Chapter 23 Peripheral Vascular Surgery Quiz & Flashcards

Questions and Answers

What is the popliteal?

Artery of the knee

What are the azygos?

Veins of the thoracic wall

What does mesenteric refer to?

Abdominal organs - bowel of the colon

What is the circle of Willis?

Base of brain Signup and view all the answers

What is the cephalic?

Vein of the arm Signup and view all the answers

What is the brachiocephalic?

Innominate artery; first branch of aortic arch Signup and view all the answers

What does the portal refer to?

Vein that shunts blood through the liver for filtering Signup and view all the answers

What is the iliac?

Artery and veins of the pelvic organs/bladder Signup and view all the answers

What is the carotid?

Second branch of aortic arch Signup and view all the answers

What is the dorsalis pedis?

Artery of foot Signup and view all the answers

What is the saphenous?

Longest vein of body Signup and view all the answers

What is the peroneal?

Artery of lower leg Signup and view all the answers

What is the profundus femoris?

Artery of the hip and thigh Signup and view all the answers

What are aortic bodies?

Receptors for control of blood pressure, O2, and CO2 Signup and view all the answers

What are aortic sinuses?

Small dilations in ascending aorta Signup and view all the answers

When is a contrast solution needed on the sterile field?

When an intraoperative arteriogram is anticipated. Signup and view all the answers

What are hemostatic agents typically used in peripheral vascular surgery?

Gelfoam, topical thrombin, Surgicel, and Avitene. Signup and view all the answers

How is the irrigation pump set up for angioscopy?

A pneumatic pressure cuff is placed around the bag of Ringer's solution and inflated to a pressure between 200 and 300 mmHg. Signup and view all the answers

What is used to confirm normal blood flow in a vessel?

The Doppler ultrasound. Signup and view all the answers

What is arteriosclerosis obliterans?

A common disorder of the arteries characterized by thickening and loss of elasticity of the arterial walls. Signup and view all the answers

A type of arteriosclerosis is ___?

atherosclerosis. Signup and view all the answers

Where does atherosclerosis involvement tend to begin?

The two main areas are the aortic bifurcation and the superficial femoral artery. Signup and view all the answers

What implant can be used to hold a vessel open after balloon angioplasty?

A stent (intraluminal expandable wire mesh stent, or Palmaz stent). Signup and view all the answers

What is a potential complication of an angioplasty?

A balloon that is too large can result in dissection of the vessel. Signup and view all the answers

What medications can be used during an angioplasty?

Heparin to prevent clots; nitroglycerin to eliminate vasospasms; contrast dye to visualize the vessels and lesions. Signup and view all the answers

What can occur as a result of needle perforation when trying to locate a subclavian catheter?

The needle can cause a pneumothorax or hemorrhage. Signup and view all the answers

If a guidewire enters the ventricle, what can it cause?

The guidewire in the ventricle can cause dysrhythmias. Signup and view all the answers

Identify several types of emboli.

Blood clot, fat, air, and cellular debris such as tumor portions. Signup and view all the answers

Identify three types of treatment for embolism.

Anticoagulants (heparin or Coumadin); enzymes (urokinase or streptokinase); embolectomy (balloon or open technique). Signup and view all the answers

What are the treatments for a thrombus occlusion?

High dosages of anticoagulants such as heparin allow the patient's own fibrinolytic system to lyse the occluding clot. Signup and view all the answers

What catheter is used for an embolectomy?

A Fogarty embolectomy catheter. Signup and view all the answers

What is plaque?

An atherosclerotic lesion that appears within the artery and causes the intima to obstruct the lumen. Signup and view all the answers

What examinations may be performed to identify a lesion of the common carotid artery?

The history and physical will provide information about neurological deficit; arteriography to outline the specific location; a CT scan may rule out cerebral infarction. Signup and view all the answers

What is the primary indication for carotid endarterectomy?

Transient cerebral ischemia. Signup and view all the answers

What is the cause of a transient ischemic attack (TIA)?

