Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Test Taking Tips The endovascular approach is the predominant approach in the majority of vascular patients. Although you are not supposed to know the technical aspects of endovascular surgery, you should know indications, contraindications, and complications. Vascular emergency questions are frequently asked. Risk factor modification, vascular lab testing (ABI), and visceral aneurysm are commonly tested. +++ ANATOMY AND BASICS +++ At what arterial layer does dissection happen? ++ Media +++ What is the strength layer of an artery? ++ Adventitia +++ What is the name of macrophages that absorb fat in the vessel wall during atherosclerosis? ++ Foam cells +++ What is the most important risk factor for stroke and cerebrovascular disease? ++ Hypertension +++ What are the first branches of internal and external carotid arteries? ++ First branch of Internal is Ophthalmic First branch of External is Superior Thyroid +++ What degree of carotid stenosis should undergo intervention? ++ >50% in symptomatic patients and >70% in asymptomatic patients +++ What is the normal size for an abdominal aorta? ++ 2 to 3 cm +++ PERIPHERAL ARTERIAL DISEASE +++ How are ankle-brachial index/digital-brachial index (ABIs/DBIs) and segmental pressures measured? Pulse volume recordings (PVRs)? What is their significance? ++ Normal ABI at rest: 1.0 to 1.2, mild arterial insufficiency: 0.7 to 0.9, claudication: 0.5 to 0.7, pain at rest, and ultimately tissue necrosis <0.4 (falsely elevated ABIs may be seen in diabetic patients or those with chronic renal disease due to extensive vascular calcification) PVRs analyze the waveforms at sequential sites along the patient’s leg—triphasic or biphasic waveforms indicate more perfusion than monophasic. ++ FIGURE 24-1 Calculating the ankle-brachial index. (Reproduced with permission from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery, 11th ed. New York, NY: McGraw Hill; 2019.) Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ What is the half-life of heparin? Intraoperative therapeutic dosing? How is it reversed? ++ Half-life is 60 to 90 minutes. Intraoperative dosing is 70 to 100 units/kg (activating clotting time of 250 to 350 seconds if measured). Protamine sulfate: 1 mg/100 units of heparin. +++ What are the classic signs/symptoms of acute arterial occlusion? In what order do they present? ++ The “6 Ps” include Paresthesias, Pain, Pallor, Poikilothermia, Pulselessness, and Paralysis +++ What percentage of emboli originate in the heart? First and second most common causes? ++ 80% of peripheral emboli are due to cardiac etiology (first—atrial fibrillation; second—acute MI) +++ At what anatomic sites do atherosclerotic ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.