adventitia
the external covering of an organ or other structure, derived from connective tissue, especially the external covering of a blood vessel.
bifurcation
the act of splitting into two branches
capillary
smallest blood vessel; brings nutrients and oxygen to the tissues and absorbs carbon dioxide and waste products between the blood and tissue fluid in capillary beds
claudication
to limp; pain in a limb (especially the calf) while walking that subsides after rest; it is caused by inadequate blood supply (cramping pain) means to "cramp".
contralateral
pertaining to the opposite side
diastole
relaxation phase of the cardiac cycle
embolus
an abnormal particle (e.g. an air bubble or part of a clot) circulating in the blood
fogarty catheter
catheter, small in diameter and is balloon-tipped, used to facilitate the removal of an embolus
in situ
in the original or natural place or site
innominate
not named or classified
ischemia
decreased supply of oxygenated blood to a body part or organ
intima
innermost layer of a blood vessel, endothelial lining of the vessel along with underlying layer of connective tissue containing variable amounts of elastic fibers.
mitigate
To make less severe
morbidity
illness or disease
mortality
related to death
occlusion
closure or blockage (as of a blood vessel)
papaverine
Vasodilator relaxes smooth muscle in arterial wall stops vasospasm
patency
the state of being open
phrenic
pertaining to the diaphragm
pledget
small square of Teflon sutured over a hole in a vessel, it exerts external pressure over any small needle holes to prevent bleeding and to promote clotting
plethysmography
determining the change in volume of an organ or part; used in the diagnosis of deep vein thrombosis
sinus
dilated channel for venous blood
thrombus
a blood clot formed within a blood vessel and remaining attached to its place of origin
valve
flap of connective tissue between an atrium and a ventricle, or in a vein, that prevents backflow of blood
tunica interma
Inner most layer, Simple Squamous Epithelium
tunica media
middle layer of artery; made up of smooth muscle fibers and thick layer of elastic connective tissue
tunica externa
outermost layer, connective tissue, tough collagen fibers, protects the blood vessels, thickest layer in veins
external carotid artery
the branch of the carotid artery that supplies blood to the face and tongue and external parts of the head
internal carotid artery
the branch of the carotid artery that supplies blood to the brain and eyes and internal parts of the head
vasodilaton
open;increase blood flow brings heat close to the body.
vasoconstrition
is the decrease in the diameter of a vessel
blood pressure
measurement of the force exerted by the heart against the arterial walls when the heart contracts and relaxes
3 factors that affect arterial blood pressure
pumping action of the heart; blood volume; resistance to flow/thickness of the blood
types of emboli
thromboemboli (95%)fat (post femur fx)air (IV cath insertion)amniotic fluid
Ca mets septic emboli (endocarditis)foreign body (additives in IV drugs)
treatment for embolism
enzymatic lysis; anticoagulants Heparin; surgery
fusiform
type of true aneurysms that are circumfenetial: spindle shaped, thick in the middle and tapers at ends
cause of TIA
Embolism
inflammation of a vein
phlebitis
plaque
deposits of cholesterol, calcium, and fat that build up on artery walls and can lead to cardiovascular disease
symptoms of TIA
contralateral hand/arm weakness or sensory loss, face and leg symptoms. Ocularly, can have ipsilateral visual symptoms (amaurosis fugax) or aphasia
intraluminal stent
placed in a vessel after angioplasty to maintain patancy. (palmaz stent) made of stainless steel mesh, titanium, or poly propylene
Arterial blood refers to
blood that is transported AWAY from the heart to the tissues of the body
veins are equipped with
valves that close if blood begins to back up
arterial blood pressure is dependent on
blood volume
Ventricular contraction
Systolic blood pressure is recorded during what?
Stroke volume is correlated with the force of ____________ _____________.
