Preferred treatments Flashcards
What is the preferred treatment in Renal Artery Stenosis in atherosclerotic lesions (90% of cases)?
Most lesions are at the ostia (connecion to aorta).
ASTRAL and CORAL trials showed no advantage for stenting over medical treatment.
Intervention is in severe disease that fails to respond to aggressive medical therapy.
Open surgery in good risk patients with bilateral RAS or branched vessel disease who fali medical treatment and children with developmental RAS.
Balloon-expandable stents may be concidered, over open surgery, in low volume centers and for unilateral stenosis.
What is the preferred treatment in symptomatic Innominate Artery Stenosis?
Endovascular stenting.
What is the preferred treatment for thoracoabdominal aneurysems?
Endovascolar in degenerative aneurysems.
Open in connective tissue dessease.
What is the preferred treatment of acute aortic dissection type B?
Acute is up-to 14 days.
Id dissection is not complicated (pending rupture, endorgan malperfusion) conservative controling BP with BB in ICU to control symptoms.
If symptomatic in sub-acute (14-90 days): endovascular treatment.
What is the preferred treatment in Takayasu?
Steroids tretreatment.
What is the preferred treatment in symptomatic mid aortic syndrom (Life limitting cludication, severe stenosis, uncontroled hypertension) in Takayasu?
Open Aorto-Aortic bypass
What is the preferred treatment in renal stenosis due to Takayasu with uncontroled hypertension?
Endovascular with stent graft.
If failure, open bypasses.
What is the preferred treatment in symptomatic carotid stenosis (cerebelar ischemia or 70% symptomatic stenosis) due to Takayasu?
Open bypass from aortic arch.
What is the preferred treatment in symptomatic subclavian stenosis due to Takayasu?
Open bypass from aortic arch.
What is the preferred treatment in symptomatic coronary artery stenosis due to Takayasu?
CABG
What is the preferred treatment in Renal Artery Stenosis in fibromuscular dysplasia (FMD)?
This cases are less common.
Stenosis is usauly at the main renal artery (string of beads).
Treatment is PTA
What is the treatment of Adventitial Cystic Disease?
Resection and reconstruction in oclussion secondary to thrombosis. Posterior approach.
In none thrombosed artery, imaging-guided cyst aspiration or operative cyst evacuation and excision, offer good short-term outcomes (lowest recurrence in cyst recession).
What is the preferred treatment in case of Blunt Thoracic Aortic Injury?
In case of stage 1-3 and stable patient, the 1st line is medical treatment to control BP and later definitive TEVAR.
In Stage 4 and unstable patient TEVAR is preferred when applicable and open surgery is an option.
What is the preferred treatment for popliteal artery aneurysm?
Open medial approch. bypass + exclusion/ligation of the aneurysm.
Posterior approch is preferred for large, confined to the popliteal space and aneurysms causing symptoms from compression.
What is the preferred treatment for cervical trauma with hard signs?
Open surgicl approach.
