Vascular Surgery Flashcards
AAA
etiology
types
risk factors
Etiology
- MCC is atherosclerosis
- abdominal full-thickness dialtion of the aorta resulting in a diameter > 3cm or exceeding normal by 50%
- faster expansion = smokers = risk fo rupture and dissection
Types
- infrarenal most common
- superreanl
- pararenal
- juxtarenal
Fusiform = circumfrential around the artery
Saccular = dilation on only one side (berry)
Risk Factors
- white, old man > 65
- smokers
- family history
- HTN, HLD, congential diseases
AAA
symptoms
PE
Symptoms
- asymptomatic
- chronic abd. pain
- low back pain
- heamturia
- sudden onset pain in abd., back or flank with syncopeor shock = RUPTURE (to the retroperitoneal place)
- feel pusitile mass
Screening
- US is best to see it
Diagnosis
- CT scan is gold standard CT angio with contrast
- US is good
Medical manage
- BP management: bblockers and ACE
- Statins
- stop smoking
AAA
Surgical Repair
Indications by size
type
Surgical: open v EVAR
Indications
Immediate Surgical Repair for…
- anyuresum with SYMPTOMS
- anyuresums > 0.5 cm growth in 6 months
Elective repair
- infrarenal or juxtarenal AAA > 5.5cm
- growing anyuresum > 1cm/year
- saccualr one
Postop complciations include
- hernia
- sexual dysfunction
- para-anastomatic anyureusm
- graft thrombosis
- graft infection
the Repair
- go in and graft the aorta
EVAR for AAA
EVAR: endovascualr: interlumenial covered stent through the femoral and illiac arteries
- can be done percut. under local anesthesia
- lower periop. mortality by smae 5 year riak as open
Risks
- higher risk of complcaitions, dissection, pesudoany. leak etc.
so they put the stent in, they leak the anyresum- it will clot and remian there
EndoLeak Complication
- Type 1 : leak from the aorta above or below the stent
- Type 2: a tributart artery wasnt covered and the anyerusm grows
- Type 3: a hole in graft
- Type 4: leaking out of teh stent before it epitheliailed
- Typ 5: they dont know
Carotid Artery Dissection/disease
a dissection or occlusion is bad, but the circle of willis is a closed loop so tehre is collateral circulation
Etiology
- narrowing of the carotid artery usually due to atherosclerosis – increased risk for stroke or TIA
- rated as severe or meoderate
- - MCC is atherosclerosis at the bifurcation of teh carotid into internal and external
RF
- age, men, DM, HTN, HLD, smoking
Symptoms
- asymp.
- TIA or CVA
- heat bruit on exam
Diagnosis
duplex US doppler see the flow
CTA or MRA too
MAangement
Symptomatic pt.
- revascualrization if > 50% stenosis
- if < 50% stenosis = no revasc.
- 50-70% = CEA
- severe 70-99% = CEA
- stent consider if > 70
Aymsptomati
- no revascualizration
- only if > 60% stensosi with high risk of stroke and death due to stroke
Caroid Artery Disease
CEA procedure
CEA: carotide endarterectomy
- bascailly take the clot out, can possible balloon and stent
Revascualrization contraindaicted if…
- < 50% stenosis
- chronic total occulaions: you have collateral so the surgeyr is too risky
Medical Management
- antiplatlet: clopidogrel or aspring
- manage HTN
- statin! gog LDLD < 70
- stop smoking
Complcaitions fo CEA
- stroke
- MI
- Cerebreal hyperperfusion (carotid body is here at bifuracation: but this can resolve)
- infection
Peripheral Vascualr Disease
etiology
risk factors
causes
PVD
Etiology
- any stenosis, occlusion or anyuresum of the lower extremities with a variety of presention of symptoms
Risks
- smoking
- DM
- HTN, LD, older age
causes
- most commonyl due to atherosclerosis
- can be buerger diease
- vasculitis
- trauma
- congenital things, anyr.
Symptoms
- 1/2 symptomatic
- atypical leg pain, claudication (pain + cramps)
- rarely: come in with critical leg ischemia
Advnaced disease
- ischemic pain at arest
- nonhealing wounds
leriche syndrome: aortioilliac obstructive diease
- both LL fatigue, ED and paleness of both legs
PVD
where is the occlusion based on pain
PE
diagnosis
Pain at butt/hip => aortoilliac
pain at thigh => illiofemoral
pain in uppe 2/3 calf = superfical fem.
pain in lower 1/3 calf = popliteal
foot pain = tibal or perioneal
PE
- distal hair loss
- trophic skin cahnges
- hypertrophic nails
- ulcerations
Diagnosis
ABI: BP in ankle to upper arm
- ABI < 0.9 = PAD dx.
- 1-1.4 = normal ABI
Toe-brachial index
- < 0.7 = PAD
PAD
medical management
MEdical
- stop smkoing
- statin
- antiplatlet: aspring, clopidogrel (or dual)
- anticoag: coumadin or DOAC (ellaquis) for symptoms
- cilostazol: a periphealt vasodialtor to help with symptoms
PAD
surgical revascularization
for those not responding to medical mangement
Percutaneous approach
- not as long term durable
- balloon and stent placement with meds
Surgical
- those who have aortic anyuresm
- those who failed percut. intervention already
- those with lots of vessesl occluded
Surgical = endarterctomy
- direct removal of the obstructive plaque from teh artery
- good for large vessels
Surgical = bypass
- use saphenous vein graft for
- aortofemoral
- iliofemoral
- femorpopliteal most common
Complcaions
- infection
- clot
- pseudoany.
