All About Grafts
Dissect This
Did Someone Say Fistula?
I Cant Feel My Arm (when Im with you)
Just A Stick And A Burn
100

The 2 most common organisms that cause vascular graft infections.

Staph aureus (MC short term)

Staph Epidermidis (more indolent course)

- Coagulase-negative staphylococci such as S epidermidis can have a more indolent course as these bacteria are less virulent and aggressive.

- Infections from gram-negative bacteria such as Escherichia coli, Pseudomonas, Klebsiella, Enterobacter, Serratia, and Proteus usually occur early and are more severe. These infections can be prone to poor wound healing, anastomotic disruption, and hemorrhage. Systemic infections and subsequent seeding of grafts with these pathogens may have a prolonged course.

Fungal graft infections can occur, but they are much less common and typically limited to immunosuppressed patients. Candida albicans is the offending pathogen in most reported cases.


100

The anatomic defect that leads to a thoracic aortic dissection

Intimal tear

100

Most common cause of an AV graft thrombosis 1 year after creation?

Intimal hyperplasia

Late access thrombosis usually occurs 1 to 2 years after access placement and most commonly is due to intimal hyperplasia. In a prosthetic access, this occurs most commonly at the graft-venous anastomosis.

100

This structure lies between the subclavian vein and anterior scalene

phrenic nerve

100


This arterial disorder


Fibromuscular dyplasia

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory arterial disease that primarily affects women. 1. It most commonly affects the renal, extra-cranial carotid, and vertebral arteries, but has been reported in almost every arterial bed

200

Name 2 perioperative risk factors for vascular graft infection 

Perioperative risk factors:

Prolonged preoperative hospitalization

Infection in a remote site

Recent percutaneous arterial access at the implant site (peripheral or cardiac angiography)

Breaks in aseptic technique

Emergency/urgent operation

Reoperative vascular procedure

Extended operating time

Concomitant gastrointestinal or genitourinary procedure

Postoperative wound complication (superficial infection, skin necrosis, lymphocele)

Patient-related risk factors:

Malignancy

Lymphoproliferative disorder

Autoimmune disease

Corticosteroid administration

Chemotherapy

Malnutrition

Diabetes mellitus

Chronic renal insufficiency/end-stage renal disease

Liver disease or cirrhosis

200

Name 2 genetic syndromes that can make one high risk for aortic dissections.

Syndromic conditions commonly associated with a risk of aortic dissection include Marfan, Loeys-Dietz, and Ehlers-Danlos syndromes. 

200

Classic initial symptom of an aortic graft-enteric fistula

Herald bleed (classically hematemasis)

EGD is the first diagnostic evaluation for an upper GI hemorrhage. With a history of an aortic graft, a high index of suspicion should prompt extension of the endoscopic evaluation to the distal duodenum to make the diagnosis and rule out other etiologies. 

200

Name this neonatal brachial plexus injury

Erb-duchenne palsy (Erb's palsy)

200

This artery


Left anterior tibial artery

300

MC material used for dialysis AV grafts

 Polytetrafluoroethylene (PTFE) 

PTFE grafts are preferred over biological and other synthetic grafts due to low thrombosis risk, longer patency, ease of implantation, and low risk of disintegration with infection.

300

The Blood vessel that provides a critical collateral pathway for intestinal perfusion when the superior mesenteric artery is occluded

Pancreaticoduodenal artery


The mesenteric collateral circulation network is robust, explaining why most patients develop symptoms only when at least two of the tree arteries are severely narrowed. This is not an absolute requirement, and some patients develop symptoms with single-vessel disease. The pancreaticoduodenal artery provides a vital collateral pathway between the celiac artery and the superior mesenteric artery.

300

The anatomic location where most AAA grafts fistulize 

 Common aortoenteric fistulas involve the third or fourth part of the duodenum (D3/D4).

300

Surgical treatment for patients with neurogenic thoracic outlet syndrome who fail conservative mangement.

First rib resection 

This is considered for patients that fail conservative approaches with physical therapy.  Injection of botulinum toxin is a relatively new treatment and can allow patients to get additional benefit from physical therapy and provide relief to symptoms.  This is not an initial treatment, however, and when performed, should be done under image guidance by experienced practitioners.

300

Typical dosing per kg of systemic heparin when occluding a vessel

80-100 U/kg

400

The surgical maneuver required to gain access to the infrarenal aorta

Maddox Maneuver



400

Retrograde filling of an aortic aneurysm sac by lumbar branches or by the inferior mesenteric artery

Type II endoleak (most common type)


Type II endoleak, the most common type, is characterized by retrograde filling of the aneurysm sac by lumbar branches or by the inferior mesenteric artery. 

Type I endoleak is due to failure to achieve satisfactory seal at proximal zone (type Ia) or distal zone (type Ib). 

Type III endoleak is due to failure of an individual component or of seal between components of graft system, preventing exclusion of the aneurysm sac. 

Type IV endoleak is caused by leakage through porous materials of the graft. 

Type V endoleak is due to persistent growth of the aneurysm sac without detectable leak (endotension).

400

The ideal initial location for an AV fistula creation in a left handed patient. 

Right radiocephalic fistula (cimino fistula)

400

During a first rib resection for TOS, the resident accidentally transects the phrenic nerve. This complication most likely manifest as this.

Hemi-diaphragmatic paralysis/dysfunction

400

The half-life of heparin

60-90 minutes

500

The extra-anatomic procedure to perform in a patient with occlusive aortoiliac disease who is a poor surgical candidate.

Axillo-bifemoral bypass


500

Primary treatment for a type B thoracic aortic dissection

The mainstay of medical therapy for acute type B dissection is beta blockade with short-acting agents, such as esmolol, in an ICU. 

500

Initial surgical intervention for a bleeding aortic-enteric fistula in an unstable patient.

Endovascular therapy with stent graft placement across the fistula 

This offers a bridging therapy for hemodynamically unstable patients prior to their definite procedure.

500

The syndrome associated with axillary-subclavian vein thrombosis associated with strenuous and repetitive activity of the upper extremities.

Paget-Schroetter Syndrome, refers to axillary-subclavian vein thrombosis associated with strenuous and repetitive activity of the upper extremities.

500

On the first postoperative day after endovascular repair for a ruptured abdominal aortic aneurysm, a patient develops increased abdominal pain and tenderness, as well as hematochezia. Your next step is this.

Flexible sigmoidoscopy

Colonic ischemia has been shown in up to 23% of patients after ruptured abdominal aortic aneurysm (AAA). Therefore, it is recommended that patients undergoing endovascular repair for ruptured AAA have a postoperative flexible sigmoidoscopy to assess for colonic ischemia. If a patient shows signs of possible colonic ischemia such as hemodynamic compromise, hematochezia, abdominal pain or tenderness, and/or leukocytosis, sigmoidoscopy should be performed urgently to determine the next step in management.

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