)
Semi closed: Transverse or longitudinal arteriotomies at proximal and distal extent of lesion |
|
What is the advantage of a semi closed?
The lesion is detached and removed in ________ manner w/ ____________ |
- can see the distal end of the atheroma
- retrograde - loop stripper |
|
T or F:
Semi closed is used on thicker, harder and more calcified lesions |
FALSE:
Semi closed is used on thinner, softer and LESS calcified lesions |
|
Extraction is ___________ removal of lesion through ___________.
Performed by use of long jawed clamps and/or a ________. Used on ____________ |
- retrograde or antegrade
- single arteriotomy - dural elevator * Many times the clamp jaws serve as the dural elevator - thicker, harder, more calcified lesions |
|
T or F:
Extraction uses a transverse or longitudinal arteriotomies |
FALSE:
Extraction uses ONLY ONE arteriotomy |
|
What is the disadvantage of extraction?
|
- Distal end of the atheroma is not seen
|
|
T or F:
Eversion require the proximal transection of artery beyond site of disease or can be used in an open endarterectomy w/a longitudinal arteriotomy |
FALSE:
Eversion require the DISTAL transection of artery beyond site of disease or can be used in an open endarterectomy w/a longitudinal arteriotomy |
|
In eversion the vessel is _________ or ____________ to ____________.
Once the atheroma is removed the vessel is ________ into __________ and _____________. |
- turned back
- peeled back - separate the vessel wall from the atheroma - folded back - position - sewn together |
|
T or F:
Selective is a modification of an open procedure |
FALSE:
Selective is a modification of the SEMI-CLOSED procedure |
|
Selective is used to remove __________ in arterial segments of branch.
_____ removal through ___________ w/ a ____________. Performed w/in _____________________. |
- discontinuous lesions
- retrograde - distal longitudinal arteriotomy - loop stripper - diseased arterial segment |
|
What are the two surgical assessment aides?
Both are used ______________. ___________ is an assessment too using radiographic contrast |
- Intraoperative arteriography
- Intraoperative duplex - post vascular surgery - Intraoperative arteriography |
|
A true aneurysm is a _________________ .
The two types are _______________ _______________ |
- Dilation of all layers of the arterial wall
- fusiform - saccular |
|
T or F:
Pseudoaneurysms contain arterial layers |
FALSE:
Pseudoaneurysms DO NOT contain arterial walls * They are completely separate from the artery except for the communicating channel thru which the blood travels to reach it |
|
A pseudoaneurysm is also considered a _____________ and a ______________.
They are caused by ____________ _____________or _______. They are located close to ____________ into _________. |
- Peripheral arterial mass
- Pulsatile hematoma (active lumen active blood Q) - trauma - infection - intervention - entry site - arterial lumen |
|
T or F:
Pseudoaneurysms are most commonly found at the brachial artery |
FALSE:
Most commonly found at the COMMON FEMORAL ARTERY but also at the brachial artery |
|
Pseudoaneurysms are connected to the lumen by ____________.
They may result due to ____________ following ________. |
- channel or neck
- poor compression - removal of catheter |
|
T or F:
Arterial sticks below inguinal ligament increase chance of pseudoaneurysm |
FALSE:
Arterial sticks ABOVE inguinal ligament increase chance of pseudoaneurysm |
|
T or F:
Use of anticoagulants and small diameter catheters are risk factors of pseudoaneurysms |
FALSE:
Use of anticoagulants is, but use if LARGE DIAMETER catheters * Increased diameter = increased risk |
|
T or F:
Superficial lying arteries due to body habitus tend to be a risk factor |
FALSE:
DEEP lying arteries due to body habitus tend to be a risk factor |
|
Duplex findings:
Blood in the __________ surrounded by a _____________. _________ seen layered w/in pseudoaneurysm. |
- hematoma
- fibrous wall - Thrombus |
|
T or F:
Duplex findings of a pseudoaneurysm demonstrates swirling high velocities that are seen w/color Q |
FALSE:
Duplex findings of a pseudoaneurysm demonstrates swirling LOW velocities that are seen w/color Q |
|
How is the neck of the pseudoaneurysm identified on Doppler WF?
|
- "to and fro" pattern
|
|
T or F:
During diastole, high velocity is detected flowing out of the native artery & into the contained rupture |
FALSE:
During SYSTOLE, high velocity is detected flowing out of the native artery into the contained rupture |
|
During diastole, flow ___________ to __________ and into the ___________.
