Chap 139 LE aneursyms

Question 1

How often is FA aneurysm bilat?

Other associated aneurysm?

Answer 1

25% if true aneurysm (most False)

50%

Question 2

What diseases are associated with FA aneurysm?

Answer 2

degenerative, Behcet, parkes weber, wegners

Question 3

How often to pseudoaneuryms of FA occur with diagnostic and therapeutic interventions?

Answer 3

0.2%

8%

Question 4

When to intervene?

Answer 4

> 2.5cm

symptomatic

Question 5

What does false aneurysm look like on US?

Answer 5

to and fro (ying-yang)

Question 6

What are therapeutic options for false aneurysm?

Answer 6

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

Question 7

What is normal diameter of popliteal? what is aneurysmal?

Answer 7

0. 5-1.1

1. 5 times the normal segment diameter (>1.5-2)

Question 8

How common are popliteal aneurysm? how many bilat? how many have AAA

Answer 8

most common peripheral aneurysm but still rare
50%
30-50%

Question 9

How do they present?

Which is most common presentation?

Answer 9

asympto
rupture (rare)
chronic ischemia (claudication)
acute ischemia
compressive (vein, nerve)

lower limb ischemia
30% acute

Question 10

How do you treat endovascular?

Answer 10

convered stent
oversize 10-15%
LZ 2 cm

Question 11

How to treat open?

Answer 11

smaller
medial approach

posterior approach

Question 12

What is the difference between open and endo?

Answer 12

similar but reintervention rate higher in endo

5yr patency 70%, 80% if add plavix

Question 13

What are advantages/disadvantages of medial/posterior approach?

Answer 13

posteriro
decompress aneurysm
ligate geniculates

medial
avoid aneurysm
familiarity

Question 14

What is a persistent sciatic artery aneurysm?
what % anerysmal
what artery hypo plastic?
presentation?
What do you pay attention to when operating?

Answer 14

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)

Question 15

What is the most common peripheral aneurysm?

Answer 15

popliteal

Question 16

How many PA have coexisting AAA?

Answer 16

30-50%

Question 17

What are CSVS recommendations for screening in PA?

Answer 17

screen for AAA

screen for contra PA

Question 18

How many PA are bilateral?

Answer 18

50%

Question 19

What structures pass through the adductor hiatus?

Answer 19

superficial femoral artery
superficial femoral vein
spahenous nerve
saphenous branch of descending genicular artery

Question 20

Name 6 non-atheromatous causes of IC?

Answer 20

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

Question 21

What are indications for treatment of PA?

Answer 21

> 2.0cm
symptoms

presence of aneurysm (low risk procedure)
>3.0 (if asympto)

Question 22

Between what two muscles is the popliteal vessels found in the infrageniculate medial approach?

Answer 22

sartorius

vastus medialis

Question 23

In posterior approach, which side is the upper portion of the S incision directed?

Answer 23

medial

Question 24

What are three nerves encountered in the posterior exposure

Answer 24

medial sural nerve
tibial nerve
peroneal nerve

Question 25

Which patients to consider for thrombolysis with PA thrombosis?

Answer 25

patients without motor loss

patients with no distal runoff

Question 26

How do you mix cathflo?

Answer 26

10mg in 1L of NS
10mg bolus
infusion 0.5mg/hr

Question 27

What is risk of ICH with thrombolysis?

Question 28

What are results for thrombolysis in PA?

Answer 28

restore 1-2 vessel outflow in 80-90%
failure results in amputation
at 30d thrombi may have improved limb salvage