Surgical Aspects of Vasc. Disease

Question 1

what are some symptoms of peripheral artery disease (PAD)?

Answer 1

intermittent claudication
rest pain
erectile dysfunction

Question 2

what are some signs of PAD?

Answer 2

absent pulses
bruits
muscular atrophy
decreased hair growth
thick toenails
tissue necrosis/ulcer/infection

Question 3

what’s the diff between PAD ulcer and venous stasis ulcer?

Answer 3

PAD: ulcer on toes/foot (distal)

venous stasis: medial malleolus ulcer

Question 4

risk factors for atherosclerosis?

Answer 4

SMOKING
htn
DM
fam hx
obesity
high cholesterol
sedentary lifestyle

Question 5

indications for surgical treatment in PAD?

Answer 5

“STIR”

• severe claudication refractory to conservative tx
• tissue necrosis
• infection
• rest pain

Question 6

what is rest pain?

Answer 6

pain in the foot (over distal metatarsals)

• pain at rest (duh)
• typically arises at night and resolves with hanging foot over bed (gravity=extra flow)

Question 7

indication for amputation?

Answer 7

irreversible tissue ischemia (no hope with bypass)

• necrotic tissue
• severe infection
• severe pain w/out bypassable vessels

Question 8

what are the 6 P’s of acute arterial occlusion?

Answer 8

• pain
• pallor
• paralysis
• paresthesia
• polar/poikilothermia (cold)
• pulselessness

Question 9

indication for CEA in asymptomatic pts?

Answer 9

carotid artery stenosis>60%

Question 10

indication for CEA in symptomatic pts?

Answer 10

carotid stenosis>50%

Question 11

what are symptoms of carotid artery stenosis?

Answer 11

amaurosis fugax (look it up!)
TIA
RIND - reversible ischemic neurologic deficit
CVA

Question 12

what’s one of the worse complications of a CEA?

Answer 12

STROKE

Question 13

what are some other post op complications for CEA?

Answer 13

• stroke
• MI
• hematoma
• infection
• hemorrhage
• htn or hypotension
• thrombosis
• vagus/hypoglossal n. injury
• intracranial hemorrhage

Question 14

what’s the mortality rate after CEA?

Answer 14

about 1%

Question 15

what med do you give post op after CEA?

Answer 15

ASA

Question 16

what’s the most common cause of death after CEA?

Answer 16

MI

Question 17

indications for surgical tx of varicose veins?

Answer 17

• persistent or debilitating pain
• recurrent superficial thrombophlebitis
• erosion of overlying skin with bleeding
• manifestations of ven. insuffic.

Question 18

how are varicose veins removed?

Answer 18

stab that shiz!

• stab incisions made
• hooks loop vein and you rip it out

Question 19

primary tx of DVT?

Answer 19

systemic anticoagulation

Question 20

for surgical patients, what is the risk of post op DVT?

Answer 20

-20-25% of gen surg pts
-50-60% in knee or hip arthroplasty
basically DVT prophy is super important (stockings, pneumatic compression, heparin or LMWH)

Question 21

what’s the indication for surgical tx of venous insufficiency?

Answer 21

• non healing ulcers

- disabling s/s refractory to conservative tx

Question 22

procedures to tx venous insufficiency?

Answer 22

• ablative procedures of superficial veins
• antireflux procedures
• bypass operations for obstruction

Question 23

indication for IVC filter?

Answer 23

in pts with proximal DVT who can’t be anticoagulated for some reason
Reason? prevention of pulm. emboli