You need to obtain measurements in _______ & _____. There is a classic ________ sign w/pseudoaneurysm |
- returns back
- the native artery - contained rupture - aneurysm & neck - "pepsi" |
|
5 complications of pseudoaneurysms:
____________ w/_____________. _____________ thromboembolization. ______________ of the native artery. Persistent _____________ & __________. |
- rupture
- severe hemorrhaging - arterial - extrinsic compression - pain & lump |
|
During the physical assessment the tech should:
_____ pt for _____________ Feel ____________ Listen _____________ |
- palpate
- lump or bump in groin - pulsatility or thrill - for bruit |
|
UGCR is _____________.
The pt is given ____________ for pain and in some cases w/ ____________ drug. Irrigate groin w/ _______________. |
- Ultrasound Guided Compression Repair
- Demoral - anti-anxiety - 2% lidocaine |
|
UGCR procedure:
Visualize the _______ while ________ until ____________. During ___________ evaluate ___________. |
- neck
- compressing - flow is absent in the neck - compression - distal pulses |
|
UGCR procedure:
Utilize color to check adequate ____________. Do not compress _________ because ____________. |
- vein Q
- aneurysm itself - may force contents into arterial system |
|
6 pitfalls of UGCR:
A very ______________. Procedure may take ____________. Many times very ____________. Can ___________. It is not ____________. Difficult on ___________. |
- long procedure (especially if pt is anticoagulated)
- more than one lab personnel - painful for pt - tie up lab space - always successful - LG pts |
|
A hematoma is a discrete collection of ___________.
May be the result of ___________. |
- blood
- previous catheter procedure |
|
T or F:
A hematoma is a palpable lump w/some pulsatility |
FALSE:
Hematoma is a palpable lump w/NO PULSATILITY * No active arterial channel |
|
T or F:
A duplex evaluation of a hematoma will show some flow in lumen |
FALSE:
Duplex eval of a hematoma will show NO FLOW in lumen |
|
Hematomas can be ____________ or __________ formation due to ____________.
There are usually layers of ___________. |
- anechoic
- echogenic - age of thrombus - echogenicity |
|
T or F:
Hematomas are commonly treated |
FALSE:
NO TX needed for most |
|
The UE venous system is comprised of _______ & __________ veins.
Most veins in _______ system are accompanied by ________. Q return is dependent on _____________ & ___________. |
- superficial
- deep - deep - artery of the same name - gravity - cardiac output generated pressure gradients |
|
T or F:
Like the LE, majority of flow return of the UE is through the superficial system |
FALSE:
UE is done through superficial LE is done through deep system |
|
What are the 8 RF's of UE DVT?
Which is the most common? |
- Central venous catheter (PICC) *MOST COMMON
- cancer - physical activity - obesity - drug abuse - pregnancy - IV placement superficial to deep |
|
DVT of UE caused by Central venous catheter is usually in _____________.
_____________ is harsh on cells & causes them to become irregular. You would measure ______________. Used for pts w/___________ as ____________. Drug _____________. |
- Axillary-subclavian veins
- chemotherapy - central venous pressure - Gastrointestinal dysfunction >>> parenteral nutrition - administration |
|
T or F:
Two common places of UE DVT are the Subclavian vein and Brachial veins |
FALSE:
Subclavian IS but Brachial veins ARE NOT |
|
What are the 4 most common locations of UE DVT?
Of these which is the most common? |
- Subclavian vein
- Internal Jugular Vein - Axillary Vein - ASVT - Axillary-Subclavian vein *** MOST COMMON |
|
ASVT is commonly due to ____________ also known as ____________.
This condition is caused by ___________ of ___________ while in ____________. |
- Effort thrombus
- Paget Schroetter Syndrome - excessive use - shoulder or arm - unusual position *EX: drywall installer |
|
T or F:
Primary subclavian-axillary vein thrombosis is the result of multiple iatrogenic factors |
FALSE:
Primary subclavian-axillary vein thrombosis has NO DIRECT CAUSE that is obvious on initial evaluation |
|
Primary subclavian-axillary vein thrombosis is ______________ and the most common victim is ___________.
