VASCULAR PERIPHERAL Flashcards
Berger disease
small to medium-sized arteries and veins and nerves man who smoke upper and lower extremities 20-50-year-old can cause superficial thrombophlebitis HAND AND foot claudication infrapopliteal and brachial artery Segmental occlusions of skip lesions
Aortoiliac system usually spared
surgical treatment and minimal no palpable target vessels for bypass
time was higher his ankle pressure and supine patient in brachial
20 mmHg
Normal ABI
One-1.2
Criteria for peripheral arterial disease ABI
0.9
Claudication ABI
There 0.5-0.7
Rest pain ABI
less than 0.4
ABI findings with chronic renal disease
false elevation of ABI from calcinosis of the medial layer
Causes vessel rigidity off and tibial vessels there is digital vessels and toes
utility transcutaneous oximetry and diabetics
not reliable
Absolute contraindications for thrombolytic therapy
recent stroke or TIA
recent bleeding
Significant coagulopathy
Relative contraindications to thrombolytic therapy
motor and sensory deficit acute limb ischemia recent major surgery Recent trauma Uncontrolled hypertension Intracranial tumor Pregnancy
guidelines for thrombolytic therapy for the time course
after 48 hours increased bleeding risk
With normal motor he consents her exam or sensory deficits only:
heparin and possibly thrombolytic therapy may be used; versus open embolectomy / bypass
treatment for acute limb ischemia with motor and sensory deficit
relative contraindication for thrombolyzes
take this patient to the operating room
treatment for acute limb ischemia with complete motor and sensory loss
amputation almost universal
criteria to define irreversible ischemia
Doppler signal absence venous or arterial system
Duration of ischemia greater than 6-8 hours
Modeling scan
Absence of capillary refill
Complete anesthesia and paralysis
most common site for embolus to lodge and upper extremity
Brachial artery!
Management for brachial artery embolus
If atrial fibrillation related:
( and not presenting with acute coronary syndrome)
Heparinization
to the operating room embolectomy
May be performed under local making an incision at the elbow
Brachial, radial, ulnar arteries isolated
Transverse arteriotomy in the brachial artery proximal to radial and ulnar origins a Fogarty embolectomy
most common cause of occlusion of femoropopliteal bypass a month after surgery
Intimal hyperplasia
Early failure and occlusion of femoropopliteal bypass within 30 days
Technical error
This includes poor choice of target vessel and in adequate caliber of saphenous vein
Failure of femoropopliteal bypass from 30 days to 2 years
Intimal hyperplasia
Leg femoropopliteal bypass occlusion
After 2 years progression of atherosclerotic occlusive disease either inflow or outflow problem
Treatment of femoral occlusion acute onset in patient with a atrial fibrillation 4 hours of neurosensory symptoms
heparin
The femoral embolectomy
where is the occlusion was an absent femoral pulse most likely with embolic disease
Common femoral artery
Which responds best to thrombolytic therapy embolic disease or thrombosis
Thrombolytic therapy is best for thrombosis
Embolism best treated with embolectomy
pros and cons of in situ saphenous vein bypass
in situ:
vasa vasorum maintained
better size match
Kidneys and overall smaller saphenous vein
Due to drainage
More likely to produce technical error
valves must be cut-incomplete valve excision can cause thrombosis
Tributaries must be ligated-and if missed because an adequate distal perfusion
findings of bilateral renal artery stenosis and cause
fibromuscular dysplasia String of beads effects medium-sized arteries Mostly young women internal carotid second most common site after renal arteries The fascia with intracranial aneurysm
Treatment of bilateral renal artery stenosis at
Initial management of medical
Refractory hypertension more responsive to percutaneous transluminal angioplasty stenting not routinely needed!
treatment of renal artery stenosis if failed percutaneous management
open surgical bypass-NOT endarterectomy
Saphenous vein or synthetic graft-curate higher than those with percutaneous approach
Graft choice for renal artery bypass and 6 her old girl
Internal iliac artery! Vein conduit (example saphenous vein) tendon to become aneurysmal over time in kids
acute mesenteric ischemia causes and presentations
embolization:
Cardiac most common source
thrombosis:
Carefully long-standing pain and food fovea
Exam diffuse atherosclerosis and bruits
Mesenteric venous thrombosis:
These are hypercoagulable state
acute venous occlusion needs a massive bowel edema - presentation is often more subtle
nonocclusive mesenteric ischemia:
Shocks or causes hypoperfusion
Sudden onset pain out of proportion elevated lactic acid
Most common site of mesenteric embolism
Proximal branch off of the SMA
celiac artery is rare given the angle of takeoff
Inferior mesenteric artery is rare given small caliber of takeoff
workup for acute mesenteric embolization
CT scan provided the best diagnostic yield initially
Surgery offers best chance of treatment which is SMA embolectomy
Go to the operating room without angiography
His history is suggestive of underlying mesenteric arthrosclerosis or thrombosis with his workup
Arteriography helps plan arterial bypass
A CT scan shows thrombosis and mesenteric vein was treatment
Heparin alone
Providing no peritonitis
Initial management for nonocclusive mesenteric ischemia
Fluids for underlying shock his initial management
typically not lytic therapy
pathophysiology of unilateral renal artery stenosis
this is an ischemic kidney and it produces hypertension
Hypertension is caused by angiotensin II mediated vasoconstriction to increased renin secretion from infected kidney
Increased aldosterone initially to sodium one retention
Pathophysiology of bilateral renal artery stenosis and treatment
There’s no healthy kidney to compensate for fluid and sodium overload that is produced by angiotensin II mediated vasoconstriction-
Congestive heart failure
ACE inhibitor his contraindicated because of decreased glomerular filtration rate
was indicated and contraindicated for bilateral renal artery stenosis
diuretics very helpful
Creatinine clearance reduced
Congestive heart failure
Ace inhibitors contraindicated
most common site were cardiac embolus lodge
common femoral artery next common iliac artery Then was popliteal artery 70% lower extremities 13% upper extremity 10% cerebral 5-10% visceral
thoracic outlet syndrome arterial disease is most commonly caused by
cervical rib
(Arterial involvement at least, and symptom) - arterial component at risk for poststenotic aneurysm
Neurogenic most common
Other causes arterial pathology including one long transverse process of C7 osteoarthritis Scalene hypertrophy Trauma fibrous band
