ABS Vascular Surgery flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

AAA elective repair threshold

Elective repair is offered for an infrarenal aortic diameter of 5.5 cm in men or 5.0 cm in women, growth exceeding 0.5-1.0 cm per year, or the presence of symptoms.

Popliteal artery aneurysm threshold

Repair is indicated at 2.0 cm diameter or when mural thrombus causes distal embolization. About half are bilateral and 40% coexist with abdominal aortic aneurysm, so both should be imaged.

Mycotic aortic aneurysm

An infected aneurysm, most often from Salmonella species, presenting with fever, pain, and saccular morphology. Treatment is excision with debridement plus extra-anatomic bypass or covered in-situ graft and prolonged antibiotics.

Leriche syndrome

Aortoiliac occlusive disease triad of buttock and thigh claudication, absent or diminished femoral pulses, and erectile dysfunction, caused by occlusion of the distal aorta or bilateral common iliac arteries.

Aortobifemoral bypass patency

The standard open operation for aortoiliac occlusive disease; five-year primary patency is approximately 85-90%, with elective operative mortality of 1-3% in non-infected cases.

NASCET 70 percent rule

In symptomatic patients with 70-99% internal carotid stenosis by NASCET criteria, carotid endarterectomy plus best medical therapy roughly halves ipsilateral stroke risk compared with medical therapy alone.

Timing of carotid endarterectomy

For symptomatic carotid stenosis, endarterectomy should be performed within 14 days of the index ischemic event, ideally between 3 and 7 days, provided the patient is neurologically stable.

Carotid duplex 70% criteria

Peak systolic velocity above 230 cm/s, an internal-to-common carotid velocity ratio above 4.0, and end-diastolic velocity above 100 cm/s together indicate 70% or greater internal carotid stenosis.

Hyperperfusion syndrome

Occurs days after carotid revascularization with unilateral headache, seizures, and intracerebral hemorrhage from loss of cerebral autoregulation. Strict postoperative blood pressure control is the main preventive measure.

Critical limb-threatening ischemia criteria

Rest pain or tissue loss with ankle pressure below 50 mmHg, toe pressure below 30 mmHg, or transcutaneous oxygen below 30 mmHg; diabetes may mask this with a falsely elevated ankle-brachial index.

Ankle-brachial index above 1.3

A falsely elevated index suggests non-compressible, calcified tibial arteries from diabetes or end-stage renal disease. Toe-brachial index or pulse volume recordings are then needed to assess perfusion.

Cilostazol for claudication

A phosphodiesterase-3 inhibitor that improves walking distance in intermittent claudication; it is contraindicated in heart failure and is paired with supervised exercise and risk factor control.

BEST-CLI trial conclusion

In patients with chronic limb-threatening ischemia who have a usable single-segment great saphenous vein, surgical bypass achieved better amputation-free survival and fewer major reinterventions than endovascular therapy.

May-Thurner syndrome

Compression of the left common iliac vein between the right common iliac artery and the vertebral body, producing left leg swelling, iliofemoral deep vein thrombosis, and chronic venous insufficiency.

Phlegmasia cerulea dolens

Massive iliofemoral venous thrombosis with severe pain, cyanosis, and edema that threatens venous gangrene from compartment tamponade; treatment is anticoagulation plus catheter-directed thrombolysis or thrombectomy.

Stemmer sign

Inability to pinch and lift the skin of the dorsum of the second toe, indicating lymphedema rather than edema of venous or systemic origin.

Hard signs of vascular injury

Pulsatile or expanding hematoma, active bleeding, palpable thrill or audible bruit, absent distal pulses, or evident distal ischemia; these mandate immediate exploration or angiography.

Takayasu arteritis

Granulomatous large-vessel arteritis of young women causing subclavian and aortic stenoses with blood pressure discrepancy and absent pulses; treated with corticosteroids and revascularization only during remission.

Giant cell arteritis

Large-vessel vasculitis of patients over 50 with headache, jaw claudication, visual loss, and elevated sedimentation rate; high-dose steroids are started immediately and temporal artery biopsy confirms the diagnosis.

Ankle-brachial index measurement

Divide the higher of the dorsalis pedis or posterior tibial systolic pressure in each leg by the higher of the two brachial systolic pressures; a value of 0.90 or less is abnormal.

Duplex diagnosis of DVT

Loss of venous compressibility, absent spontaneous or phasic flow, and non-augmenting flow after distal squeeze; failure to compress the common femoral or popliteal vein is the primary diagnostic criterion.

Skin perfusion pressure

A laser Doppler measure of perfusion used when ankle-brachial index is unreliable; values below 30 mmHg predict poor wound healing and help select amputation level.

Type I endoleak

Blood flow at the proximal or distal attachment site of an endograft; it indicates an inadequate seal and carries a risk of rupture, so it is treated when detected.

Type II endoleak

Retrograde flow into the aneurysm sac from lumbar arteries or the inferior mesenteric artery; generally monitored, with intervention reserved for sac enlargement greater than 5 mm.

Aortic graft infection

Presents with fever, leukocytosis, pseudoaneurysm, or aortoenteric fistula, most often from Staphylococcus epidermidis; treatment is graft excision, wide debridement, extra-anatomic revascularization, and prolonged antibiotics.

Protamine reversal of heparin

One milligram of protamine sulfate neutralizes approximately 100 units of unfractionated heparin; the dose is based on total intraoperative heparin given, and rapid infusion may cause hypotension.

Abdominal compartment syndrome

Sustained intra-abdominal pressure above 20 mmHg with new organ dysfunction; managed with decompressive laparotomy, often leaving an open abdomen after ruptured aortic aneurysm repair.

Spinal cord ischemia after TEVAR

Paraparesis from interruption of intercostal and artery of Adamkiewicz supply; treated by raising mean arterial pressure, draining cerebrospinal fluid to below 10 mmHg, and correcting anemia.

Revised cardiac risk index

A preoperative model scoring ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine above 2 mg/dL, and high-risk surgery such as open aortic repair.

Below-knee versus above-knee amputation

Below-knee amputation preserves the knee and greatly improves prosthetic gait and energy efficiency, so it is preferred whenever the limb is viable at that level; above-knee is required when the knee cannot be preserved.

Smoking cessation before vascular surgery

Cessation at least four weeks before elective reconstruction reduces pulmonary complications, improves graft patency, and lowers cardiac events; continued smoking more than doubles late graft failure.

Diabetic foot ulcer offloading

Total contact casting or a removable walker is essential to heal plantar neuropathic ulcers; pressure relief outweighs the choice of dressing once infection is controlled and perfusion is adequate.