Vascular and Microvascular Surgery

What properties enable arteries to compensate for changes in blood pressure and blood volume?

Elasticity and distensibility

Identify the venous structure that prevents blood backflow

Semilunar Intimal folds

Patients with acute arterial insufficiency with occlusion usually presents with the onset of the six Ps. sudden severe pain, pulsenessless, parathesia, paralysis, pallor and poikilothermia (coolness) of an extremity. This occlusion can be the result of which condition.

Rupture of an unstable atherosclerotic plaque.

Patients with arterial disease are treated surgically more often than patients with chronic venous insufficiency (CVI) because

CVI is not life-threatening or limb-threatening

Which statement regarding risk factors for developing vascular disease is true?

Arteriosclerosis is a natural part of the aging process

While arteriosclerosis is a natural part of the aging process and occurs when the walls of the arterial vasculatureundergo changes such as increased thickness and hardening, reducing the elasticity of the arteries, certain risk factors for arteriosclerosis are modifiable by the individual. Select the dyad of modifiable risk factors that could minimize the potential for acute or chronic vascular insufficiency.

Cigarette Smoking and sedentary lifestyle.

Vascular surgery patients are at risk for impaired skin integrity and ineffective tissue perfusion related to surgical positioning, presence of vascular disease, and vascular clamping. Positioning of the patient undergoing vascular surgery is of particular importance because of restricted circulation distal to the area of arterial obstruction and a generalized state of poor circulation. An appropriate protective intervention is reflected in which true statement about patient positioning for vascular surgery.

The nurse should protect the patient's vulnerable neurovascular bundles from compression

The Doppler transducer is the most widely used instrument for vascular study. What statement regarding a Doppler is true?

water soluble gel is needed when doppler is used on intact skin.

Varicose veins are enlarged and distended veins that are visible and palpable beneath the skin. Secondary varicose veins are believed to be a result of insufficiency of the deep venous system. The primary objective of varicose vein surgery, for the patient with secondary disease, is to prevent extremity:

ulceration, secondary edema, pain, and fatigue.

For this diagnostic, three blood pressure cuffs are placed on the leg and inflated to 65mm Hg. Each cuff reading produces a waveform, which is compared with the waveforms from the other two cuffs. a reduced wave in one area may indicate reduced blood flow at that point. What is the name of a pulse volume recorder is used to measure the arterial pulse waveform during systole?

Arterial plethysmography

Surgically created arteriovenous fistula are also referred to as a(n) _________ and are indicated for enabling _________.

Arteriovenous shunt; hemodialysis

During an open exploration of above-knee popliteal artery, an incision is made into the femoral artery with a #11 knife blade and extended with Potts angulated scissors. What is the proper name of this surgical approach?

Femoral arteriotomy

Select the statement that best describes the comparative difference between open aortic aneurysm repair and endovascular aneurysm repair (EVAR).

All of the options mentioned are correct

Heparin sodium is an anticoagulant. The basic mechanism of heparin's action is best described as:

blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin.

Which drug is used to reverse, or neutralize, the effects of heparin?

Protamine sulfate

A perioperative nurse circulator is preparing the OR for a vascular procedure where heparin will be used. She has obtained the heparin from the medication dispensing system and is preparing to mix the heparin in IV saline according to the dosage on the surgeon's preference/pick-list. The surgical technologsit is preparing the sterile back table. Which expected and appropriate risk reduction strategies related to the use of heparin would the scrub person perform?

Label syringe and medicine cup with the drug name, strength, and amount.

During ________ hemodialysis, the patient's blood is shunted outside the body through an artery.

extracorporeal

An incision made in the artery is called an ________.

arteriotomy

A blood clot, air, or organic material that is free flowing in the vascular system is known as a(n) ________.

embolus

A reduction in the patient's total blood volume is called ____________.

hypovolemia

Intravenous (IV) administration of thrombin can cause a(n) ________.

fatal embolus

Names frequently associated with vascular instrumentation include DeBakey and Cooley, both of whom were cardiothoracic surgeons and pioneers of cardiothoracic and peripheral vascular surgery.

true

_____________ is administered to reverse the effects of systemic heparin.

Protamine sulfate

Ischemia of tissue may be caused by ________________________.

loss of blood to the tissue

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

A direct anastomosis between an artery and a vein is called a(n) ________.

AV fistula

A metal, umbrella-shaped filter is inserted into the ________ to prevent emboli from entering the pulmonary system.

inferior vena cava

______________ is the removal of a fatty fibrotic plaque that develops in the intimal layer of the arteries.

Endarterectomy

The medical term that means "in its normal position" is ________.

in situ

A bifurcated graft is ________________.

Y-shaped

A(n) ________ is a stationary clot in the arterial or venous system.

thrombus

The largest vein of the body is the ___________.

vena cava

The elastic nature of the arteries allows them to _____ during systole and _____ during diastole to maintain vascular pressure

contract; relax

The tunica externa (also called the _________), which is composed of connective tissue, protects the vessel from injury and provides structural strength

adventitia

Arterial plaque is identified as a thick, yellow, rubbery material that adheres to the lumen (__________ layer) of the artery.

intimal

Obstruction or stenosis of an artery commonly forms at the ________.

bifurcations

In situ saphenous vein bypass is a surgical alternative to using a ________ to bypass a diseased femoral artery

synthetic graft

Femorofemoral bypass is performed to bypass unilateral atherosclerotic disease in the ________ artery.

iliac

Abdominal aortic aneurysm is a condition in which a section of the abdominal aorta becomes ____________.

thin and bulges

Subsequent to the arteriotomy made into the common carotid artery during a carotid endarterectomy, a graft may be sutured over the arteriotomy. What is the very next step prior to closing the wound?

Check for leaks

The surgeon is performing a carotid endarterectomy and needs to elevate the plaque. Which instrument should the surgical technologist pass to the surgeon?

Freer

During a femoral-to-femoral bypass, the surgical technologist has several drugs on the back table, including Heparin, papaverine, and lidocaine with epinephrine. Which of these drugs is used to control vasospasms?

Papaverine

The patient in PACU just received a femoropopliteal bypass to restore blood flow to the blocked section of the femoral artery in the leg using a section of another blood vessel. What is used to assess the pedal pulses after the procedure?

Doppler

Which of the following anatomical structures make up the peripheral vascular system?

Arteries, veins, and lymphatic vessels

An intraoperative vasospasm can be controlled by a moistened gauze with lidocaine.

True

The _______ syringe would be appropriate for testing a Fogarty-type embolectomy catheter with a balloon volume of 1 mL or less

Tuberculin

Which of the following are used on tips of hemostats to prevent breaking of delicate monofilament suture when tagged?

Suture aid booties

The surgeon is asking for a 6-0 Prolene BV1 to close an artery, what needle holder does the Surgical Technologist place the suture on, to give the surgeon?

Castroviejo Needle Holder

The difference between a thrombus and embolus is that a thrombus is moving in the vessel

False

Knowledge of the peripheral vascular system is required of the first assistant, but not of the surgical technologist.

False