Vascular disorders (arterial) Flashcards
When should you admit a femoral-popliteal PAD?
REFER IF - progressive symptoms, short-distance claudication, rest pain, ulceration
ADMIT IF: chronic limb threatening ischemia or foot infection
When should you admit a tibial-pedal PAD?
ADMIT IF: any patient w/ DM and foot ulcer + infection (emergent I&D) with broad spectrum abx
What is the cornerstone of aorta-iliac PAD treatment?
cardiovascular risk reduction + exercise program
- smoking cessation
- weight loss
How do you treat aorta-iliac PAD?
- antiplatelet therapy (aspirin or clopidogrel)
- low dose rivaroxaban w/ aspirin
- high dose statin
- cilostazol (walking distance improvement)
- endovascular therapy (best for single stenosis)
What is a surgical intervention for aorta-iliac PAD?
Bypass grafts
What’s first line for a femoral-popliteal PAD?
medical + exercise therapy, risk factor reduction
- antiplatelet therapy (aspirin or clopidogrel)
- low dose rivaroxaban w/ aspirin
- high dose statin
- cilostazol (walking distance improvement)
What’s general treatment for all PAD?
- antiplatelet therapy (aspirin or clopidogrel)
- low dose rivaroxaban w/ aspirin
- high dose statin
- cilostazol (walking distance improvement)
and lifestyle changes
CARS. Cilostazol anti platelet rivaroxavan statin
When should you surgically intervene for a femoral-popliteal PAD?
Progressive claudication, incapacitating, interferes significantly w/ essential daily activities or if pain at rest or ulcers threaten foot
–>
Bypass surgery (femoral-popliteal using autologous saphenous vein)
What are alternative surgical treatments for femoral-popliteal PAD??
Endovascular techniques – angioplasty + stenting in patients undergoing aggressive risk factor modification with smaller lesions
Thomboendarectomy to remove plaque
What’s first line treatment for tibial-pedal PAD?
Prevent ulcers, revascularization to avoid major amputation if ulcer appears + not healing
Bypass + endovascular techniques (saphenous vein)
Amputation
How do you treat first line acute arterial occlusion of a limb?
Immediate revascularization + heparin
What are other ways to treat acute arterial occlusion of a limb?
Endovascular techniques - pharmacomechanical thrombectomy catheters, catheter directed thrombolysis, immediate revascularization
Surgical intervention
When do you admit for an AAA?
tender aneurysm to palpation, signs of aortic rupture, evidence of infection
When should you electively repair an AAA?
5.5cm or larger in men or 5 cm in women OR >.5cm expansion in 6 months OR symptomatic
What are other ways to treat AAA?
Risk factor management (smoking, HTN, hyperlipidemia)
When should you refer a TAA patient?
ascending >4.5cm, descending >5cm
How do you treat an ascending aorta TAA?
~5.5cm – open surgery required, repari
How do you treat a descending aorta TAA?
> /5.5cm, endovascular grafting
How do you treat PAAs?
Immediate surgery when acute embolization or thrombosis has caused acute ischemia (open surgical bypass)
Indicated when
- Ass w/ peripheral embolization
- >2cm
- Mural thrombus present
How do you treat a pseudoaneurysm femoral artery?
Pseudoaneurysm femoral artery – US compression or thrombin injection
How do you treat a primary femoral aneurysm?
Primary femoral aneurysm - Open surgery w/ prosthetic interposition grafting
Admit for aortic dissection if
acute
needing urgent surgical repair (ALL Type A and Type B with malperfusion, rupture, symptoms, uncontrolled BP)
How do you treat an acute aortic dissection medically?
beta blockers (cardioprotective) + BP control (sodium nitroprusside or nicardipine) –> 100-120/60-70
What are additional treatments for aortic dissection?
IV CCBs - nicardipine
Additional - nitroprusside for HTN
Morphine sulfate for pain
Long term BB for HTN
How do you treat a Type A aortic dissection?
urgent, transfer to appropriate facility
How do you treat a Type B aortic dissection w/ malperfusion?
URGENT surgery if aortic branch compromise
How do you treat a Type B aortic dissection w/o malperfusion?
BP control
