Cardiothoracic and Vascular Surgery Review

Comprehensive vocabulary flashcards covering arterial, venous, lymphatic, and thoracic disorders based on surgical review notes.

Acute Peripheral Arterial Occlusion (The 5 Ps)

The classic constellation of clinical findings indicating acute limb ischemia: Pain, Pallor, Pulselessness, Paralysis, and Paresthesia (or anesthesia), often accompanied by a 6th P: Poikilothermia (perishing cold).

Leriche Syndrome

A condition caused by atherosclerotic occlusive disease at the aortic bifurcation, characterized by the clinical triad of bilateral buttock or thigh claudication, erectile dysfunction (impotence), and absent or diminished femoral and distal pulses.

Boyd Classification of Intermittent Claudication

A clinical staging system for claudication: Grade 1 (pain starts during walking but disappears as metabolites wash away), Grade 2 (pain continues but walking is possible with effort), Grade 3 (pain compels rest), and Grade 4 (ischemic rest pain).

Fogarty Balloon Catheter

A specialized balloon-tipped catheter passed proximally and distally through an arteriotomy to extract thrombi and emboli from an occluded blood vessel during embolectomy.

Buerger's Disease (Thromboangiitis Obliterans)

A non-atherosclerotic, segmental acute and chronic inflammatory panvasculitis affecting small- and medium-sized arteries, neighboring veins, and nerves in the extremities, classically seen in young male smokers aged $<40$ years.

Ankle-Brachial Index (ABI)

The ratio of systolic blood pressure measured at the ankle to that at the brachial artery; values between $1.0$ and $1.2$ are normal, $0.5-0.9$ indicate intermittent claudication, and $<0.5$ (or $0.1-0.4$) represent critical limb ischemia.

Fontaine Classification

A four-stage clinical categorization of peripheral artery disease: Stage I (asymptomatic), Stage IIa (mild claudication), Stage IIb (moderate-to-severe claudication), Stage III (ischemic rest pain), and Stage IV (ulceration or gangrene).

Nicoladoni-Branham Sign

A clinical sign of an arteriovenous fistula where digital manual compression of the artery proximal to the fistula leads to shrinkage of the vascular swelling, cessation of the bruit/thrill, reflex bradycardia, and normalization of pulse pressure.

Adson's Test

A provocative clinical test for thoracic outlet syndrome performed by having the seated patient take a deep breath, extend the neck, and turn the head toward the ipsilateral side; diminution or disappearance of the radial pulse signifies compression.

Raynaud's Phenomenon

An episodic, reversible digital vasospastic response triggered by cold or emotional stress characterized by a sequential triphasic color change: digital pallor/blanching (ischemia/syncope), cyanosis (asphyxia), and rubor (reactive hyperemia).

DeBakey Classification of Aortic Dissection

An anatomic classification of aortic dissection: Type I originates in the ascending aorta and extends distally into the descending aorta; Type II is confined strictly to the ascending aorta; Type III originates in the descending aorta with distal propagation.

Stanford Classification of Aortic Dissection

A clinical staging system dividing dissections into Type A (involving the ascending aorta, regardless of the site of entry tear) and Type B (limited to the descending aorta distal to the left subclavian artery).

Mycotic Aneurysm

An infected false aneurysm resulting from focal destruction of the arterial wall by circulating blood-borne organisms (intravascular, e.g., infective endocarditis) or adjacent suppurative processes (extravascular), most commonly caused by Staphylococcus and Salmonella.

Arteria Radicularis Magna (Artery of Adamkiewicz)

The major feeding segmental tributary to the anterior spinal artery in the lower thoracic and upper lumbar regions; intraoperative interruption during thoracoabdominal aortic repair carries a high risk of spinal cord ischemia and paraplegia.

Subclavian Steal Syndrome

A hemodynamic disorder in which severe stenosis or occlusion of the proximal first part of the subclavian artery causes reversal of blood flow through the ipsilateral vertebral artery, siphoning cerebral circulation to supply the exercising ipsilateral arm.

Mattox Maneuver

A surgical approach involving left medial visceral rotation to mobilize the left colon, left kidney, spleen, and pancreas to the midline, providing full exposure of the suprarenal and infrapancreatic abdominal aorta and celiac axis.

Takayasu's Arteritis

A chronic granulomatous panarteritis predominantly affecting young Asian females ($10-40$ years of age) that targets the aorta and its major branches (most commonly the subclavian artery), culminating in lumen stenosis, thrombosis, and loss of peripheral pulses ('pulseless disease').

Virchow's Triad

The three primary pathophysiologic determinants predisposing to intravascular thrombus formation: endothelial/vessel wall injury, stasis or turbulence of blood flow, and hypercoagulability of blood.

Phlegmasia Cerulea Dolens

A severe form of deep vein thrombosis characterized by extensive occlusion of major deep veins as well as collateral channels, presenting with massive painful cyanotic swelling, compromised arterial inflow, and potential venous gangrene.

Homan's Sign

Resistance of the calf muscles to forced passive dorsiflexion of the ankle, historically evaluated for deep vein thrombosis but deemed unreliable due to low specificity.