_____________ snydrome. |
- effort induced ("effort thrombosis")
- young males * Heavily associated w/occupation - Paget-Schroetter |
|
Secondary subclavian-axillary vein thromobsis is the result of _______________ and/or ___________.
What are the 6 poss etiologies? Which is the most common cause? |
- multiple etiologic
- iatrogenic factors - Malignancy - Heart failure - Infection - Polycythemia - Estrogens - PICC line, IV line or other catheters ***most common |
|
T or F:
UE DVT is more common in female than male |
FALSE:
More common in MEN than female 2:1 ratio |
|
T or F:
UE DVT often leads to PE |
FALSE:
Can lead to PE BUT NOT OFTEN 0-28% of the time according to Rutherford |
|
UE clinical features:
____________ swelling of _________ . Arm ______ or ___________. HX of ___________ or _____________. Swelling may __________ from_______ into ________. ______ & _______ possible. |
- abrupt onset
- one arm - heaviness/tingling/ache - recent - unusual trauma - spread - arm >>>> hand - tenderness - pain |
|
UE DVT is usually obvious from ____________.
Must rule out other causes for swelling such as ____________. Perform ___________. |
- clinical presentation
- insect bites, allergies, burns - Duplex exam |
|
T or F:
UE DVT is more common in males in the L arm |
FALSE:
More common in males in the RIGHT arm than the L * 3:1 ratio * Dominant extremity involved 60-80% |
|
3 RF's for superficial thrombophlebitis:
Recent ___________ _______ use _____________ |
- IV
- drug - trauma |
|
What are the 3 poss location of SVT?
Which is the most common? |
- Cephalic vein ****(most common)
- Basilic vein - Median cubital vein |
|
5 clinical features of UE SVT:
__________ __________ over area _________ _________ to touch ___________ or ___________ |
- swelling
- tenderness - redness (erythema) - warm - palpable bump or lump |
|
T or F:
The dx of SVT is difficult to make |
FALSE:
Usually OBVIOUS from palpation * duplex exam |
|
T or F:
Normal UE venous Q is spontaneous, phasic and hyperemic |
FALSE:
Normal: Spontaneous, respiratory phasicity and pulsatility proximally * NOT HYPEREMIC/CONTINUOUS |
|
T or F:
Like the LE, in UE flow increases w/expiration as the intrathoracic pressure decreases |
FALSE: (OPPOSITE OF LE)
UE: - Q decreases w/expiration - intrathoracic pressure increases |
|
UE venous Q:
Q ___________ w/ expiration Intrathoracic pressure __________ Q ___________ w/ inspiration Intrathoracic pressure _____________ |
- decreases
- increases - increases - decreases |
|
T or F:
An abnormal venous signal can demonstrate absent, hyperemic or diminished Q |
TRUE
|
|
In a duplex eval of UE DVT, the tech is looking for:
Visible ________ ____________ of vessel ____________ of veins |
- thrombus
- non-compressibility - Dilation |
|
T or F:
Compression is demonstrated the same for all veins of the UE |
FALSE:
All EXCEPT SUBCLAVIAN VEIN * Must do sniff test or Doppler |
|
Tx of UE DVT:
________ infusion followed by ____________. ________ of arm in _______ supported by _______. |
- IV Heparin
- oral Warfarin - elevation - forward or extended position - pillow |
|
UE DVT can also be tx using _____________.
What are 3 examples? |
- thrombolysis
- streptokinase - urokinase - tPA (tissue plasminogen activator) |
|
T or F:
Tx options for SVT include: Heparin, anti-inflammatory drug, or thrombolysis |
FALSE:
SVT: Heparin (possible anticoagulant), anti-inflammatory drug but NOT THROMBOLYSIS |
|
T or F:
SVT is always tx |
FALSE:
May do nothing and rescan in 1-2 days |
|
A poss surgical tx of SVT is __________.
