Vascular Surgery Flashcards
Etiology of subclavian steal syndrome
Stenotic plaque in subclavian artery before vertebral branch. Exercise causes reverse flow, stealing blood from brain and shunting it to arm
Signs of claudication in arm with exercise
Simultaneous posterior neurologic signs
(Visual changes, equilibrium problems)
Subclavian steal syndrome
Dx, tx of subclavian steal
Duplex scan showing reversal of flow
Bypass surgery curative
Cutoff for elective repair of AAA
< 4cm observe
> 5-6 cm elective repair
> 1cm/yr elective repair
Tx for unruptured AAA
Endovascular stent inserted percutaneously
What if an AAA becomes tender
Rupture is imminent
Immediate repair is needed
Excrutiating back pain in AAA
Rupture is minutes to hours away.
Emergency surgery required as aneurysm already leaking
Tx for intermittent claudication
Stop smoking, exercise program, cilostazol
Workup of intermittent claudication that is disabling
Doppler study (no pressure gradient then microvascular and no surgery can be done) If stenosis suspected get CT or MRI angio
Tx for claudication with specific areas of stenosis or blockage
Short segment: angioplasty and stenting
Longer segment: bypass graft
Calf pain when laying down prevents sleep
Helps to sit up, dangle legs off bed
Leg skin is atrophic and hairless
No peripheral pulses
Rest pain
Signs of arterial embolization
Pain, pale, poikilothermia, pulseless, parasthetic, paralytic
Dx, Tx for arterial embolus
What if tx delayed
Doppler
Early- thrombolytics
Embolectomy w/Fogarty catheter for complete occlusion
Fasciotomy if tx delayed for several hours
Sudden, severe, tearing chest pain radiating to back
Unequal upper extremity pulses
Widened mediastinum on CXR
Dx, Tx?
EKG, cardiac enzymes to rule out MI
Spiral CT scan
Surgical repair if ascending aneurysm
Management of ascending aortic aneurysm versus descending
Ascending- surgical management
Descending- medical management by controlling hypertension in ICU
