Summary of Essentials - Ch. 55-58 (Vascular) Flashcards
DDx - amaurosis fugax?
Carotid embolus, central retinal artery occlusion, giant cell arteritis, retinal vein occlusion, retinal detachment, papilledema, optic neuritis
Presentation - amaurosis fugax (ipsilateral), arm/leg weakness and numbness (contralateral), +/- aphasia, emobli to the retina on fundoscopy, carotid bruit (specific, not sensitive)
Carotid stenosis
True or false - dizziness, syncope, headaches are not typical carotid symptoms
True
Work-up of suspected carotid artery disease?
Carotid duplex to determine % ICA stenosis Confirmatory imaging (CTA or MRA)
Who should get a carotid end arterectomy?
Greatest benefit for symptomatic 70-99% stenosis
Less benefit for symptomatic 50-69%/asymptomatic 60-99%
NO benefit for <50%
Who should get carotid stenting?
Symptomatic ICA stenosis with high cardiac risk or hostile neck (previous radiation/surgery)
Presentation - calf/thigh/buttock pain walking, relieved by rest, reproducible at same distance, absent pulses, muscle atrophy, hair los, dry/atrophic skin, toe ulcers, thickened toenails
Peripheral artery disease
Dx PAD?
H&P supplemented by ABI with Doppler
CT/MRA only if intervention is planned
Management of PAD?
Conservative for claudication: smoking cessation, walking program, statin, aspirin
Best drug: cilostazol (alternative - pentoxifylline, less effective)
Ischemia rest pain or tissue loss: interventional (angioplasty/stenting for short occlusion/stenosis), endarterectomy, surgical bypass (long occlusion)
Presentation - PAD + arm claudication and dizziness?
Subclavian steal syndrome
Presentation - buttock claudication, absent femoral pulses, impotence
Leriche syndrome
Presentation - young male smokers with distal artery and vein occlusions
Buerger’s disease
When might ABI be falsely normal?
DM with medial calcinosis
Presentation - elderly male smokers, acute abdominal pain radiating to the back or flank, hypotension, tachycardia, pallor, diaphoresis,
AAA
Dx AAA?
Unstable - H&P
Stable - CT angio
Abdominal U/S can diagnose presence/size, not useful for rupture
Who should be screened for AAA?
Men aged 65-75 with any smoking history or start at 60 if 1st degree relative with AAA; patients with femoral or popliteal artery aneurysm; aortic diameter >3 cm
Management of ruptured AAA?
IV access, limit fluids
Permissive hypotension (as low as 70)
Avoid intubation until in the OR
If stable - CT to confirm and determine if EVAR
If unstable - open repair (consider U/S if dx in question)
Management of non-ruptured AAA?
<5.5 cm - observe
>5.5 cm - open or EVAR
Define acute leg ischemia
Decreased limb perfusion of <2 weeks duration
What is the sine qua non of acute limb ischemia?
Pulselesness
What suggests a thrombotic cause of acute limb ischemia?
Exam or contralateral non-ischemic limb that may show signs of chronic PAD
What suggests an embolic cause of acute limb ischemia?
AFib, atrial flutter, valvular disease, heart failure
Irreversible damage of skeletal muscle tissue in acute limb ischemia begins at ___ and may be completed at ___.
3 hours; 6 hours
Dx acute limb ischemia?
Doppler (fast) CT angio (more information)