This is best performed ________ and most successful w/___________ pts. |
- Thrombectomy
- early - effort thrombosis |
|
_____________ are used when other tx fail.
They must _____________. Considered a ____________ procedure |
- stents
- maintain patent lumen - interventional |
|
Endovascular aneurysm repair or ____________ w/_____________.
|
- endograft repair
- stent-grafts |
|
T or F:
Asymptomatic aneurysms > 4 cm in diameter are an indication for placement |
FALSE:
Asymptomatic aneurysms > 5 CM in diameter |
|
Indications for placement:
All _______ & ___________. Usually for pts who are at high risk for ___________ |
- symptomatic & ruptured aneurysms
- conventional open repair |
|
Have to decide if the endograft fails will the pt die due to ___________ and/or the ______ to replace the ________ w/ a ______________
|
- endograft failure
- open repair - endograft - conventional graft |
|
T or :
According to Rutherford, w/improvements in technology and increasing experience the conversion of endovascular to open operation is falling |
TRUE
|
|
High risk pts have been defined by the Endovascular Graft Committee as:
pts w/ ______, _______ aneurysms whose operative risk is __________. Example: if the operative risk is in excess of _______ on the basis of _______ ________ or ________ disease or previous __________ or ________. |
- LG
- life-threatening - excessive - 3-4 times normal - heart -lung - liver - abdominal scarring - infection |
|
T or F:
The first generation of endografts was developed in which the fabric is supported throughout by a contiguous metal frame |
FALSE:
1st generation EMPLOYED A TAPERED TUBULAR FABRIC GRAFT W/BALLOON DEPLOYED OR SELF EXPANDING STENTS AT EA END |
|
T or F:
2nd generation endografts had either hooks or barbs to help prevent graft migration |
FALSE: (1st generation DID)
2nd generation: This type of graft REMAINS IN PLACE W/MINIMAL OR NO ANCHORING DEVICES |
|
The 2nd generation of endografts was developed in which the _______ is supported throughout by a ____________.
This ____________ hes to add __________ & prevent _______. |
- fabric
- contiguous metal frame - metal modular frame - column strength - kinking |
|
Most endografts have a _______ w/_______ to extend into the ___________.
Typically the _____ & ____ are contiguous. Access for this main piece of the endograft is therefore typically through the _____________. |
- trunk (aortic body)
- bifurcated legs - common iliac - trunk - R iliac leg - R CFA |
|
Because the inside diameter of the delivery system (sheath) is usually 21 French (7mm or 3/8") the ___________ is ___________.
|
- CFA
- surgically exposed |
|
T or F:
The distal end is placed infrarenally |
FALSE:
The PROXIMAL end is placed infrarenally |
|
Surgeons must consider the distance from the _____________ to the point where the endograft ___________.
Endograft ________ must be ___________ to __________ |
- proximal placement
- bifurcates - bifurcation - proximal - native aortic bifurcation |
|
The sheath is withdrawn and the ___________ endograft is deployed throughout the __________ and ___________.
The single piece of left iliac leg is placed by access thru the ___________. The left iliac leg is inserted slightly (overlapping) into the _______ of the ____________. |
- self-expanding
- distal aorta - R CIA - L CFA - left bifurcation branch - main trunk endograft |
|
Closure occurs when the entire endograft is ____________ under flouroscopy and _____________ then the ________ are closed and the ___________ closed.
|
-placed satisfactorally
- Q well established - arteriotomies - incision sites |
|
Endoleak is a condition association w/ _______________ defined by the persistence of blood Q __________ of the endoluminal graft but __________ or _____________ being tx by the graft.
