Chapter 32 Peripheral Vascular Surgery

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Aneurysm

Ballooning of an artery as a result of weakening of the arterial wall. It may be caused by atherosclerosis, infection, or a hereditary defect in the vascular system.

Angioplasty

Dilation of an artery using endovascular techniques - - an arterial catheter --- may include insertion of a supportive stent inside the artery to maintain blood flow.

Arteriosclerosis

A disease characterized by thickening hardening, and loss of elasticity of the arterial wall.

Arteriotomy

An incision made in an artery, usually to perform an anastomosis with a graft or another artery or to remove plaque or a thrombus.

Atherosclerosis

The most common form of arteriosclerosis, which causes plaque to form on the inner surface of an artery.

Bifurcation

The Y shape of an artery or graft.

Doppler duplex ultrasonography

A type of ultrasonography that amplifies sounds that pass through tissue and produces a visual image of blood flow.

Embolus

A moving substance in the vascular system. An embolus may consist of air, a blood clot, atherosclerotic plaque, or fat.

Endarterectomy

The surgical removal of plaque from inside an artery

Hemodialysis

A process in which blood is shunted out of the body ad passed through a complex of set of filters for treatment of end stage renal disease---sometimes poisoning --- also called renal replacement therapy.

Hemodynamic

A term referring to the pressure, flow, and resistance in the cardiovascular system.

Infarction

A blockage in an artery that may lead to ischemia and tissue death.

In situ

A term meaning "in the natural position or normal place, without disturbing or invading surrounding tissues".

Intravascular ultrasound

A diagnostic tool in which a transducer is introduced into an artery and ultrasound is used to translate the physical characteristics of the lumen into a visible image.

Ischemia

The decrease in or absence of blood supply to a localized area, usually related to vascular obstruction.

Lumen

The inside of a hollow structure, such as a blood vessel.

Percutaneous

A term that literally means "through the skin." In a percutaneous approach in surgery, an incision is not made,; rather, a catheter or other device is introduced through a puncture site.

Stent

A tubular device placed inside an artery for dilation, support, and prevention of stricture.

Thrombus

Any organic or non-organic material blocking an artery; generally refers to a blood clot or atherosclerotic plaque but also includes fat or air.

Umbilical tapes

Lengths of cotton mesh tape used to loop around a blood vessel for retraction. See vessel loop

Venous stasis

Pooling of blood in the veins caused by inactivity or disease. Stasis can cause distention of the veins.

Vessel loop

A device used to retract a vessel during surgery. A length of thin Silastic tubing or cottom tape --- umbilical ape -- is passed around the vessel. The ends can be threaded through a bolster 1/8 to 1/4 inch or 0.3 to 0.6 cm length of rubber Silastic tubing - - - - to secure the loop against the blood vessel.

Three layers of blood vessels

tunica externa, tunica media, tunica intima

Tunica externa

also called adventitia is composed of connective tissue and protects the vessel and provides structural strength.

Tunica media

is composed of inner layers of smooth muscle that is bounded by connective tissue. Autonomic

Smooth muscle is under the control

of the autonomic nervous system.

Tunica intima

secretes substances that cause vasodilation or constriction and prevents platelet aggregation .

Arteries carry oxygenated blood

away from the heart.

Exception to the arteries is the

pulmonary arteries which carry deoxygenated blood to the lungs.

Arterioles provide

vascular resistance, regulating the flow of blood into organs and tissue.

Systole

ventricular contraction

Diastole

resting phase of the heart.

The capillaries are microscopic vessels

that as function as the transition and exchange mechanism for oxygen and other substances between the vessel walls and the tissue cells. No muscle fibers. One cell thick.

Veins that dilate abnormally is called

varicosity.

Systemic circulation

Oxygenated blood in the LEFT VENTRICLE is pumped through the ascending aorta to the rest of the body. Blood returning from the body passes from the capillaries into the venous system and returns to the LEFT ATRIUM through the vena cava.

Pulmonary circulation

Deoxygenated blood in the right ventricle is pumped through the pulmonary arteries -- THE ONLY ARTERIES THAT CARRY DEOXYGENATED BLOOD --- to the lungs. Blood is oxygenated in the capillaries of the alveoli -- lungs --- and returns to the left ventricle through the pulmonary veins -- THE ONLY VEINS THAT CARRY OXYGENATED BLOOD.

Renin-angiotensin-aldosterone system

is the hormonal regulation of arterial pressure that is influenced by fluid fluid volume and other facts.

Hypotension

is a negative alteration in blood pressure.

Hypertension

is high blood pressure that is typically caused by cardiovascular disease such as arteriosclerosis. also occurs with chronic renal failure.

Diurnal

having a daily cycle or occurring every day.

Elasticity of the arterial walls

The ability of the artery to expand and relax. Arteries stiffen with with atherosclerosis resulting in hypertension.

Peripheral vascular resistance

Vascular resistance occurs when the muscular layer of the artery is unable to relax or arteries are stiff with a reduced diameter.

