Chap 139 LE aneursyms Flashcards
How often is FA aneurysm bilat?
Other associated aneurysm?
25% if true aneurysm (most False)
50%
What diseases are associated with FA aneurysm?
degenerative, Behcet, parkes weber, wegners
How often to pseudoaneuryms of FA occur with diagnostic and therapeutic interventions?
0.2%
8%
When to intervene?
> 2.5cm
symptomatic
What does false aneurysm look like on US?
to and fro (ying-yang)
What are therapeutic options for false aneurysm?
US guided compression
10-20 minutes, bedrest 6 hours
success 70%
blind compression
can be as good as US guided
US guided thrombin injection
1000units
success reaching close to 100%
open surgical repair
What is normal diameter of popliteal? what is aneurysmal?
- 5-1.1
1. 5 times the normal segment diameter (>1.5-2)
How common are popliteal aneurysm? how many bilat? how many have AAA
most common peripheral aneurysm but still rare
50%
30-50%
How do they present?
Which is most common presentation?
asympto rupture (rare) chronic ischemia (claudication) acute ischemia compressive (vein, nerve)
lower limb ischemia
30% acute
How do you treat endovascular?
convered stent
oversize 10-15%
LZ 2 cm
How to treat open?
smaller
medial approach
posterior approach
What is the difference between open and endo?
similar but reintervention rate higher in endo
5yr patency 70%, 80% if add plavix
What are advantages/disadvantages of medial/posterior approach?
posteriro
decompress aneurysm
ligate geniculates
medial
avoid aneurysm
familiarity
What is a persistent sciatic artery aneurysm?
what % anerysmal
what artery hypo plastic?
presentation?
What do you pay attention to when operating?
rare anomaly prone to aneurysm
40% become aneurysm
femoral
large buttock mass,
local compressive symptoms, distal ischemia
avoid sciatic nerve (so don’t expose the artery surgically)
What is the most common peripheral aneurysm?
popliteal
How many PA have coexisting AAA?
30-50%
What are CSVS recommendations for screening in PA?
screen for AAA
screen for contra PA
How many PA are bilateral?
50%
What structures pass through the adductor hiatus?
superficial femoral artery
superficial femoral vein
spahenous nerve
saphenous branch of descending genicular artery
Name 6 non-atheromatous causes of IC?
Pop entrapment syndrome Adventitial cystic disease Chronic compartment syndrome Kinking/endofibrosis of iliacs Arteritis Thrombosis of persistent sciatic artery FMD Aortic coarctation Takayasu Peripheral emboli Vascular tumor
What are indications for treatment of PA?
> 2.0cm
symptoms
presence of aneurysm (low risk procedure)
>3.0 (if asympto)
Between what two muscles is the popliteal vessels found in the infrageniculate medial approach?
sartorius
vastus medialis
In posterior approach, which side is the upper portion of the S incision directed?
medial
What are three nerves encountered in the posterior exposure
medial sural nerve
tibial nerve
peroneal nerve
Which patients to consider for thrombolysis with PA thrombosis?
patients without motor loss
patients with no distal runoff
How do you mix cathflo?
10mg in 1L of NS
10mg bolus
infusion 0.5mg/hr
What is risk of ICH with thrombolysis?
What are results for thrombolysis in PA?
restore 1-2 vessel outflow in 80-90%
failure results in amputation
at 30d thrombi may have improved limb salvage
