Beloy - Vascular Surgery (Exam 4)

Question 1

What is the INR goal for someone on Coumadin?

Answer 1

INR 2-3

Question 2

How do we reverse Coumadin?

Answer 2

FFP and vitamin K

Question 3

Where do you place a chest tube?

Answer 3

• Mid axial line, 5th intercostal space (level of the nipple line).
• Slide the tube over the top of the rib (because the intercostal a/n/v is on the bottom of the rib)

Question 4

Once you have placed a chest tube you want to _________________________________.

Answer 4

Once you have placed a chest tube you want to put to suction or water seal.

Question 5

What are the 3 most common vessels used for CABGs?

Answer 5

1. Internal mammary a.
2. Saphenous v.
3. Radial a.

Question 6

If a vessel is clogged, you can either unclog it (aka __________), make an opening (aka __________), or create a new pathway for the blood to flow (aka __________)

Answer 6

If a vessel is clogged, you can either unclog it (aka angioplasty), make an opening (aka place a stent), or create a new pathway for the blood to flow (aka bypass).

Question 7

In order to sew new vessels to the heart you must stop the heart. This includes cooling and a high potassium based solution. What is this process called?

Answer 7

Cardiopulmonary bypass

Question 8

T/F: Your pt’s carotid artery is 65% stenosed. This is indication for a carotid endarterectomy.

Answer 8

False - only if >70% stenosed

Question 9

No matter the location of an aneurysm or dissection, what are your two options for fixing it? Describe each method

Answer 9

• Endovascular:
  
  • an incision is made in the femoral and/or brachial a. and a stent is introduced, directed under fluoroscopy and is deployed in the landing zone
• Open repair:
  
  • Traditional repair. Longer healing time, actually will replace the injured blood vessel section with graft (new plumbing).

Question 10

How do you classify aortic dissections?

Answer 10

• Debakey:
  
  • ​Type I: involves ascending aorta, aortic arch, and descending aorta
  • Type II: ascending aorta only
  • Type III: descending aorta only
• Stanford:
  
  • ​Type A: includes Debakey types I and II
  • Type B: Debakey type III

Question 11

• Stanford type A aortic dissections require ____________.
• Stanford type B aortic dissections require ____________.

Answer 11

• Stanford type A aortic dissections require surgery.
• Stanford type B aortic dissections require BP control.

Question 12

What is an endoleak?

Answer 12

An endoleak is an endovascular repair complication. It’s when you have persistent blood flow outside the lumen of the endoluminal graft but within the aneurysm sac or adjacent segment being treated by the device.

Question 13

Which type of endoleak is the most common?

Answer 13

Type II: patent lumbar arteries

Question 14

What is the normal range for ABI?

Answer 14

0.9-1.4

Question 15

Where are the 5 locations you can amputate on the lower extremities?

Answer 15

• Toe
• Transmetatarsal
• Below-knee
• Above-knee
• Hip disarticulation

Question 16

Name that wound: Wounds that are thought to occur due to improper functioning of venous valves, usually of the legs, a major cause of chronic wounds.

Answer 16

Venous stasis ulcers

Question 17

What score are you going to get on this exam?

Answer 17

100%

Question 18

How do you reverse heparin?

Answer 18

Protamine

Question 19

What focused Physical exam should you do for every patient in vascular surgery?

Answer 19

1. vitals
   
   1. record blood pressure in both arms to check for subclavian disease
2. Head/neck
   
   1. asess quality of temporal and carotid pulses, listen to bruits
3. Chest
   
   1. assess heart sounds, rate, rhythym, murmurs, pericardial rubs
4. abdomen
   
   1. assess for pulsatile masses, listen for bruits over viseral/renal/iliac vessels
5. lower extemeties
   
   1. assess the quality of pulses, femoral, popliteral, dorsalis pediss, posterior tibial, check the skin for ulcerations and color changes
   2. hair distribution, edema

Question 20

What is the most common blockage in the coronary arteries?

Answer 20

LAD (left anterior descending)

Question 21

If someone has a 100% block carotid artery that occured over time, what is your plan?

Answer 21

Doesn’t necessarily need to be fixed, but should exercise extreme caution and monitoring of the other carotid artery.

Question 22

During angiogram and intervention of PAD, which artery is access usually obtained through?

Answer 22

Lower extremity/aorta - Common femoral

Upper extremity - brachial or femoral depending on location

Question 23

What blood thinning medication would you use for carotid-subclavian bypass?

Answer 23

Heparin.

Question 24

What is steal syndrome? What causes it?

Answer 24

• vascular access steal syndrome is a syndrome caused by ischemia (not enough blood flow) resulting from a vascular access device (such as an arteriovenous fistula or synthetic vascular graft–AV fistula) that was installed to provide access for the inflow and outflow of blood during hemodialysis.