|
- endoluminar vascular grafts
- outside the lumen - aneurysm sac - adjacent vascular segment |
|
Type I Endoleak:
Occurs when a persistent channel of blood Q develops due to ______ or ___________ at the ________. This type of leak is usually present _________ in the course of tx but may also be encountered ______ when _________ thru a __________ around the area of ________ to the ___________. |
- inadequate
- ineffective - graft ends - early - late - blood erodes - blood clot seat - device fixation - aortic wall |
|
T or F:
Type II Endoleak is a antegrade type of leak |
FALSE:
Type II Endoleak is a RETROGRADE type of endoleak |
|
Type II Endoleak;
Occurs when there is persistent blood Q ________ due to _________ blood Q from ________, ______ or ____________. In some cases where there are two or more patent vessels a situation of ______ and ___ develops creating an ______ w/in a channel created w/in ________. |
- into the aneurysm sac
- retrograde - patent lumbar arteries - inferior mesenteric artery - other collateral cessels - inflow - outflow - active blood Q - aneurysm sac |
|
Type III Endoleak:
Related to ________ or ________ at the _________ between segments of __________ or ________ of the graft fabric This type may be develop _____ due to __________ or ______ in the course of the tx when there is _______ of one of the ___________ due to ________ or ________. |
- inadequate
- ineffective seal - graft joint - overlapping graft segment - rupture - early - technical problems - late - displacement -extensions - aneurysm retraction - device breakdown |
|
Type IV Endoleak:
Related to the ________ & ___________ of blood thru the ___________. |
- porosity
- passage - fabric of the graft |
|
T or F:
Since the grafts used in endovascular devices are preclotted most fabrics will not initially leak through |
FALSE:
Grafts used in endovascular devices ARE NOT PRECLOTTED---most fabrics WILL initially leak through |
|
With the development of thinner graft materials, which type of endoleak is becoming more common?
|
Type IV Endoleak
|
|
T or F;
UE arterial disease is as common as in the LE, rarely life threatening and there are several disease processes or conditions |
FALSE:
UE arterial disease is NOT AS COMMON as LE disease, rarely life threatening and there are several disease processes or conditions |
|
T or F:
Distal subclavian is the most common arterial occlusive disease |
FALSE:
PROXIMAL subclavian is the most common arterial occlusive disease |
|
Arterial occlusive disease;
Often _________. may have ___________ which could result in ___________. Poss ___________ in _________. |
- silent
- steal syndrome - cerebral ischemia - reversal of Q >>>> vertebral |
|
T or F:
Arterial occlusive disease is more common the R UE in middle aged patients |
FALSE:
More common in the LEFT ARM and is usually in OLDER PTS |
|
T or F;
35 mmHG or more difference between brachial pressure in arms is indicative of arterial disease |
FALSE:
30 mmHG or more difference between brachial pressure |
|
If bilateral, may have _______ difference or more
Poss ____________ Severe cased pt may have ___________ ___________ ______ |
15 - 20 mmHG
- bruits - rest pain - skin ulcer - gangrene |
|
T or F:
Claudication is common in UE Arterial disease |
FALSE:
Claudication is RARE due to collateral flow * vertebral |
|
Takayasus Arteritis affects primarily the _____________ which typically results in ______ or _______.
It actually damages the __________ and is more common in _________. Etiology is ________, it is similar to ___________. |
- aorta & its main branches
- stenosis or occlusion - intima - Women than in men - unknown - giant cell arteritis |
|
T or F:
Takayasu's Arteritis can affect the axillary or brachial arteries |
FALSE:
can affect SUBCLAVIAN or AXILLARY ARTERIES |
|
T or F:
Steal is common in takayasus Why or why not? |
FALSE:
Steal is RARE---disease affects both the prox & distal segments of the subclavian artery |
|
T or F:
Claudication is not possible as vertebral can act as a collateral |
FALSE:
Claudication IS POSSIBLE as vertebral artery CANNOT ACT as a collateral |
|
___________ is common in UE arterial.
It is important to check pts hx for ______________. sxs are ___________ , ____________ or ______________ |
- emboli
- Heart disease/conditions - cold sensitivity - gangrene - purplish digits |
|
T or F:
Clot usually from heart or a distal aneurysm |
FALSE:
Clot usually from heart of a PROXIMAL ANEURYSM |
|
T or F:
Typically affects larger vessels |
FALSE:
Typically affects SMALLER VESSELS -- usually digits |
|
Buerger's disease or ______________ is a condition in which ______________ are _____________.
The etiology ___________ and affects ___________ most commonly. May go undetected until _____ involve __________. |
- Thromboangitis obliterans
- all 3 layers of the arterial wall - inflammed - unknown - young male smokers - lesions - forearm arteries |
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T or F:
Buerger's Disease causes occlusion of medium and large arteries in hand & digits |
FALSE:
Buerger's disease causes occlusion of SMALL & MEDIUM arteries in hand and digits |
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7 sx of Buergers Disease:
______ in hands/fingers _____________ __________ changes skin ____________ ________ pain _____________ ____________ Fingers _____ & ___________ |
- coldness
- paresthesias - skin color (purplish-red) - lesions - rest - intermittent claudication - cold / damp |
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Buerger's disease may result in _________ or __________ and lead to _________ of ___________.
