36 Questions
Which artery is the most common site of upper extremity stenosis?
Brachial artery
What is the most common treatment for subclavian steal syndrome?
Covered stent to subclavian artery
In thoracic outlet syndrome, which structure passes over the 1st rib anterior to the anterior scalene muscle?
Subclavian vein
What is the most likely consequence of proximal subclavian artery stenosis in subclavian steal syndrome?
Reversal of flow through ipsilateral vertebral artery into the subclavian artery
What is the most common complication of aneurysms above the inguinal ligament?
Rupture
What are the most common complications of aneurysms below the inguinal ligament?
Embolism and thrombosis
Which risk factor is associated with visceral artery aneurysms?
Medial fibrodysplasia
When should splenic artery aneurysms be repaired?
If symptomatic, occurring during pregnancy, in women of childbearing age, or > 3 cm
What is the primary association of popliteal artery aneurysms?
Atherosclerosis
What are the surgical indications for popliteal aneurysms?
Symptoms, size > 2 cm, or mycotic condition
"What is a common cause of pseudoaneurysms in the femoral artery?"
Percutaneous interventions or suture line disruption
What is the primary treatment for fibromuscular dysplasia affecting the renal artery?
Balloon angioplasty
What is the primary consequence of Buerger’s disease?
Severe rest pain
What characterizes Marfan’s disease?
Aortic root dilatation and mitral valve prolapse
Where is the right internal jugular site preferred for dialysis catheter placement?
Permanent catheters
What is the ideal diameter for a Cimino fistula at 6 weeks?
6 mm
How is venous obstruction commonly attributed to A-V fistula/graft failure?
Intimal hyperplasia
What is the initial diagnostic modality for identifying inflow/outflow/anastomosis problems in a fistula?
Ultrasound (U/S)
How are arterial inflow issues such as subclavian stenosis typically treated?
Covered stent placement
What is the recommended treatment for venous outflow issues caused by venous hyperplasia?
Balloon angioplasty
What is the recommended approach to control bleeding from a graft/fistula?
Apply pressure
Which symptoms are associated with venous insufficiency?
Swelling and night cramps
What is the recommended treatment for superficial thrombophlebitis?
Warm compresses and elevation of the affected limb
Where is deep venous thrombosis (DVT) most commonly found?
Calf
What are the mainstays of treatment for venous insufficiency?
Leg wraps, ambulation, weight loss
How are acquired A-V fistulas typically managed?
Surgical repair
What is the primary cause of pain in thoracic outlet syndrome?
Brachial plexus irritation
How is subclavian vein compression diagnosed?
Venography
What is the characteristic symptom of mesenteric vein thrombosis?
Subacute bloody diarrhea and crampy abdominal pain
How is nonocclusive mesenteric ischemia (NOMI) managed?
Volume resuscitation and improving cardiac output
What causes median arcuate ligament syndrome?
Celiac artery compression
What imaging modality is used to diagnose chronic mesenteric angina?
CTA
What is the recommended treatment for SMA embolism?
Open embolectomy with planned 2nd look laparotomy
How is cervical ribs related to thoracic outlet syndrome diagnosed?
Cervical spine and chest MRI
What can result from subclavian artery compression caused by weight lifting?
Hand pain from ischemia
What is the characteristic symptom of SMA thrombosis?
Similar symptoms to embolism, often at the SMA ostium
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
Test your knowledge about the most common complications and risk factors associated with visceral, peripheral, and splanchnic artery aneurysms.
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