Great Saphenous Veins are used for: (3)

CABG
Fem-Pop / Tib-Fib bypass

CABG

Coronary Artery Bypass Graft

What does atretic mean? What is another word meaning the same thing?

closed / absent
Atresia

Anastomosis

Location where graft connects with artery/vein

Arteriovenous Fistula (AVF)

pre-capillary shunt between artery & vein

What is Intimal Hyperplasia and the problem with it?

Rapid growth of vein wall
can compromise vein/graft lumen

Seroma

pocket of clear fluid found next to bypass/surgery site

A percutaneous transluminal angioplasty is inserted.... and is what?

through the skin;
local dilation of artery/stenosis w/ an inflatable catheter

Two veins carefully evaluated pre-op for hemodialysis access placement

cephalic & basilic

Two arteries that could be used for CABG

Radial or ulnar

Saphenous vein mapping:
-Procedure 1: Determines Vein ______
-Procedure 2: ______ and ______ the course of the saphenous or superficial arm veins
-Procedure 3: determines suitability of ______ artery for CABG

-Suitability
-Mapping & Marking
-Radial

Bypass Grafts:
Make sure saphenous vein is ______ and ______.
Does it continue ______ the leg?
Is it a ______ system?
Does it contain residual ______?
Is it the right ______?

present & patent
Through
Double
Thrombus
size

Perforator veins are hard to see if they're normal. Abnormal ones are easily seen and most are >____ mm and in which group?

3.5
Cockett's

(Procedure 1)
When determining suitability, pt is in ______ position and you rule out ______. Its bad to remove the GSV if it is a ______.

Semi-fowler's; DVT; collateral

To determine vein size use ___-___MHz transducer, ID GSV at ______ and continue following it

7-14; SFJ

Evaluate ______ GSV if the ipsilateral GSV is <____ mm because it is...

contralateral; 2; too small

When arterialized vein diameter expands ___-___ times.
Veins >___ mm have higher patency rates

1.5-2
2.5

When mapping GSV move how far after last mark for the next one?

about 2 inches

CABG:
Radial artery advantages over Saphenous vein
-Appropriate vessel ______
-______ walls
-Less ______
-Better ______

-Caliber
-thicker
-hyperplasia
-availability (not everyone has good GSV)

Radial Artery Harvest Issues:
-______ digits
-______ syndrome
-Ipsilateral ___-___ disease in arm
-Stenosed, occluded, or ______ radial artery
-Incomplete ___ ___ in hand

-Ischemic
-Raynaud's
-athero-occlusive
-atretic
-palmar arch

Pre-op RA Harvest:
-Bilateral ______ pressures to rule out subclavian disease.
-Look for arterial ______, ______, ______ and _____ walls

-Brachial
-Stenosis, occlusion, atresia, calcified

Avg inner diameter of RA:
Men=
Women=

2.8mm
2.4mm

______ ______ patency essential for RA harvest

palmar arch

Allen test includes compressing the radial and ulnar arteries then...

releasing one artery at a time

Palmar Arch test:
PPGs placed on ______ or ______ and the ______ digit

thumb/index; 5th

Palmar Arch test:
Gain adjusted to make ______ amplitude between digits using ______ sweep speed.
There should be little/no ______ in PPG amplitudes

similar; low
drop

Palmar Arch test:
When compressing RA and UA at the same time, they should both ______.
When compressed separately they should ______ flatline

flatline; not

Palmar Arch Test:
If RA compressed and flatlines, what dominance is it?
Can you harvest it?

Radial artery; no

Palmar arch test:
W/ UA compression, if little to no change there is adequate ______ perfusion

RA

Types of Autogenous vein bypass grafts of lower extremities (2)

reversed / in situ

3 interventional procedures on lower extremities when stenosis/occlusion is present:

-Bypass grafts
-percutaneous angioplasty
-stents

aorto-bifemoral graft travels from

dist ao to dist iliac/CFA

Fem to Fem jump graft bypasses....
This means...

One iliac artery stenosis/occlusion
One iliac supplies both legs

Axillo-Femoral graft travels from....
It bypasses...

Axillary artery to Distal EIA/CFA
Severe aorto iliac disease

Ax Fem grafts used in conjunction w/

fem-fem jump graft

W/ Aorto-fem grafts, technical problems, graft failure, and infection is most likely to occur at ______ sites and should be given careful attention

anastomotic

Infrainguinal:
Synthetic Polytetrafluoroethylene (PTFE) graft, bypasses

CFA to dist SFA or prox Pop

Newer PTFE graft material allows placement to extend

below the knee

PTFE graft material may appear

double walled

Below the inguinal ligament, the synthetic Dacron allows

fem to distal

Above groin, synthetic dacron is also used for

fem-fem & iliac grafts

Below inguinal, autogenous vein graft used in situ and bypasses....
It often extends from...

fem-pop
CFA to dist tib

A vein or synthetic has better patency rates

vein

W/ in situ graft, GSV is used in its ______ bed. ______ leaflets are excised with ______

Native; valve; valvulatome

In Situ graft lies ______ in prox but is ______ at distal anastomosis

superficial; deeper

______ and ______ are ligated with in situ graft. Prox and Dist ends of vein are connected to ______

Perforators & tributaries
Artery

In Situ Vein graft:
Prox anast may be at what 3 sites?
Which site is most common

CFA -- most common
PFA
SFA

In Situ Vein Graft:
May extend to dist...(2)
Which is less common?

PTA
ATA -- less common

Non ligated larger perforator w/ in situ can cause

AV Fistula