____________ of _______ may be necessary. ____________ usually halts progression of the disease. |
- digital gangrene
- ulceration - amputation - fingers or parts of - debridement - necrotic tissue - cessation of smoking |
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T or F:
Arterial reconstruction is always possible in thromboangitis obliterans |
FALSE:
Arterial reconstruction NOT ALWAYS POSSIBLE IF MULTIPLE ARTERIES INVOLVED |
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Trauma can be a cause of UE arterial disease:
_______ & ___________ wounds. __________ mechanisms. Improperly _________ or _______ in ___________. ________ forces. May have diminished ___________ |
- gunshot / knife
- penetrating - fitted shoulder harness or gear - subclavian region - compression - distal pulses |
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Occupational problems:
__________ force to _______ or ___________. White finger syndrome is _____ induced __________. This can be caused by ________ or _______ and the pts feels ___________ or __________. It can also progress to ___________. |
- excessive
- shoulder - hand - vibration - vasospasm - pneumatic drills - jackhammers - numbness or tingling - Raynaud's |
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T or F:
Hypothenar Hammer Syndrome is using hand as hammer and can lead to occlusion of radial artery |
FALSE:
Hypothenar Hammer Syndrome is using hand as a hammer and can lead to occlusion of ULNAR ARTERY |
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T or F:
TOS is more commonly caused by a venous issue |
FALSE:
TOS is more commonly a NEUROLOGIC issue * Neurogenic TOS: 95% * Venous TOS: 1-3% * Arterial TOS: 1% |
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Neurologic TOS involves __________ at lowest trunk of ___________.
There is __________ & _________ of ___________ & _______. |
- nerve compression
- brachial plexus - numbness - tingling - hands - fingers |
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Vascular TOS is due to ________ of ______ or ________ at the __________.
Typically causes compression of __________ first. |
- compression
- subclavian artery - subclavian vein - thoracic outlet - brachial plexus |
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T or F:
Car accidents are the most common cause of vascular TOS |
FALSE:
CONGENITAL BONY ABNORMALITIES are MOST COMMON CAUSE but also common after car accidents |
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Vascular TOS can also be caused by skeletal or soft tissue:
Skeletal from ___________ _______ or _________. Soft tissue from ____________ or ____________. |
- cervical
- rib - clavicle (costo clavicular) - fibromuscular bands - scalene muscle |
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Vascular TOS compression produces a ___________.
Why? ________ formation occurs over time. ____________ lesions. Artery ________ which usually forms as a result of ______. ______________ of thrombi |
- subclavian artery stenosis
- Because at the 1st rib - aneurysm - intimal - thrombosis - the intimal lesion - embolization |
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T or F:
In vascular TOS, pts may complain of Raynaud's sxs Why or why not? |
TRUE:
Vasoconstriction is restricting blood Q so can mimick Raynaud's |
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T or F:
A coronary catheter may be done using the Cephalic vein |
FALSE:
A coronary catheter may be done using the BRACHIAL ARTERY |
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Complications post catheterization may be:
__________ __________ _______ damage which may include ______ or _______. Arterial ___________ |
- Hematomas
- Pseudoaneurysms - arterial wall - AV fistulae - wall dissection - thrombosis |
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Sxs of catheterization problems may be:
Pain in area of ____________. ___________ ____________. ________ at puncture site. _____________ as a result of _____________. |
- puncture
- palpable lump - pulsatile mass - Digit ischemia - thromboembolus |
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T or F:
It is normal for hand & finger blood Q to increase in response to cold or emotions |
FALSE:
It is normal for hand & finger blood Q to DECREASE in response to cold or emotions |
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____________ of __________resulting in cessation of digital artery Q is abnormal.
When this occurs the stereotypical sxs are known as ________. |
- spastic closure
- digital arteries - Raynaud's syndrome |
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Raynaud's syndrome can also be described as a condition that exists when sx of intermittent ________ of the __________ or __________ occur in response to ____________ as well as ___________ ___________.
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- ischemia
- fingers - toes - cold exposure - emotional stress |
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Syndrome are _____ & _____ that occur together and characterize a particular ____________.
