Vasc surg Flashcards
DVT- Eti
- Age, CA, recent surg
- Patho: Virchow’s triad: stasis, vasc injury & hypercoaguability
DVT- Sx
LE pain, swelling & tenderness
- Homan sign
- Calf MC
DVT- Dx
Duplex US- vein incompressability
DVT- Tx
- Heparin or LMWH -> warfarin
- Goal INR 1.5-2.5
- x 3 mo if provoked, x 6 mo unprovoked
Prevent: SCDs, LMWH
Varicose veins- Eti
- Risks: female, pregnancy, fam hx, prolonged standing
- Dilation of superficial veins d/t valvular incomp.
- Very common- 10-20% population
Varicose veins- Sx
- Aesthetic concerns- dilated tortuous veins
- Local pain, burning heaviness with standing
- LE edema
- Deep veins = venous stasis sx
Varicose veins- Dx
Venous duplex imaging
Varicose veins- Tx
- Stockings- must fail to get surg
- Surg: Ablation of greater saphenous vein
- Phlebectomy
Peripheral vasc dz- Eti
- Occlusive dz of LE
- Superficial femoral MC
Peripheral vasc dz- Sx
- Rest pain at metatarsals, received by dangling foot
- Intermittent claudication- pain w/ walking relieved by rest
- poor perfusion, hair growth, thick toe nails
- Gangrene & non-healing ulcers
- Rubor, pallor w/ elevation
Peripheral vasc dz- Dx
- ABIs
Peripheral vasc dz- Tx
- Med: ASA or clopidigrel, pentoxifylline
- Surg: Bypass graft: fem-pop
Venous stasis ulcers
- Medial malleolus MC
Thrombangitis obliterans- Eti
- Multiple segmental occlusions in tibial & pedal arteries
- Young male smokers
Thrombangitis obliterans- Sx
- Pain and gangrene in extremities d/t arterial spasm
Thrombangitis obliterans- Dx, Tx
- Tissue Bx
- Tx: Stop smoking, amputation if gangrene
Carotid endarterectomy- Eti
- Atherosclerosis of carotid artery
- Risks: Smoking, HTN, DM
Carotid endarterectomy- Sx
- Amurosis fugax
- TIA or CVA
- Reversible ischemic neuro deficit
- Carotid bruit
Carotid endarterectomy- Dx
- Carotid US, doppler
- Arteriogram = gold standard
Carotid endarterectomy- Tx
- Surg indicated if asymp > 60% occlusion or
- Symp > 50% occlusion
- Angioplasty +/- stent
- post-op ASA
Carotid endarterectomy- Risks
- Stroke, MI,
- Mortality = 1%
IVC filter
- Filter in IVC to catch DVTs before becoming PEs
- Indicated if anticoag contraindicated
- Does not treat underlying disease
Thrombolectomy
- Open extraction of potential PE thrombus who are hemodynamically unstable
- Anticoags contraindicated
Amputation
- Indications: Tissue ischemia, gangrene, non-healing ulcers
- Bypass first if possible
