Surgical Aspects of Vasc. Disease Flashcards
what are some symptoms of peripheral artery disease (PAD)?
intermittent claudication
rest pain
erectile dysfunction
what are some signs of PAD?
absent pulses bruits muscular atrophy decreased hair growth thick toenails tissue necrosis/ulcer/infection
what’s the diff between PAD ulcer and venous stasis ulcer?
PAD: ulcer on toes/foot (distal)
venous stasis: medial malleolus ulcer
risk factors for atherosclerosis?
SMOKING htn DM fam hx obesity high cholesterol sedentary lifestyle
indications for surgical treatment in PAD?
“STIR”
- severe claudication refractory to conservative tx
- tissue necrosis
- infection
- rest pain
what is rest pain?
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)
indication for amputation?
irreversible tissue ischemia (no hope with bypass)
- necrotic tissue
- severe infection
- severe pain w/out bypassable vessels
what are the 6 P’s of acute arterial occlusion?
- pain
- pallor
- paralysis
- paresthesia
- polar/poikilothermia (cold)
- pulselessness
indication for CEA in asymptomatic pts?
carotid artery stenosis>60%
indication for CEA in symptomatic pts?
carotid stenosis>50%
what are symptoms of carotid artery stenosis?
amaurosis fugax (look it up!)
TIA
RIND - reversible ischemic neurologic deficit
CVA
what’s one of the worse complications of a CEA?
STROKE
what are some other post op complications for CEA?
- stroke
- MI
- hematoma
- infection
- hemorrhage
- htn or hypotension
- thrombosis
- vagus/hypoglossal n. injury
- intracranial hemorrhage
what’s the mortality rate after CEA?
about 1%
what med do you give post op after CEA?
ASA
what’s the most common cause of death after CEA?
MI
indications for surgical tx of varicose veins?
- persistent or debilitating pain
- recurrent superficial thrombophlebitis
- erosion of overlying skin with bleeding
- manifestations of ven. insuffic.
how are varicose veins removed?
stab that shiz!
- stab incisions made
- hooks loop vein and you rip it out
primary tx of DVT?
systemic anticoagulation
for surgical patients, what is the risk of post op DVT?
-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)
what’s the indication for surgical tx of venous insufficiency?
- non healing ulcers
- disabling s/s refractory to conservative tx
procedures to tx venous insufficiency?
- ablative procedures of superficial veins
- antireflux procedures
- bypass operations for obstruction
indication for IVC filter?
in pts with proximal DVT who can’t be anticoagulated for some reason
Reason? prevention of pulm. emboli