Signs & sxs are produced by a ____________ __________. |
- signs
- sxs - abnormality - root abnormality |
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The root abnormality or disease is the ___________ of the _______.
A phenomenon is an observable _____ or ________. |
- abnormal vasospastic closure
- digital arteries - fact - event |
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Same signs & sxs produced by fact or event other than the ____________.
__________ + ____________. If recognized, the other fact or event can b recognized as the __________ and can become a _______ in itself |
- root abnormality
- vasoconstructive - atherosclerotic induced ischemia - root abnormality - syndrome * miracle of evolution |
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Raynaud's disease is also known as __________ & ___________.
It is due to abnormal ___________ of ___________. |
- Raynaud's syndrome
- Vasospastic Raynaud's Syndrome - spastic closure - digital arterial Q |
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T or F:
Raynaud's syndrome stereotypical sxs include observable color changes of red to white to blue |
FALSE:
WHITE >>> BLUE >>>> RED |
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Vasospasm completely ___________ near the digits causing a ___________ of one or more fingers or toes
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- restricts arterial Q
- white waxy |
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T or F:
The first returning arterial blood is rapidly saturdated w/O2 and produces a redness or rubor |
FALSE:
The first retuning arterial blood is rapidly DESATURATED w/O2 and produces CYANOSIS or BLUENESS * W/relaxation of the vasospasm |
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As blood Q ____________ the __________ condition replaces cyanosis w/ _________________.
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- increases
- hyperemic - rubor or redness |
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Primary Raynaud's Disease is also known as _________ or ___________.
The arteries _______ due to ___________ ________. Regarded as ____________ |
- Vasospastic Raynaud's Syndrome
- True Raynaud's Syndrome - close - abnormal vasospasm - a disease |
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Unlike the digital arteries of normal individuals which are relatively ________ to cold, the pts w/primary Raynauds Disease display a remarkable ability to ________ w/complete ________ occurring when the skin temperature ___________ a _____________.
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- unresponsive
- constrict - closure - falls below - threshold level |
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Secondary Raynaud's Phenomenon is also known as __________.
Arteries are __________ or _________ due to a ________, ___________ or ________________ or ___________ __________ from ___________. |
- Obstructive Raynaud's Syndrome
- occluded - nearly occluded - fixed vasculitis - thrombus - atherosclerosis - extrinsic compression >>> vasocontriction |
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In Obstructive Raynaud's Syndrome there is a ____________ lesion.
When this fixed ________ lesion is combined w/the normal vasoconstriction near the digits, Q to the digits ____________ or ______. |
- Q limiting
- Q restricting - ceases - nearly ceases |
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Arteriolar constriction is usually ____________, but when it is ________ on a substrate of fixed _______ ________, previously adequately perfused fingers may become _____________.
This is the mechanism principally responsible for the appearance of _______________. |
- tolerated well
- arterial obstruction - ischemic - raynaud's phenomenon |
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Primary Raynaud's Disease etiology is ___________ whereas Secondary Raynaud's Phenomenon etiology is ______________.
|
- unknown
- digital or palmar arteries are occluded or nearly occluded |
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T or F:
Primary Raynaud's disease is due to vasospasm only |
TRUE;
Not from secondary causes |
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T or F:
There is occlusive disease in Secondary Raynaud's Phenomenon and Primary Raynaud's Disease |
FALSE:
There is in Secondary Raynaud's Phenomenon but NO OCCLUSIVE DISEASE IN PRIMARY RAYNAUDS |
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In Primary Raynaud's Disease the arteries ______ or _______ causing complete __________ during _______.
It is initiated by ________ to ___________ or increase in _____________. |
- constrict
- spasm - closure - spasm - hypersensitivity - cold exposure - sympathetic nerve stimulation |
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T or F:
Primary Raynaud's Disease is more common in males ages 11-45 |
FALSE:
Primary Raynaud's Disease is more commin in WOMEN ages 11-45 4:1 ratio |
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Although Primary Raynaud's Disease is more common in women it is common among ________ who have _____________ involving ____________ or ____________
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- men
- occupations - use of jackhammers - other vibratory equipment |
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Secondary Raynaud's Phenomenon sxs are secondary to other medical conditions:
_________ disorders. ____________ disorders. Drugs, __________ & ___________. Traumatic ___________. __________ disease. |
- connective tissue
- hematologic - neoplasms, toxins - arteritis - Buerger's |
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In dx of Raynaud's Syndrome ____________, __________ and __________ or _____________ readings are obtained.
