Flashcard Set Preview
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| 1 |
evaluation process for a pt presenting after a TIA
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examination for carotid bruits, residual neurologic deficit, and evidence of cardiac disease,...
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tx options when duplex study indicates stenosis of the carotids
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medical tx w/ aspirinsx therapy w/ carotid endarterectomy
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level of carotid stenosis at which sx tx leads to significant advantage in stroke prevention
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> 70% stenosis of the ICA w/ ipsilateral symptoms
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indications for carotid endarterectomy
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70% ICA stenosis AND (neuro symptoms or bruits)
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perioperative risk of stroke w/ a carotid endarterectomy
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1-3%
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nerves that may be injured in a carotid endarterectomy
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hypoglossalvagusmarginal branch of the facial
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steps in a carotid endarterectomy
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1. incision into SCM w/ carotid sheath dissection2. open sheath (protecting vagus) and isolate...
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important aspects of carotid endarterectomy
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technical perfection - no plaque can be left, which many surgeons check on the table w/ on-table...
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risk of recurrent carotid narrowing following carotid endarterectomy
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13% over 5 years on the side of the proceduretake aspirin after procedure to help prevent re-stenosis
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| 10 |
atherosclerosis is a...
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SYSTEMIC DISEASE!
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first branch of the ICA
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opthalmic artery
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amaurosis fugax
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transient blindness due to an emboli from the carotid artery bifurcation traveling to the retina
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Hollenhorst plaque
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bright shiny spot seen in a retinal artery upon examination of the fundus during a TIA w/ transient...
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when to perform an endarterectomy on a pt who had a stroke
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2-4 weeks after the stroke or when the pts neuro status stabilizes
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risk assoc w/ a carotid angiogram
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stroke
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| 16 |
sx of arterial occlusion
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painpulselessnesspallorpoikilothermiaparesthesiasparalysis
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most important initial management of pt w/ arterial occlusion
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immediate revascularization b/c the earlier the revascularization, the more complete the...
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likely dx in a pt s/p embolectomy for arterial occlusion w/ inability to dorsiflex foot and...
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compartment syndrome (aka ischemia-reperfusion injury) due to muscle edema after reperfusion:pressure...
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management of pt w/ compartment syndrome
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IMMEDIATE fasciotomy
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most common sources of arterial emboli
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cardiac (a-fib or acute MI)aneurysm or atherosclerotic plaque of the aorta
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most common sites of arterial embolization
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1. femoral2. iliac3. popliteal
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long-term management of pt w/ compartment syndrome/fasciotomy
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chronic anticoagulation w/ warfarinangiography or CT of chest/abdomen after recovery to attempt...
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| 23 |
things to look for on PE in pt w/ claudication
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assess for pulses, bruits, or thrills in legsexamine skin for ulcerationsmotor/sensory function
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implication of absent popliteal and pedal pulses w/ good femoral pulses
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occlusion of the superficial femoral artery, typically at the adductor hiatus
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noninvasive labs to do on the pt w/ PAD
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calculate the ankle-brachial indexexamine doppler tracing of arterial waveform at various levels...
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signs of peripheral vascular insufficiency
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reproducible claudicationforefoot rest painischemic ulceration (usually on malleoni and toes)gangrene
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correlation of ABI and symptoms
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normal 0.9 - 1.1mild claudication 0.6 - 0.8severe claudication < 0.5rest pain < 0.3
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normal doppler waveform and pathologic changes
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normal is tri-phasic: rapid systolic flow, reverse flow secondary to vessel recoil, and prolonged...
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management of pt w/ claudication
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**for most pts, sx is not the answer**principle management decision depends on the degree that...
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do an arteriogram on every pt with claudication?
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NOarteriogram has inherent risk and is strictly a preop test
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likely dx and tx needed in a pt w/ absent ipsilateral popliteal, dorsalis pedis, and femoral...
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aortoiliac occlusive disease, which is a more progressive disease, and the pt will need aortoiliac...
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management of the pt who presents w/ an ulcer secondary to peripheral vascular disease
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assess whether the blood supply is sufficient to allow the ulcer to heal; if not, some sort...
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tx for occlusion of the superficial femoral artery w/ distal reconstitution
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reversed or in situ saphenous vein graft from the common femoral artery to the popliteal artery...
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tx for high grade stenosis of the iliac artery but patency of the lower extremity vessels
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surgical revascularization using a large diameter graft from the aorta to the femoral artery...
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tx for high grade stenosis of the iliac artery and occlusion of the superficial femoral artery
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lower extremity revascularization in addition to aortoiliac reconstruction
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tx for occlusion of the superficial femoral and popliteal arteries w/ distal reconstitution
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femoropopliteal bypass w/ preference for the popliteal, anterior and posterior tibial arteries...
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locations of PAD that are good and bad for PTA
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bad: femoral b/c high rate of re-occlusiongood: iliac w/ much higher rate of patency at 5 yrs
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tx for multiple obstructions in the upper and distal leg
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experienced vascular surgeon needs to decide this; primary amputation may be the best choice
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long-term follow up for the pt s/p vascular bypass surgery
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frequent duplex of graft to assess for graft stenosisaspirincontrol lipidseducation about foot...
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most likely cause of death in a pt w/ PAD
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CADatherosclerosis is a systemic disease!!
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