When small pieces of plaque break away from the common carotid or internal carotid artery and temporarily block blood flow. Signup and view all the answers

TIAs are forerunners to permanent ___?

stroke. Signup and view all the answers

What are the signs and/or symptoms associated with a TIA?

May demonstrate contralateral weakness; confusion and/or speech difficulty that may resolve shortly after the episode. Signup and view all the answers

Identify at least two materials available for vascular grafts.

Autologous or autogenous, synthetic (polyester, polytetrafluoroethylene, and velour), and composite. Signup and view all the answers

What instruments are typically used to perform an arteriotomy?

The artery is grasped with DeBakey forceps, entered with a #11 blade, and extended with Potts scissors. Signup and view all the answers

What is used to remove the plaque?

Elevated with a Freer elevator or Penfield #4 dissector. Signup and view all the answers

Describe the size and characteristics of the suture for closure of the arteriotomy.

The common carotid is sutured with a 6-0 polypropylene double-armed suture swaged on taper needles. Signup and view all the answers

Where is the aorta located and which artery is isolated prior to incision?

Located in the retroperitoneal space; the inferior mesenteric artery is isolated. Signup and view all the answers

What type of graft must be preclotted prior to the aorta being incised?

A bifurcated knitted Dacron graft. Signup and view all the answers

Why is irrigation performed prior to beginning the anastomosis?

To remove small pieces of thrombus from the aortic wall. Signup and view all the answers

What can be used to patch any leaks found in the anastomosis?

Interrupted, pledgeted Prolene sutures. Signup and view all the answers

What are the priorities for a ruptured AAA?

Have draping materials, a knife, cautery, and large aortic cross-clamp ready. Signup and view all the answers

What additional instruments are needed for an aortofemoral bypass?

A tunneling device, such as Sarot clamp. Signup and view all the answers

Why is it important to use warm wet towels or a bowel bag when displacing the small bowel?

To prevent drying out and desiccation of tissue. Signup and view all the answers

What can be used as a carrier for vessel ties?

Schnidt tonsil clamps, Sarot clamps, right angle clamps. Signup and view all the answers

How are pledgets typically loaded?

By carefully folding in half and placing the needle through the fold. Signup and view all the answers

What device is used to remove valves from an autograft saphenous vein?

A Cartier valvulotome. Signup and view all the answers

Why is a partial occlusion clamp used during a femoropopliteal bypass?

It allows blood flow to continue through the vessel. Signup and view all the answers

What can be used to aid in the visualization of small sutures for loading?

A white paper towel is laid between the Mayo and the operative site. Signup and view all the answers

What are the four types of vessel anastomoses that can be done?

Artery side to vein side, artery end to vein side, artery end to vein end, and vein end to artery side. Signup and view all the answers

What are the most likely vessels to be used for an arteriovenous shunt?

Cimino fistula and shunt. Signup and view all the answers

Why is an arteriovenous shunt or fistula completed?

To establish vascular access for long-term renal dialysis. Signup and view all the answers

Describe DVT.

A disorder involving a thrombus in one of the deep veins of the body. Signup and view all the answers

How can DVT be life-threatening?

If the thrombus becomes an embolus, it can enter the lungs, causing a PE. Signup and view all the answers

Using your medical dictionary, define 'claudication.'

Means 'to cramp' and is brought on by exercise and relieved by rest. Signup and view all the answers

Why are IVC filters used?

To prevent the embolus from reaching the pulmonary circuit. Signup and view all the answers

What types of precautions are needed during this procedure?

Radiation precautions due to fluoroscopy. Signup and view all the answers

Where is the IVC filter usually placed?

Distal to the renal vein. Signup and view all the answers

Describe varicose veins and what causes them to develop.

Veins that have become elongated, dilated, and tortuous. Signup and view all the answers

When is treatment for varicose veins indicated?

