Chapter 110 Flashcards
Where does the Aortoiliac Atherosclerosis start usually?
AI disease typically begins at the aortic terminus and common iliac artery origins and slowly progresses proximally and distally over time.
Which group of patients with AI disease usually fail conservative management and require surgical intervention?
1- Third of them have orificial profunda femoris disease.
2- 40% have significant SFA disease.
3- Rarely with renal or mesenteric involvement.
What is the clinical presentation of pateints with AI diseae?
1- Claudication with varying degree.
2- Rarely associated with CLI unless it is large thromboemboli that arise from a cardiac or other proximal source and lodge at the aortic bifurcation, referred to as saddle emboli, which can lead to profound acute bilateral lower extremity ischemia.
Why it is rare that AI disease can produce CLI?
Due to the abundant collateralization around the
point of obstruction, which reconstitutes the infrainguinal system with sufficient flow to ensure adequate resting tissue perfusion.
what are the collateral pathways in AI disease?
1- The primary compensatory networks develop from the lumbar and hypogastric feeding vessels and connect to circumflex iliac, hypogastric, femoral, and profunda recipients.
2- Additional collaterals that arise in more extreme degrees of obstruction include the internal mammary artery–to–inferior epigastric connection and the SMA–to–IMA and hemorrhoidal artery pathway.
What is Blue Toe Syndrome?
@ Blue toe syndrome occurs when atherosclerotic debris breaks free from an aortic or iliac plaque and embolizes to the distal vessels secondary to Wire manipulation during
coronary or peripheral angiographic procedures or surgical
cross-clamping across a calcific aortic plaque.
@ It is typically characterized by palpable pedal pulses in the presence of patchy ischemia (livedo), but more severe ischemia or gangrene of the proximal or distal forefoot may occur.
What is Small Aorta Syndrome or Hypoplastic Aorto-iliac syndrome?
It is an image based diagnosis usually in young women who smoke characterized by atretic or very narrow aorta with a characteristic stenotic posterior plaque at the aortic bifurcation
What is the percentage of male patients who have erectile dysfunction 2ry to AI disease?
30% of male patients may have difficulty achieving and maintaining an erection owing to inadequate perfusion of the internal pudendal arteries
What is the definition of Leriche’s syndrome?
Leriche’s syndrome is associated with terminal aortic occlusion causing claudication (thigh, hip, or buttock), atrophy of the leg muscles, impotence, and reduced femoral pulses.
