Aortoiliac Disease1

Question 1

Describe type I aortoiliac ds

Answer 1

infrarenal and proximal common iliacs

Question 2

Which patients more commonly have type I aortoiliac ds

Answer 2

young smokers and females

Question 3

Describe type II aortoiliac ds

Answer 3

diffuse ds of the iliac arteries

Question 4

Describe type III aortoiliac ds

Answer 4

AIOD + infrainguinal ds

Question 5

Define Leriche syndrome

Answer 5

buttock claudication, impotence, and diminished or absent femoral pulses

Question 6

Dx of aortoiliac ds

Answer 6

ABIs, pulse volume recordings, US, CTA or MRA

Question 7

What is the first line tx in patients with claudication

Answer 7

medical therapy

Question 8

What are the goals of medical therapy

Answer 8

1. decrease risk of cardiovascular mortality 2. improve sx�s 3. prevent limb loss

Question 9

Surgical treatment of aortoiliac disease

Answer 9

aortiobifemoral bypass (Gold standard), EVAR-stenting

Question 10

Can external iliac arteries be stented

Answer 10

yes

Question 11

Name complications of aortoiliac angioplasty and stenting

Answer 11

cardiac events, contrast nephropathy, access site problems (thromboembolism, atheroembolism), dissection, pseudoaneurysm, bleeding and AV fistula

Question 12

During an aortobifem where is the aorta clamped

Answer 12

infrarenal or above the SMA

Question 13

How long should renal ischemia time be

Answer 13

less than 15mins

Question 14

Name the complication of aortobifem bypass

Answer 14

seroma, hematoma, infection, kinking, pseudoaneurysm, thrombosis and pelvic ischemia

Question 15

How does pelvic ischemia after aortobifem present

Answer 15

colonic ischemia, buttock infacrtion, lumbar plexopathy with neurologic deficit

Question 16

Which patients get nonatherosclerotic aortoiliac occlusive ds

Answer 16

young patients, nonsmoking, hypercoagulable, fibromuscular dysplasia, mid aortic syndrome, radiation arteritis and trauma induced intimal fibrosis

Question 17

Define fibromuscular dysplasia

Answer 17

serial stenosis and intervening mural aneurysms involving the proximal third of the external iliac artery

Question 18

Tx of fibromuscular dysplasia

Answer 18

open surgical and EVAR

Question 19

What type of disease seen with professional cyclists

Answer 19

endofibrosis of the external iliac artery from repeated trauma

Question 20

What is the mechanism of endofibrosis in cyclists

Answer 20

tethering of the iliac artery by the psoas arterial branch, muscle hypertrophy, and fibrous tissue