Ventricular contraction
stroke volume
the amount of blood pumped by the left ventricle in each contraction
blood will not circulate
without a pressure gradient between the arterial and venous system
arterial blood pressure is dependent on
blood volume; ventricular contraction; resistance; viscosity/thickness; heart rate
directly affects resistance
viscosity/thickness
central venous pressure (CVP)
Venous blood pressure within the right atrium
aorta
largest artery in the body
right and left coronary arteries
directly supply the myocardium with oxygenated blood
begins at the ascending aorta
Aorta
three major arteries arise from the aortic arch
brachial sephalic; left common carotid; left subclavian
brachial sephalic or innominate artery
supplies the arm and head
bifurcates into the right subclavian and right carotid
brachial sephalic
supplies the right arm
right subclavian
supplies brain and right side of head and neck
right carotid
supplies brain and left side of head and neck
left common carotid
supplies left arm
left subclavian
abdominal aorta
branches to supply the abdominal wall and abdominal viscera
celiac artery
an artery that originates from the abdominal aorta just below the diaphragm and branches into the gastric artery the common hepatic artery and the splenic artery
splenic artery
largest and most obvious branch of the celiac artery, leads to the spleen.
3 main branches of splenic artery
left gastroepiploic; pancreatic; polar
left gastroepiploic artery
supplies lesser curvature of the stomach and esophagus
pancreatic artery
a branch of the splenic artery that supplies the pancreas
polar artery
supplies the spleen
common hepatic artery
artery which runs superiorly and branches off to hepatic artery proper; gastroduodinal; right gastric
hepatic artery proper
Superior to liver; divides into the right and left hepatic arteries supplies the liver and gall bladder
gastroduodinal artery
supplies the stomach, body of pancreas and duodenum
gastric artery
Division of coeliac artery that delivers blood to stomach
super renal artery
supplies the adrenal gland
renal gland
supply the kidneys and a small portion of the adrenal gland
lumbar arteries
supply the spinal cord and its meninges as well as the skin and muscles of the lumbar region of the back
the abdominal aorta bifurcates into the left and right
common iliac arteries at the level of the fourth lumbar vertebra
common iliac arteries
divides inferiorly into 2 main branches right and left: internal iliac and external iliac
right and left iliac arteries become
the femoral arteries as they exit the pelvis and cross the inguinal ligament
upper extremity arterial blood begins at
the aortic arch where the left subclavian artery originates
right subclavian artery branches from
the brachiocephalic artery and becomes the axillary arteries as it enters the axillary region
common carotid bifurcates into
external carotid and internal carotid
external carotid
supplies structures in the neck and head area external to the skull
internal carotid
supply blood to the brain
circle willis
A structure at the base of the brain that is formed by the joining of the carotid and basilar arteries.
the majority of abdominal aortic aneurysms begin
below the renal arteries
arteriovenous (AV) fistula is preferred over an external shunt for long term dialysis because of a decreased chance of
thrombosis
fatty deposits on the walls of arteries are called
atherosclerosis
the rupturing of erythrocytes is called
hemolysis
the self retianing retractor used during femoral popliteal bypass is
weitlaner
a diagnostic test that examines blood flow and metabolic functions of the heart and brain is
positron emission tomography
what procedure is performed for chronic cerebral ischemia
carotid endarterectomy
the movement of blood through a vessel can be assessed by
doppler device
the agent used to flush an artery to prevent clotting is
heparin
a vascular clamp used for occluding peripheral vessels is
bulldog
the instrument commonly used to clamp the aorta during an abdominal aneurysmectomy is
satinsky
the instrument commonly used to remove plaque from the carotid during an endarterectomy is a/an
freer elevator
which synthetic material used for grafts requires preclotting?
