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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.)

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 lesions most commonly occlude?

  • Atherosclerosis forms at branch points ...

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