For pain, easy fatigability, recurrent thrombophlebitis, and complications. Signup and view all the answers

Study Notes

Peripheral Vascular Surgery Key Terms

Popliteal: Artery located at the back of the knee, supplying blood to the leg.
Azygos: Essentially consists of veins found within the thoracic wall, aiding drainage.
Mesenteric: Refers to arteries and veins associated with the abdominal organs, particularly the bowel of the colon.
Circle of Willis: The arterial structure at the brain's base, important for cerebral circulation.
Cephalic: A major vein in the arm, significant for venous return.
Brachiocephalic: The innominate artery; the first major branch of the aortic arch.
Portal: Vein responsible for directing blood through the liver for filtration.
Iliac: Refers to arteries and veins supplying blood to pelvic organs and the bladder.
Carotid: Second branch of the aortic arch, crucial for supplying blood to the brain.
Dorsalis Pedis: Artery that serves the foot, important for lower limb circulation.
Saphenous: The longest vein in the body, located in the lower extremity.
Peroneal: Artery that supplies blood to the lower leg.
Profundus Femoris: Artery responsible for blood supply to the hip and thigh regions.

Medical Definitions and Procedures

Aortic Bodies: Receptors that monitor blood pressure, and levels of O2 and CO2, regulating cardiovascular function.
Aortic Sinus: Small dilations found in the ascending aorta, associated with coronary circulation.
Contrast Solution: Required on sterile fields during intraoperative arteriograms to enhance imaging.
Hemostatic Agents: Commonly used during vascular surgery include Gelfoam, topical thrombin, Surgicel, and Avitene.
Angioscopy Irrigation: Involves using a pneumatic pressure cuff for irrigation to enhance visual clarity during procedures.

Conditions and Treatments

Arteriosclerosis Obliterans: A frequent arterial disorder characterized by thickening and decreased elasticity of arterial walls, leading to reduced blood flow.
Atherosclerosis: A variant of arteriosclerosis linked with plaque formation in arteries.
Transient Ischemic Attack (TIA): Caused by plaque detachment from arteries, potentially leading to strokes and characterized by temporary neurological deficits.
Deep Vein Thrombosis (DVT): Formation of a thrombus in deep veins, primarily affecting the iliac and femoral veins; can be life-threatening if it leads to pulmonary embolism.

Surgical Procedures and Instruments

Angioplasty: Often accompanied by stent placement to maintain vessel patency post-procedure. Potential complications include vessel dissection if balloons are oversized.
Embolectomy: Performed using a Fogarty catheter to restore blood flow by removing emboli.
Vascular Grafts: Available in materials such as autologous, synthetic (like polyester or PTFE), and composite options for bypass surgeries.
Suture for Arteriotomy: Typically, a 6-0 polypropylene double-armed suture is used for carotid repair procedures.
IVC Filter: Deployed distal to the renal vein to prevent emboli from traveling to the pulmonary circulation.

Vascular Anatomy and Conditions

Varicose Veins: Enlarged, twisted veins caused by factors such as heredity, hormonal changes, and prolonged standing. Indicated treatments involve addressing pain and complications.
Claudication: Refers to cramping induced by exercise, which is relieved by rest, often associated with vascular insufficiency.

Other Relevant Procedures

Anastomosis Types: Various techniques include artery side-to-vein side, artery end-to-vein end, and vein end-to-artery side connections.
Biopsy and Diagnostic Evaluations: Techniques like CT scans and arteriography are essential for identifying vascular lesions, particularly in carotid arteries.

Preoperative Considerations

Preparation for AAA: Essential instruments and materials should be on hand, including clamps for hemostasis and measures to control hemorrhage.
Warm Wet Towels: Used during surgery to keep bowel tissue moist, preventing damage and reducing postoperative adhesions.

Patient Care Considerations

Radiation Precautions: Important during procedures involving fluoroscopy to avoid unnecessary exposure.
Treatment Indications: Decisions for surgical intervention are guided by symptoms, risk factors, and potential complications associated with vascular diseases.

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Test your knowledge on key terms related to peripheral vascular surgery with these flashcards from Chapter 23. Each card features a medical term along with its definition, helping you to reinforce your understanding of vascular anatomy and terminology. Perfect for medical students and professionals alike.

Peripheral Vascular Surgery Flashcards CH 23