Dacron knit polyester
the commonly used suze of suture for peripheral vasculat anastomosis of the popliteal artery is
5-0
the scissors commonly used to extend the arteriotomy during an endarterectomy is a/an
potts-smith
right and left internal jugular vein
drains the brain and the menninges as well as the deep regions of the face and neck
cephalic and basilica veins
drains the superficial tissues of the upper extremeties
basilica vein merges with the
brachial vein just below the head of the humerus to form the axillary vein
intercostals and subcostal veins
drains the muscles of the thoracic wall
inferior vena cava DOES NOT drain the veins of the
spleen, pancreas, gastrointiestinal tract, or gallbladder
hepatic portal vein
drains the spleen, pancreas, gastrointestinal tract, or gallbladder
nutrients from digestion are filtered through the
liver cells
anterior and posterior tibial veins
drains from the deep veins of the foot
lower extremities divide into 2 groups the:
superficial and deep
greatest saphenous vein
longest vein in the body
the primary indicator of occlusive vascular disease
claudication
the 4 p's of complete occlusion of a large normal artery due to an embolism
painful, parasethic, pale, pulseless
arterial embolism may consist of
blood clot, piece of fat, air
major emboli lodge at
bifurcations, origin of large branches, sites of pathologic narrowing
nonoperative therapy for unstable patients
high doses of anticoagulant and enzymatic lysis
arterial embolectomy
balloon tipped fogarty catheter with heparinized saline
arteriosclerosis obliterans
generalized disease affecting the arterial system and involves the fromation of atheroma within the lumen of an artery that restricts blood flow to target tissue
urokinase and streptokinase
types of enzymatic lysis
recommended treatment of aneurysms of the abdominal aorta
resection with synthetic graft placement
balloon dilation of the peripheral artery is an option for patients with
artherosclerotic disease known as percutaneous transluminal angioplasty
most common approach for peripheral vessel angioplasty is through
the ipsilateral femoral artery
may be placed within the vessel after balloon angioplasty to maintain patency of the repair
intraluminal stents
stents may be made of
stainless steel mesh, titanium, polypropylene, other inert materials
two basic reconstructive procedures utilized
bypass grafting and endarterectomy
synthetic grafts made of
knitted polyester, knitted velour (Dacron), Woven polyester (Dacron), polytetraflouroethylene (PTFE)
can be taken across the knee joint without kinking
Polytetraflouroethylene (PTFE)
the only artery in the body that carries unoxygenated blood is the
pulmonary artery
the pacemaker of the heart is the
SA node
which arteries are formed by the bifuracation of the abdominal aorta?
Iliac
the process by which blood cells are formed is known as
hemopoiesis
which of the following arises from the left ventricle
aorta
the pancreas lies behind the sotmach and duodenum in the right and left upper quadrants and is divided into _________protions
three
which organ is responsible for the synthesis of many of the coagulation factors
liver
the atrioventricular (AV) valve between teh left atrium and the left ventricle is the
bicuspid
the inner layer of an artery is known as the
intima
which of the following vessels arises from the right ventricle
pulmonary artery
which of the following vessels do not empty into the right atrium
pulmonary veirns
the large artery found behind the knee is the
popliteal
the large artery that arises from the left side of the aortic arch and descends into the arm is the
subclavian
knitted polyester (Dacron) requires_____________to keep blood from seeping through
preclotting
knitted polyester (Dacron) functions well above the
but may kink across the knee joint
knitted polyester (Dacron) is _______________for rapid tissue growth
porous
intraoperative monitoring uses an Art line in the ___________
radial artery
swan ganz measures
CVP
self retaining retractor of choice for superficial peripheral vascular procedures
Weitlaner
Dietrich coronary set includes____________________
____________________;_____________________;______________________;___________________
vascular dilators;bulldogs;CV forceps;potts coronary scissors;vascualr clamps
are used for most anastomosis
castroviejo needle holder and Debakey forceps
suture boots to tag suture
rubber shods
retract blood vessels
vessel loops or Dacron tape
pledgets
reinforce anastomosis
needles most commonly used for vascular anastomosis
taper needle
femoral guages for peripheral anastomsis
5-0 or 6-0
common carotid guages for peripheral anastomsis
6-0
used for anastomisis and to close arteriotomies
polypropylene (prolene)
intra arterial irrigation
sodium heparin in sodium chloride
for suppression of arterial vasospasm
papverine
hemostatic agents
gelfoan; surgicel. avitene
arteriotomy
used for multiple peripheral vascular procedures
heperanize patient;clamp proximal;clamp distal;incise vessel with #11 blade on # 7 handle;extended with angeled______________
arteriotomy; potts scissors
____________ procedure preps from_________ and down to and including the _____________
aortofemoral bypass; axillary; feet
should be readily available for the patient
blood
to moisten surgeons hand before he ties prolene suture
saline
aortofemoral bypass incision
anterior abdominal and incisions over bilateral groin
prep for femoropopliteal bypass
mid abdominal to toes with leg prepped circumfencially
common femoral artery is clamped with ______________ angled vascular clamp in teh femoropopliteal bypass
DeBakey
a__________________ __________________is placed between the two femoral arteries for patients with unilateral iliac arterial occlusion
subcutaneous graft
primary indication for carotid endarterectomy
transient cerebral ischemia
TIA or transient ischemic attacks
forerunners to a permanent stroke
allows blood flow to the brain while the carotid is clamped
javid shunt
common carotid suture
6-0
vascualr clamps are removed from the______________,____________ and ___________ carotid arteries in that order
common; external; internal
vascular clamps are applied first to the __________________then to the ____________ and lastly to the _____________________ in that order
internal carotid; external carotid; common carotid
Tunica
the wall of an artery consists of three layers called...
