Lower Extremity Flashcards
arterial anatomy of the leg?
external iliac > femoral > deep femoral, superficial circumflex iliac, SFA –> popliteal artery –> posterior tibial, peroneal, anterior tibial –> dorsalis pedis
infrapopliteal muscles medial to lateral
posterior tibial (medial) peroneal artery (tibioperoneal trunk to AT) anterior tibial (lateral)
Leriche syndrome
chronic occlusive atherosclerotic disease of the distal abdominal aorta
-impotence, buttock claudication, absent femoral pulses, cold lower extremities
TASC II
The 2006 second TransAtlantic Inter-Society Consensus; recommendations for treatment of aortoiliac and infrainguinal occlusive disease classify lesions as Types A through D (most severe).
TASC II Type A
noncalcified concentric iliac stenosis <3cm in length
Treatment: percutaneous transluminal PTA
TASC II Type B/C
lesion 3-10 cm in length
surgery or PTA
TASC II Type D
stenoses >10 cm
indications for stenting
stenting is indicated if there is >30% residual stenosis or >10 mm Hg systolic pressure gradient at rest
iliac artery aneurysm definition
> 1.5 cm; repair when > 3 cm
causes of internal iliac aneurysms
older men; associated with AAA
associated with atherosclerosis, connective tissue disease
persisent sciatic artery
fetal sciatic artery supplies majority of the leg; arises from the internal iliac artery –> popliteal;
active pelvic bleeding, next steps?
- angiography, then ortho
- nonselective pelvic arteriogram –> selective bilateral internal iliac arteriograms
avoid superselective embolization in the setting of life threatening hemorrhage
indications for uterine artery embolization
fibroids, postpartum hemorrhage
frequently used polyvinyl chloride
complications of uterine artery embolization
abscess, endometritis, ovarian necrosis, premature menopause, infertility
risk factors for peripheral vascular disease
CAD, smoking, DM, HTN, HLD, lack of exercise, family history
treatment for cladication
risk factor control, exersie, aspirin, cilostazol (platelet aggregation inhibitor with vasodilator action)
common places for atherosclerotic stenoses
common iliac artery, SFA, popliteal, TP trunk, origins of tibial arteries
Rutherford classification for chronic limb ischemia
Category 0 is asymptomatic, category 1 is mild claudication,
categories 2–3 are moderate to severe ischemia
category 4 is ischemic rest pain
categories 5–6 are minor or major tissue loss, respectively.
ABI
ankle brachial index
SBP in the ankles compared to the arms
<0.9 is abnormal
0.5-0.9 is intermittent claudication
<0.4 is rest pain
normal waveforms
normal triphasic
biphasic (moderate stenosis)
flat waveform (severe stenosis/occlusion)
femoropopliteal lesions by TASC-II
Type A: Single stenosis ≤10 cm: Endovascular treatment is the treatment of choice.
Type B: Multiple lesions (stenosis or occlusion), each <5 cm; single lesion <15 cm: Endovascular
treatment is preferred, depending on patient’s comorbidities and preference.
Type C: Multiple stenoses or occlusions >15 cm: Surgery is preferred, depending on patient’s comorbidities and preference.
Type D: Chronic total occlusion: Surgery is treatment of choice.
acute limb ischemia symptoms
pain, pallor, poikilothermia (coldness), pulselessness, paresthesia
common embolic source for acute thromboembolic disease
left atrial thrombus from Afib
workup: echocardiography
meniscus sign in IR
abrupt cutoff of ffected vessel from atherosclerotic disease
treatment for acute thromboembolic disease
embolectomy, surgical bypass graft, endovascular thrombolysis
administration of tPA
hydrophilic wire to cross lesion
multi-sidehole infusion catheter across thrombus with 0.5 mg/h for 48-72 hrs
monitor hct and fibrinogen iin the ICU. stop if fibrinogen <100, slow if<150.
definition of popliteal aneurysm; treatment
8mm
treat when symptomatic or >2cm
endovascular stent graft/surgical bypass
symptomatic popliteal aneurysm
distal ischemia due to embolism; rupture rare
Buerger disease
medium and small occlusive vasculitis of lower extremities and hands ; seen in smokers (middle aged men with claudication)
Buerger disease angiography findings
corkscree collaterals in vasa vasorum
segmental stenoses of medium and small arteries in the leg; CFA, SFA, popliteal artery usually spared
popliteal entrapment syndrome
compression of popliteal artery y calf muscle/fibrous band (aberrant medial head gastrocnemius)
cause of exercise induced claudication
treatment of popliteal entrapment syndrome
surgical release of offending muscle
cystic adventitial disease
distal claudication due to mucoid cyst in adventitia by popliteal artery causing luminal compression; middle aged men
cystic adventitial disease diagnosis
MRI; T2 hyperintensity of cystic component
treatment cystic adventitial disease
surgical resection/bypass