Brodie-Trendelenburg Test

A clinical examination maneuver for varicose veins using elevation and manual/tourniquet compression of the saphenofemoral junction to identify saphenofemoral junction incompetence (rapid filling from above upon release) versus incompetent perforators (gradual filling prior to release).

Subfascial Endoscopic Perforator Vein Surgery (SEPS)

A minimally invasive endoscopic surgical procedure where a rigid scope is inserted in the subfascial plane above the muscle to identify, isolate, and clip incompetent lower leg perforator veins in chronic venous insufficiency.

Lipodermatosclerosis

A chronic dermatologic and subcutaneous inflammatory change of the lower leg (gaiter region) secondary to chronic venous hypertension, characterized by induration, fibrosis, and brown hyperpigmentation caused by hemosiderin deposition.

Klippel-Trenaunay Syndrome

A congenital vascular anomaly characterized by the triad of cutaneous capillary malformations (port-wine stains), bony and soft tissue hypertrophy of an extremity, and atypical varicose veins associated with hypoplasia or absence of the deep venous system.

Kasabach-Merritt Syndrome

A consumptive coagulopathy occurring within an enlarging vascular tumor (hemangioma or vascular malformation) characterized by marked platelet sequestration, profound thrombocytopenia, and microangiopathic hemolytic anemia.

Paget-Schroetter Syndrome

Effort-induced thrombosis of the axillary and/or subclavian veins caused by repetitive strenuous upper extremity motion that compresses the vein between the clavicle and the first rib; also termed venous thoracic outlet syndrome.

May-Thurner Syndrome

An anatomic compression syndrome where the left common iliac vein is compressed against the lumbar vertebrae by the overlying right common iliac artery, predisposing to extensive left lower extremity deep venous thrombosis.

Milroy Disease

A congenital, inherited form of primary lymphedema manifesting at birth or during the first year of life, characterized by lymphatic hypoplasia and typically presenting as bilateral lower limb edema.

Charles Procedure

An aggressive radical excisional operation for end-stage lower extremity lymphedema with fibrotic skin changes, comprising total circumferential excision of skin, subcutaneous tissue, and deep fascia below the knee followed by split-thickness skin grafting.

Stewart-Treves Syndrome

A highly lethal lymphangiosarcoma arising as a secondary malignant complication in an extremity affected by chronic, long-standing lymphedema, classically after radical mastectomy with axillary node clearance.

Kikuchi Disease

A benign, self-limiting histiocytic necrotizing lymphadenitis of unknown cause typically presenting in young Asian individuals with painful cervical lymphadenopathy, fever, and a histologic absence of neutrophils.

Thymoma

The most common primary tumor of the anterior mediastinum, originating from thymic epithelial cells and strongly associated with autoimmune paraneoplastic disorders, most notably myasthenia gravis and pure red cell aplasia.

Bronchogenic Cyst

A congenital bronchopulmonary foregut malformation lined by ciliated pseudostratified respiratory epithelium, most frequently located in the middle mediastinum (subcarinal or paratracheal).

Meigs Syndrome

The clinical triad of a benign solid ovarian tumor (typically an ovarian fibroma), ascites, and pleural effusion (classically right-sided), which completely resolves following tumor resection.

Tension Pneumothorax

A life-threatening thoracic emergency where a one-way pleural flap valve permits air entry into the pleural space on inspiration without exit on expiration, leading to lung collapse, contralateral mediastinal shift, and compressed caval venous return.

Empyema Necessitans

A complication of untreated or uncontrolled pleural empyema characterized by dissecting extension of purulent intrapleural fluid through the parietal pleura and chest wall tissues into the subcutaneous plane.

Intralobar Pulmonary Sequestration

A congenital segment of non-functioning pulmonary tissue that shares the visceral pleural investment of the normal lung lobe, lacks a bronchial connection to the tracheobronchial tree, and receives systemic arterial blood directly from the descending thoracic or abdominal aorta.

Pancoast Tumor (Superior Sulcus Tumor)

An apical bronchogenic carcinoma (most often squamous cell carcinoma) that invades adjacent thoracic inlet structures, involving the $C_8-T_1$ nerve roots (causing ulnar pain/atrophy), upper ribs, and sympathetic trunk (causing Horner syndrome).

Superior Vena Cava (SVC) Syndrome

Obstruction of venous outflow through the superior vena cava—most commonly caused by primary lung cancer (small cell carcinoma)—resulting in facial edema, distended neck/chest veins, conjunctival suffusion, and headache.

Fat Embolism Syndrome

A systemic manifestation occurring $24-72$ hours after major trauma or closed long bone fractures (especially the femur), presenting with the clinical triad of acute respiratory insufficiency, neurologic impairment, and a petechial skin rash.

Poirier's Triangle

An anatomic space bounded by the arch of the aorta, the left subclavian artery, and the vertebral column, through which the thoracic duct ascends along the anterior surface of the esophagus.

Cardiac Myxoma

The most common primary neoplasm of the heart, most frequently arising as a polypoid pedunculated mass from the fossa ovalis of the interatrial septum within the left atrium.

Pectus Excavatum

The most common congenital chest wall deformity, colloquially termed funnel chest, caused by overgrowth of costal cartilages that forces posterior depression of the sternum.