Arterial blood is pumped by the heart through a large system of blood vessels called ...
Arteries
Arterial blood refers to...
blood that is transported "away" from the heart to the tissues of the body.
Capillaries
microscopic vessels designed to exchange nutriends and wastes between the blood and tissue fluid around the cells (capillary beds).
Capillaries unite to form...
venules. (smallest of veins.
Venules unite to form...
progressively larger blood vessels called veins, which eventually become the superior and inferior vena cava, largest of veins.
Largest veins are...
superior and inferior vena cava
Blood Pressure is the force that blood exerts against the...
internal walls of bood vessels.
Venous blood pressure is..
lower than arterial pressure.
Venous blood pressure within the right atrium is referred to as...
Central venous pressure (CVP)
The coronary arteries directly supply the...
myocardium with oxygenated blood.
Three major arteries emerge from the aortic arch:
brachiocephalic artery (a.k.a. innominate artery, the left common carotid arter, and the left subclavian artery.
brachiocephalic artery supplies...
the blood to the tissues of the arm and head, the 1st branch of aortic arch, veering to the right.
Which is the unpaired vessel arising anteriorly from the abdominal aorta, just above the bifurcation of the aorta?
Inferior mesenteric artery.
Common carotid artery ..
bifurcates into the internal and external carotid arteries at the superior border of the larynx.
External carotid artery supplies..
structures in the neck and head area external to the skull. Main branches include superior thyroid artery (serves the hyoid muscles, larynx, vocal cords, & thyroid gland) ascending phryngeal artery, lingual artery (which supplies the tongue & sublingual s
Internal carotid artery and vertebral arteries supply...
blood to the brain. It enters the base of the skull through carotid canal of the temporal bone.
Arterial Embolism -
sudden loss of circulation to an extremity. Addition to blood clots, it may consist of fat, air, or even portions of tumor that circulate through cardiovascular system until lodged in smaller vessels, blocking blood flow to extremity or organ.
Diagnostic procedures & tests for evaluation of peripheral vascular disease include:
plethysmography (diffuse sm. vessel arterial disease), DOPPLER Probe (measurement of blood flow to particular artery), Computer Axial Tomography (magnetic resonance imaging, & ultrasonography for detection of & evaluation of carotid artery atherosclerosis
Non operative therapy is the best option for...
unstable patients of arterial embolisms. (HEPARIN-anticoagulant/blood thinner) allows patient's own fibrinolytic system to lyse the occluding clot.
Surgical intervention for the removal of emboli (arterial embolectomy) involves an incision (#11 blade to punction vein with) made into the affected artery for removal of thromboembolitic material and restoration of flow to the extremity.
Arteriotomy - facilitates the removal of the embolus and the insertion of a ballon-tipped fogarty (embolectomy)catheter is done.
Aneurysms of the Abdominal Aorta
Triple AAA - asymptomatic patients are diagnosed. they are generally fusiform. majority arise below the origin of the renal arteries & terminate at the bifurcation of the aorta or common iliac arteries.