Blood viscosity is measured by

the amount of fluid in the blood. Lower viscosity means thicker blood means increased blood pressure.

The aorta

is the largest artery. Starts at the left ventricle. Descends through thoracic cavity. Passes behind the heart but in front of the spinal column. Enters abdomen passes through diaphragm behind the retroperitoneum space. Aorta bifurcates in the pelvic. Turns into the iliac arteries.

Thoracic cavity

Thoracic cavity. Starts from the left ventricle to form an arch - the aortic arch. Three major arteries come from this arch - - brachiocephalic artery, left common carotid artery, left subclavian artery. Still called the descending aorta at this point. Only when it crosses into the abdomen is called an abdominal aorta.

Head artery information is

when the brachiocephalic artery becomes the right carotid artery then branches into the external carotid artery.

Iliac arteries divide into

the internal and external iliac arteries in the pelvis with the external iliac artery converging into the femoral artery in the groin.

The largest vein in the body is the

vena cava.

Vena cava is divided into two parts:

inferior and superior segments.

Claudication

is severe pain related to the obstructed arterial flow.

A reduction in

the patient's total blood volume is called hypovolemia.

Ischemia of tissue may

be caused by loss of blood of tissue.

The medical term that means

"in its normal position" is in situ.

Arthrosclerosis is a disease

related to elevated cholesterolemia.

Lymphatics occur in groups or chains

and produces lymphocytes.

Lymphatice are

composed of ducts.

The following anatomical structures make up the

peripheral vascular system. Arteries, veins, and capillary networks. Tunica externa, tunica media, and tunica ibntima.

The tunica externa is also called adventitia. It is is

composed of connective tissue. Protects the vessel from injury and provides structural strength.

Vasodilating medications act on

the Tunica intima.

The elastic nature of the arteries allows them

to contract during systole and relax during diastole to maintain vascular pressure.

Remember that arteries are

thick walled and highly elastic.

Arteries carry oxygenated blood

from tghe heart.

The common carotid

is an artery.

Veins carry blood

back to the heart.

The largest vein of

the body is the vena cava.

The greater saphenous vein

is surgically removed to provide an autograft for peripheral or coronary artery bypass.

The greater saphenous vein is used for arterial bypass

surgery. The greater saphenous vie is readily accessible, and its connective tissue layer thickens with increased pressure. This makes it strong and able to withstand higher arterial pressure and has adequate length.

Veins carries nutrients from

the digestive system into the liver.

The inferior vena cava is a

vein.

Pulse volume recording is

arterial plethysmography that requires three blood pressure cuff readings.

Obstruction or stenosis of an artery commonly forms

at the bifurcation's.

A bifurcated graft is what shape?

Y shape

Embolectomy catheter is used in both

peripheral and coronary surgery to map the lumen of a vesse.

The tuberculin shrine would be

appropriate for testing a Fogarty type embolectomy catheter with a balloon volume of 1 mL or less.

Protamine sulfate is administered to reverse

the effects of systemic heparin.

Intravenous IV administration

of thrombin can cause a fatal embolus.

An intraoperative vasospasm can be

controlled by injections of lidocaine.

The most common form of arteriosclerosis is

Atherosclerosis.

The surgical removal of atherosclerotic plaque

from inside an artery is endarterectomy.

Arterial plaque is identified as a thick

yellow rubbery material that adheres to the lumen --- intimal layer --- of the artery.

During endarterectomy the use of a vascular

shunt may be used.

The injection of contrast media into a selected

artery and its branches to determine the exact location of strictures occlusion, or malformation is called angiography.

Trans-luminal angioplasty is the insertion

is the insertion of an arterial catheter or stent into an artery to establish patency and normal blood flow.

Angioplasty is performed

during angiography.

A process of remodeling the lumen of

blood vessel is an angioplasty.

Angioplasty may use a

stent.

A metal umbrella shaped filter is inserted into

the Vena cava to prevent emboli from entering the pulmonary system.

A direct anastomosis between

an artery and a vein is called an AV fistula.

A thrombus is a stationary

clot in the arterial or venous system.

Endarterectomy is the

removal of fatty fibrotic plaque that develops in thge intima layer of the arteries.

An incision is made in the artery is

called an arteriotomy.

An arteriotomy is made with

a #11 scalpel blade.

Closed with non-absorbable

vascular suture for a arteriotomy.

There should be

1 percent lidocaine available in the surgical field.

After a carotid endarterectomy

the arteriotomy is closed. The clamps are taken off the internal, external and common carotid arteries in that order.

Abdominal aortic aneurysm is a condition in which a section of the abdominal aorta becomes thing and

bulges.

Abdominal aortic aneurysms typically occur

just below the renal arteries and extend to the bifurcation of the common iliac arteries or just above it.

Femorofemoral bypass is

performed to bypass unilateral atherosclerotic disease in the iliac artery.

In situ saphenous vein bypass is a

surgical alternative to using a synthetic graft to bypass a diseased femoral artery.

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