Vascular 3
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Questions and Answers

Which artery is the most common site of upper extremity stenosis?

  • Axillary artery
  • Radial artery
  • Ulnar artery
  • Brachial artery (correct)

    • What is the most common treatment for subclavian steal syndrome?

  • Carotid endarterectomy
  • Angioplasty of vertebral artery
  • Thrombolytic therapy
  • Covered stent to subclavian artery (correct)

    • In thoracic outlet syndrome, which structure passes over the 1st rib anterior to the anterior scalene muscle?

  • Subclavian vein (correct)
  • Brachial plexus
  • Subclavian artery
  • Axillary vein

    • What is the most likely consequence of proximal subclavian artery stenosis in subclavian steal syndrome?

    <p>Reversal of flow through ipsilateral vertebral artery into the subclavian artery</p> Signup and view all the answers

    What is the most common complication of aneurysms above the inguinal ligament?

    <p>Rupture</p> Signup and view all the answers

    What are the most common complications of aneurysms below the inguinal ligament?

    <p>Embolism and thrombosis</p> Signup and view all the answers

    Which risk factor is associated with visceral artery aneurysms?

    <p>Medial fibrodysplasia</p> Signup and view all the answers

    When should splenic artery aneurysms be repaired?

    <p>If symptomatic, occurring during pregnancy, in women of childbearing age, or &gt; 3 cm</p> Signup and view all the answers

    What is the primary association of popliteal artery aneurysms?

    <p>Atherosclerosis</p> Signup and view all the answers

    What are the surgical indications for popliteal aneurysms?

    <p>Symptoms, size &gt; 2 cm, or mycotic condition</p> Signup and view all the answers

    "What is a common cause of pseudoaneurysms in the femoral artery?"

    <p>Percutaneous interventions or suture line disruption</p> Signup and view all the answers

    What is the primary treatment for fibromuscular dysplasia affecting the renal artery?

    <p>Balloon angioplasty</p> Signup and view all the answers

    What is the primary consequence of Buerger’s disease?

    <p>Severe rest pain</p> Signup and view all the answers

    What characterizes Marfan’s disease?

    <p>Aortic root dilatation and mitral valve prolapse</p> Signup and view all the answers

    Where is the right internal jugular site preferred for dialysis catheter placement?

    <p>Permanent catheters</p> Signup and view all the answers

    What is the ideal diameter for a Cimino fistula at 6 weeks?

    <p>6 mm</p> Signup and view all the answers

    How is venous obstruction commonly attributed to A-V fistula/graft failure?

    <p>Intimal hyperplasia</p> Signup and view all the answers

    What is the initial diagnostic modality for identifying inflow/outflow/anastomosis problems in a fistula?

    <p>Ultrasound (U/S)</p> Signup and view all the answers

    How are arterial inflow issues such as subclavian stenosis typically treated?

    <p>Covered stent placement</p> Signup and view all the answers

    What is the recommended treatment for venous outflow issues caused by venous hyperplasia?

    <p>Balloon angioplasty</p> Signup and view all the answers

    What is the recommended approach to control bleeding from a graft/fistula?

    <p>Apply pressure</p> Signup and view all the answers

    Which symptoms are associated with venous insufficiency?

    <p>Swelling and night cramps</p> Signup and view all the answers

    What is the recommended treatment for superficial thrombophlebitis?

    <p>Warm compresses and elevation of the affected limb</p> Signup and view all the answers

    Where is deep venous thrombosis (DVT) most commonly found?

    <p>Calf</p> Signup and view all the answers

    What are the mainstays of treatment for venous insufficiency?

    <p>Leg wraps, ambulation, weight loss</p> Signup and view all the answers

    How are acquired A-V fistulas typically managed?

    <p>Surgical repair</p> Signup and view all the answers

    What is the primary cause of pain in thoracic outlet syndrome?

    <p>Brachial plexus irritation</p> Signup and view all the answers

    How is subclavian vein compression diagnosed?

    <p>Venography</p> Signup and view all the answers

    What is the characteristic symptom of mesenteric vein thrombosis?

    <p>Subacute bloody diarrhea and crampy abdominal pain</p> Signup and view all the answers

    How is nonocclusive mesenteric ischemia (NOMI) managed?

    <p>Volume resuscitation and improving cardiac output</p> Signup and view all the answers

    What causes median arcuate ligament syndrome?

    <p>Celiac artery compression</p> Signup and view all the answers

    What imaging modality is used to diagnose chronic mesenteric angina?

    <p>CTA</p> Signup and view all the answers

    What is the recommended treatment for SMA embolism?

    <p>Open embolectomy with planned 2nd look laparotomy</p> Signup and view all the answers

    How is cervical ribs related to thoracic outlet syndrome diagnosed?

    <p>Cervical spine and chest MRI</p> Signup and view all the answers

    What can result from subclavian artery compression caused by weight lifting?

    <p>Hand pain from ischemia</p> Signup and view all the answers

    What is the characteristic symptom of SMA thrombosis?

    <p>Similar symptoms to embolism, often at the SMA ostium</p> Signup and view all the answers

    Study Notes

    Vascular and Neurologic Disorders of the Thoracic Outlet

    • Phrenic nerve runs on top of anterior scalene muscle and can cause back, neck, arm, and/or hand pain/weakness/tingling/numbness
    • Cervical spine and chest MRI are used to diagnose thoracic outlet syndrome (TOS), with cervical ribs being the number one anatomic abnormality
    • Brachial plexus irritation, often due to cervical rib, is the primary cause of pain in TOS
    • Subclavian vein compression, usually due to anterior scalene hypertrophy, can lead to effort-induced thrombosis, with venography being the gold standard for diagnosis
    • Subclavian artery compression, often caused by weight lifting, can result in hand pain from ischemia, and is diagnosed using duplex U/S or angiogram
    • Mesenteric ischemia, with a high mortality rate, is commonly caused by embolic or thrombotic occlusion, and nonocclusive mesenteric ischemia (NOMI) is associated with low cardiac output states
    • SMA embolism typically occurs 2–10 cm distal to the origin of the SMA, and requires open embolectomy, with planned 2nd look laparotomy being recommended
    • SMA thrombosis presents with similar symptoms to embolism, often at the SMA ostium, and is treated with thrombectomy and resection of infarcted bowel
    • Mesenteric vein thrombosis is characterized by subacute bloody diarrhea and crampy abdominal pain, and is diagnosed using abdominal CTA with venous phase
    • Nonocclusive mesenteric ischemia (NOMI) is associated with critically ill patients and low cardiac output, and is managed by volume resuscitation and improving cardiac output
    • Median arcuate ligament syndrome causes celiac artery compression, leading to chronic pain and weight loss, and is treated with transecting the median arcuate ligament
    • Chronic mesenteric angina presents with visceral angina after meals, and is diagnosed using CTA and managed with PTA and stent or bypass if necessary

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