Peripheral Vessel Angioplasty
baloon dilation of the peripheral artery (percuaneous transluminal angioplasty) for patients who are symptomatic atherosclerotic disease.
Procedural steps for Peripheral artery angioplasty...
1.-femoral artery is punctured w/ arterial needle/cannula assembly & needle/obturator is removed.
2. - guidewire introduced through cannula into femoral artery.
3. - ballon-tipped angioplasty catheter is threaded over guidwire & positioned across peripher
Drugs handled by STSR during peripheral vascular procedure include:...
*
Papaverine-for the suppression of arterial vasospasm.
**
**sodium heparin in sodium chloride for intra-arterial irrigation.
**lidocaine-with or w/o epinepherine for local procedures or post. op anesthetic.
**antibiotic of surgeon's choice in sodium chlo
Counteraction for heparine or Antagonist (reverses) is
Prodimine sulfate.
Aortofemoral Bypass
Arterial obstructions due to atherosclerosis occurs most frequently in the aortoiliac segment of the arterial system.
Procedures Aortofemoral bypass (important highlights)
Supplies: heparin, antibiotic irrigation, contrast solution.Vessel loops and/or umbilical tape, Gelfoam, Fogarty clamp inserts. Practical considerations: surgeon's hands should be moistened w/saline from an Asepto before tying Prolene Sutures, patient hep
Procedures Aortofemoral bypass (important highlights
If aorta is friable, Teflon=coated Pledgets may be used with suture to reinforce the anastomosis. this prevents tears in tissue vessels during suturing.
To presoak a graft?
soak it in patient's blood.
Abodominal Aortic Aneurysmectomy
Aneurysms are weakened areas in an arterial wall. an aortic aneurysms are a threat to life due to the size of the vessel. an elective alternative is to resect-aneurysmectomy.
Aorta-
largest Artery
Abdominal Aortic Aneurysmectomy Procedure
Supplies: Suture is 4-0, 5-0, 6-0 Prolene, 2-0, 3-0 silk ties, 18-32in. 2-0, 3-0 silk stick ties. Vessel loops and/or umbilical tape (used to retract blood vessels - leave in saline because it is handed wet to surgeon., General anesthesia, Supine Position
In Abdominal Aortic Aneurysmectomy Procedures...
Only certain amount of blood can be squeezed out of lap sponges to reuse in cell saver. However, no heparine can be present in reused blood.
In Abdominal Aortic Aneurysmectomy Procedures
an aortic vascular clamp is carefully applied to the aorta above the aneurysm.
Femoropopliteal Bypass-
the material of choice remained the autogenous saphenous vein, eventhough obstruction is in distal portion of the femoral artery can be adequately bypassed with synthetic graft material. Valvutone is used to take care of valves.
General anesthesia, affect
Femoropopliteal Bypass Procedure
General Anesthesia, Prep: midabdomen to toes is prepped w/ leg prepped circumferentially. surgeon's hands moistened w/saline from asepto before tying prolene sutures, 1st incision made over distal portion of popliteal artery, extending from post. border o
When Arteriotomy performed...
anterolateral portion of common femoral artery, & saphenous vein is anastomosed in an end to side fashion w/ continuous 6-0 Prolene suture.
Arteriotomy set up... to open up Arteries:
Mayo Stand-
1. #11 Blade
2. Pot Scissors
3. Pick Up's (Gerard's) for fine vascular procedures
4. Free elevator
Carotid Endarterectomy-
Main indication for carotid endarterectomy is transient cerebral ischemia. small pieces of plaque break away from common carotid or internal coratid artery and are flushed upstream to lodge in small cerebral vessels, temporarily blocking blood flow to tha
Carotid Endarterectomy- procedures
Positioning - supine w/head turned approximately 45 degrees to the unaffected side. General or regional cervical bloc.
Carotid Endarterectomy- procedures Pearl of Wisdom:
Typical sequence in all endarterectomies after vessel exposure is achieved: Pattern as follows in peripheral vascular surgery.
1. vessel is dissected free from surrounding tissues.
2. right angle clamp placed underneath vessel & opened.
3. *
vessel loops