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Vascular Surgery > Lower Extremity Aneurysms > Flashcards

Lower Extremity Aneurysms Flashcards

1
Q

What is the men to women ratio of true lower extremity aneurysms (all types)?

A

30:1

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2
Q

What are the main types of aneurysms and their definition?

A
  • True aneurysm - focal, fusiform dilation of the artery to 1.5 times the normal diameter of the adjacent segment of artery.
  • Pseudoaneurysm - a rim of fibrous tissue containing thrombus and arterial flow in continuity with a defect in the artery.
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3
Q

What is the appeoximated normal size of CFA in men and women?

A
  • 1 cm in men
  • 0.8 cm in women
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4
Q

What are the indication for aneurysmatic Femoral artery intervantion?

A
  • All symptomatic aneurysms should be treated.
  • Asymptomatic aneurysms of more than 2.5cm in good risk patients can be concidered for treatment.
  • Recent study (by Lawrence et al. 2014) acute complications such as ischemia or rupture did not occur in patients with asymptomatic femoral artery aneurysms less than or equal to 3.5 cm.
  • Size threashold can be reduced in the presence of intraluminal thrombuse.
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5
Q

What is the most common etiology of true aneurysms in lower extremities?

A

Degenerative aneurysems.

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6
Q

What is the major risk of lower limb aneurysms?

A

They can cause limb-threaening ischemia due to thrombose or emboly.
Rapture is a rear presentation!

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7
Q

What is the rate of association between femoral aneurysms and aortic aneurysms?

A

50-90% chance of concurrent aortic aneurysm

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8
Q

What is the rate of association between popliteal aneurysms and aortic aneurysms?

A

30-50% chance of concurrent aortic aneurysm
70% chances for aortic aneurysm if there is a bilateral popliteal aneurysms.

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9
Q

What is the rate of bilateral femoral aneurysms?

A

25-50%

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10
Q

What is the rate of bilateral popliteal aneurysms?

A

50-70%

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11
Q

What is the rate of femoral or popliteal aneurysems in men with aortic aneurysms?

A

14%

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12
Q

What is the rate of femoral or popliteal aneurysems in women with aortic aneurysms?

A

Rare

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13
Q

what is tne major etiology of Pseudoaneurysm?

A

iatrogenic injury due to instrumentation

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14
Q

What is the rate of the specific femoral arteries aneurysms (CFA, SFA, PFA)?

A

CFA 57%
SFA 27%
PFA 17%
Bilateral 26%
Associated with additional aneurysms 48%

Recent study showed higher percentage (81%) in the CFA, and lower percentage (14%, 5%) in the SFA and PFA, respectively.

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15
Q

At which age group are femoral artery aneurysms predominantly found?

A

70 year or older

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16
Q

What is the possible clinical presentaion of symptomatic femoral artery aneuryems and their rate (most common to less common)?

A

Lower extremity ischemia is the most common presentation in up to 65%.
30-40% locolized pain from compression.
Rupture (rear) 4%

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17
Q

What is the rate of asymptomatic femoral artery aneurysms?

A

30-40% are asymptomatic and found on physical examination or Duplex US.

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18
Q

What is the imaging modality of chioce for the diagnosis and assessment of lower extremities aneurysms?

A

Duplex ultrasound.

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19
Q

What is the role of CTA and MRA in the assessment of lower extremities aneurysms?

A

Although the modality of chioce is Duplex US, CTA and MRA has a role in:

  • Planning intervantion
  • Measurment
  • identify normal proximal and distal segments.
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20
Q

What is the recommended treatment approch to femoral aneurysms?

A

Open surgery with exclusion and interposition graft is the prefarred approch.
In both emergency and elective repair there is a minimal morbidity and mortality.

21
Q

What type of graft is preffered for interposition in open surgical repair of the femoral artery?

A

Syntetic PTFE or Dacron graft are better size matches and have equivalent or better patency rates than vein grafts in the femoral artery.

22
Q

How often is FA aneurysm bilat?
Other associated aneurysm?

A

25% if true aneurysm (most False)
50%

23
Q

What diseases are associated with FA aneurysm?

A

degenerative, Behcet, parkes weber, wegners

24
Q

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

A

0.2%
8%

25
Q

When to intervene?

A

>2.5cm
symptomatic

26
Q

What does false aneurysm look like on US?

A

to and fro (ying-yang)

27
Q

What are therapeutic options for false aneurysm?

A

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

28
Q

What is normal diameter of popliteal? what is aneurysmal?

A
  1. 5-1.1
  2. 5 times the normal segment diameter (>1.5-2)
29
Q

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

A

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

30
Q

How do they present?
Which is most common presentation?

A

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

lower limb ischemia
30% acute

31
Q

How do you treat endovascular?

A

convered stent
oversize 10-15%
LZ 2 cm

32
Q

How to treat open?

A

smaller
medial approach

posterior approach

33
Q

What is the difference between open and endo?

A

similar but reintervention rate higher in endo

5yr patency 70%, 80% if add plavix

34
Q

What are advantages/disadvantages of medial/posterior approach?

A

posteriro
decompress aneurysm
ligate geniculates

medial
avoid aneurysm
familiarity

35
Q

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

A

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)

36
Q

What is the most common peripheral aneurysm?

A

popliteal

37
Q

How many PA have coexisting AAA?

A

30-50%

38
Q

What are CSVS recommendations for screening in PA?

A

screen for AAA
screen for contra PA

39
Q

How many PA are bilateral?

A

50%

40
Q

What structures pass through the adductor hiatus?

A

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

41
Q

Name 6 non-atheromatous causes of IC?

A

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

42
Q

What are indications for treatment of PA?

A

>2.0cm
symptoms

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

43
Q

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

A

sartorius
vastus medialis

44
Q

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

A

medial

45
Q

What are three nerves encountered in the posterior exposure

A

medial sural nerve
tibial nerve
peroneal nerve

46
Q

Which patients to consider for thrombolysis with PA thrombosis?

A

patients without motor loss
patients with no distal runoff

47
Q

How do you mix cathflo?

A

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

48
Q

What are results for thrombolysis in PA?

A

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

Vascular Surgery (37 decks)

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