PPG readings on a normal digit will demonstrate a ______________. |
- segmental pressures
- finger pressures - PVR - PPG - normal waveform contour |
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T or F:
A PPG reading demonstrating a flattened, slow to rise (tardus-parvus) waveform indicates Secondary RS pt and a cold tolerance test is not needed |
TRUE
|
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T or F:
PPG readings on a secondary RS pt will demonstrate a peaked waveform contour |
FALSE:
PPG readings on PRIMARY RS PT will demonstrate a peaked waveform contour |
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For the cold tolerance test for RS the pt is _______ in lab for several minutes. Baseline studies performed w/________, __________, and/or ____________.
Hands are immersed into ice water for a ________ minimum and ________ maximum. |
- warmed
- PVR - PPG - pressure measurements of digits - 2 minute - 5 minute |
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The test is repeated after ________ room temperature should return to normal baseline waveforms.
If not, ___________ has occurred. If PPG flatlines or the color phase appears further evidence of ___________ is added to this test. |
- 5 minutes
- Primary vasospasm - RS |
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T or F:
If pt has secondary RS the test is normal at baseline and cold tolerance test is needed |
FALSE:
If pt has secondary RS the test is ABNORMAL AT BASELINE and cold tolerance is of LITTLE VALUE |
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Dx of TOS:
Always do _____ study. Can do ________ will do Duplex of _______ in _______ position. Obtain Doppler signals and begin abducting arms w/head rotated ____ from ____ which is known as the ____________ __________. |
- bilateral
- PVR - Subclavian artery - normal resting - away - arm - Addson's maneuver |
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Compression of the artery may be at one of what three sites?
Level of __________ Level of ________ Level of ___________ The signal is either ______ or ________ w/maneuvers. |
- first rib
- scalene muscle - mid-clavicle (artery crosses here) - decreased - absent |
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What test is used to dx palmar arch obstruction?
An incomplete arch is indicated when CW Q significantly _______ or _________. |
- Allens test
- decreases - obliterates |
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Allens test:
Have pt make ________. Compress ______________ arteries. After ______ pt opens hand revealing ____ of palm w/arteries __________. Release one _______ at a time observing ______. |
- fists
- radial & ulnar - 1 minute - pallor - still compressed - artery - color change |
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Duplex exam UE TOS:
Isonate & visualize arteries beginning w/ ___________. Should observe _______________. Velocity ranges vary: Subclavian: ____________ Brachial: _______________ Radial/Ulnar: ____________. |
- subclavian
- triphasic waveforms Subclavian: 80-120 cm/s Brachial: 60-80 cm/s Radial & Ulnar: 40-60 cm/s |
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Velocities vary from ________ & ____________.
There is a __________ in resistance during ________ or _______. |
- vessel size
- skin temperature - decrease - exercise - heat |
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For tx of emboli & thrombi _________ therapy is used.
For Buerger's disease & vibratory trauma: _______ drugs _____________ _______ dilates peripheral arteries. __________ controls fatty acids that stimulate contractility of smooth muscle which promotes ________. ____________ agents which affect viscosity |
- thrombolytic
- vasodilatory - calcium channel blockers - Prostaglandins - Vasodilation *Decrease BP & controls permeability - hemorrheologic |
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T or F:
There is no non-pharmalogic way to tx Buerger's |
FALSE:
Cessation of smoking |
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Other tx options of Raynaud's are ________ sympathetcomy or _____________ sympathectomy.
_______________ is the procedure done to disrupt sympathetic nerve supply to the upper nerve connections. ___________ is a blockade of sympathetic nerve supply by chemicals. |
- surgical
- chemical - surgical - chemical |
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Primary Raynaud's may respond to ___________ & _____________ for temporary relief.
___________ are a must. |
- sympathectomy
- calcium channel blockers - vasodilators |
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Arterial occlusive disease is tx w/ ________ or _______.
|
- bypass
- endarterectomy |