Treatment of Peripheral Vascular Disease

Question 1

What is one of the first steps in a stroke patient?

Answer 1

Get an MRI to see if there is intracranial hemorrhage. Treatment for intracranial hemorrhage is very different from treatment from ischemic event.

Question 2

How long does warfarin take to kick in? why?

Answer 2

4-6 days because you have to deplete the clotting factors which takes time

Question 3

What does it mean to bridge with heparin?

Answer 3

When you put someone on warfarin, it is common to bridge with heparin so that you have anti-coagulation activity while you are waiting for the warfarin 4-6 day onset.

Question 4

Is carotid revascularization an effective treatment for preventing stroke events?

Answer 4

Yes, very.

Question 5

What does irregularly irregular rhythm signify?

Answer 5

Atrial fibrillation

Question 6

When you see color mosaic on ultrasound using the doppler, what does it mean?

Answer 6

Turbulent blood flow. Usually seen at sites of stenosis.

Question 7

How is the severity of a stenosis indicate with the US doppler?

Answer 7

Higher velocity of flow through the narrowing, the more severe the stenosis

Question 8

What is endarterectomy?

Answer 8

Surgeon clamps vessel, opens it up and clears out gunk, and sows it back up

Question 9

If a patient has endarterectomy and still have stenosis recur later, would you redo the endarterectomy?

Answer 9

No, there is scar tissue which makes the surgery not ideal and also risk of injuring nerves. Typically, an endarterectomy that doesn’t achieve curative status is followed with stenting.

Question 10

What is typically thought to be more effective in preventing stroke: carotid endarterectomy or carotid stenting?

Answer 10

Carotid endarterectomy is thought to be better for preventing stroke. Stent is used later if endarterectomy doesn’t achieve curative status. Endarterectomy is the default procedure for carotid disease.

Question 11

Why doesn’t the external carotid cause strokes?

Answer 11

Bc it only supplies blood to the face

Question 12

Is external carotid or internal carotid the pathway for stroke?

Answer 12

Internal carotid

Question 13

While carotid stent does reduce stenosis, what is the main purpose of using the stent when preventing stroke?

Answer 13

The purpose of the stent is primarily to create a surface that can re-endothelialize and create a less embolic surface at the carotid bifurcation

Question 14

In the patient presented in class that was on 4 anti-HTN drugs but persistent HTN, what was found?

Answer 14

Renal artery stenosis. Was treated with stent and patient became normotensive and managed on 3 HTN drugs.

Question 15

What does post-prandial mean?

Answer 15

After eating

Question 16

What can post-prandial pain be a sign of?

Answer 16

Intestinal ischemia. There is an increase of O2 demand but you can’t keep up with supply. “intestinal angina”

Question 17

In the patient with post-prandial pain, what was found and stented?

Answer 17

Superior mesenteric artery atherosclerosis was found and stented. Patient no longer had post-prandial pain.

Question 18

Why are patients who don’t bridge with heparin more prone to clotting for the first few days of warfarin?

Answer 18

Warfarin depletes C and S causing hyper coagulable state for a few days. Heparin should be used to bridge so this doesn’t happen

Question 19

True or False: When patients have foot/leg discomfort from occlusion, the pain often improves when hanging leg off the side of the bed.

Answer 19

True

Question 20

In the patient with the calf pain, where was the occlusion found and stented?

Answer 20

Posterior tibial and anterior tibial arteries. Used stent for one and fibrinolytic/suction for the other.

Question 21

Why is it important to determine if the leg pain is atherosclerotic or from thromboembolic?

Answer 21

The treatment is different. Fibrinolytic medications cannot bust atherosclerotic plaque but it might dissolve a thromboembolic event.