Anatomy
What are the three main branching arteries that come off of the aorta?
Brachiocephalic artery (splits into the right subclavian and right common carotid), left common carotid artery, and left subclavian artery
What is the difference between a hemorrhagic stroke and an ischemic stroke?
Ischemic stroke is when a plaque rupture or embolism blocks blood flow to a region of the brain. A hemorrhagic stroke is when a ruptured blood vessel blocks blood flow to a region of the brain while also bleeding into the brain.
Embolic protection devices such as an IVC filter. An IVC filter is like a mesh funnel, where the opening is placed to where blood is flowing into it. If an thrombus were to embolize the IVC filter can catch it before it progresses.
Aortic aneurysms have to classifications. What are they and explain the difference.
Thoracic Endovascular Aortic Repair (TEVAR)- Aneurysm arises between the ascending aorta and the descending aorta, above the renal arteries.
Endovascular Aortic Repair (EVAR) - Aneurysm begins below the renal arteries and above the bifurcation of the common Iliacs.
Catheter based thrombolysis is indicated for patients with iliofemoral deep vein thrombosis. What kind of catheter is used, and what is unique about this catheter?
Thrombolytic catheters are used and have many holes along the side of the catheter to facilitate the dispersion of a thrombolytic. An example is the Uni-Fuse infusion catheter.
Explain the big difference between veins and arteries.
Carotid artery stenting is a treatment that has become favorable for revascularization. What are 3 indications for carotid artery stenting?
Stenosis greater than 70% or shows signs of instability, Lesion that is not favorable for surgical access, radiation induced carotid artery stenosis
What are some treatments for varicose veins and spider veins?
Elevate the patients legs in a supine position, avoid standing, compression, sclerotherapy, thermal ablation, surgery
There are multiple imagining techniques that are used to diagnose AAAs. List 3 and identify which one is the most common.
Chest X-ray, Abdominal ultrasound, and Computerized tomography with 3-D reconstruction. CTA with 3-D reconstruction is the most common.
Long term management of DVTs consists of medications that are targeted at preventing and breaking down thrombus. List the three categories of medication and provide an example for each.
Direct thrombin inhibitors - Padaxa ( dabigatran)
Factor Xa inhibitors - Xarelto (rivaroxaban)
There are two types of aortic arch branching patterns. What are they and how are they different?
The normal arch and the bovine arch. The normal arch has separate origins for the three branching arteries. In the bovine arch all three branching vessels originate from the brachiocephalic trunk.
What is the acronym to assess stroke symptoms, and what does the acronym stand for?
The acronym is PERRLA, and stands for Pupils Equal, Round, Reactive to Light, and Accommodation (ability of pupils to change size and focus on objects at different distances).
When diagnosing DVT a by product of fibrin degradation can be measured in a peripheral blood sample. What is the name of the by product?
Serum d-dimer
Endoleak is the most common complication with endovascular repair. What is an Endoleak and what is a consequence that can occur?
An Endoleak is when the stent graft does not completely exclude the aneurysm. Due to the opening to the aneurysm, blood continues to leak into the aneurysm and can cause the AAA to rupture.
Patients with proximal DVT can display a physical symptom known as edema? What is edema and what medication can be given to relieve symptoms?
With DVTs, edema is the pooling of fluids in the legs. Symptoms of edema can be treated with diuretics. One example of a diuretic to combat edema is furosemide (Lasix).
In endovascular repair stent grafts and grafts are placed in the abdominal aorta. In what vessels are the lower part of the grafts placed in?
The common iliac arteries
When preparing a carotid procedure there is a method to creating a table that is efficient for the procedure. What is the method called, and from the top to the bottom where is the equipment?
The technique is called the pancake method, and stacks equipment on top of each other with towels in the order of the procedure. From the top, the order is filter wire, balloon, stent, filter wire retrieval system.
What is the standard treatment for low-risk PE? Provide 3 examples.
Anticoagulation is the standard treatment for low risk PE. Examples of medications that are given for anticoagulation therapy are LMWH, Xarelto (rivaroxaban), and Eliquis (apixaban).
AAA are unique, because they can occur in close proximity to the renal arteries. Why is this important when performing EVAR, and what is one solution?
When deploying a stent graft to fix the aneurysm, proximity to the renal arteries can occlude flow to the kidneys. In order to prevent this a snorkel graft can be implemented to ensure continued flow in the renal arteries.
Detail the major components of Inari.
An aspiration catheter used to remove thrombus. The catheter has three self expanding nitinol discs that grab the thrombus and suck it into the catheter. Then, negative pressure is applied in the catheter and pulls the thrombus out.
Label the venous system. (venous system picture blank)
Internal jugular, External jugular, Superior vena cava, Inferior vena cava, Hepatic portal vein, Renal veins, Basilic, Brachial, Internal iliac, External iliac, Common iliac, Ulnar vein, Radial vein, Great saphenous vein, Femoral vein, Posterior tibial, Anterior tibial
The aortic arch is classified into three types. What are the three types and explain the differences.
Type I - All vessels originate within one diameter lengths of the top of the arch.
Type II - All vessels originate within two diameter lengths of the top of the arch
Type III - All vessels originate within more than two diameter lengths of the top of the arch.
In class we went over 7 different devices that are used to treat PE in the cath lab. What are they?
Ultrasound assisted thrombolysis, Angiojet, Aspirex, Angiovac, Indigo thrombectomy, QuickClear thrombectomy, and Inari.
In post-procedural care, what are 5 things you should assess in order evaluate the success of the procedure?
Lumbar/groin pain, significant drops in hematocrit levels, hypotension, pulsatile mass in the groin, bruits
Would you give thrombolytics for a hemorrhagic stroke? explain?
In hemorrhagic strokes instead of an embolism blocking blood flow, blood is actively leaking into the brain. Thrombolytics are blood thinners and are used to break down clots. Therefore with a hemorrhagic stroke thrombolytics will increase bleeding in the brain.