Vascular Surgery Flashcards
What does a patient with subclavian steal syndrome experience when the arm is exercised (or put above the heads)?
1) claudication of arm – tingling, coldness, muscle pain
2) posterior neurologic signs (visual symptoms, equilibrium problems)
How can you distinguish between thoracic outlet syndrome and subclavian steal syndrome symptomatically?
While both have similar vascular symptoms, subclavian steal features the neurologic symptoms (visual symptoms, dizziness)
How do you diagnose subclavian steal? Treat it?
A Duplex scan showing reversal of flow.
Treatment is bypass surgery
An abdominal aortic aneurysm can be safely observed if it is __cm or smaller.
4
Abdominal aortic aneurysms that grow __ cm/year or faster need elective repair.
1 cm/year
WHat is the treatment of a tender AAA?
Immediate repair! Rupture within a day or 2 is likely
Excruciating back pain in a patient with a large AAA?
Retroperitoneal hematoma! Blowout is minutes or hours away, and immediate repair is indicated
What is the first clinical manifestation of arteriosclerotic occlusive disease of the lower extremities?
Intermittent claudication: pain brought about by walking and relieved by rest
When is prophylactic surgery for arteriosclerotic occlusive disease of the lower extremiteis performed?
Never! No role for it because unpredictable natural history. Surgery only if there are disabling symptoms or to save the extremity from impending necrosis
What is the treatment of arteriosclerotic occlusive disease of the lower extremity?
Exercise, weight loss, cessation of smoking, cilostazol (PDE inhibitor that causes vasodilation of arteries and decrease of platelet clotting)
The workup of disabling intermittent claudication starts with
If positive, what next?
Doppler studies looking for a pressure gradient, If one is found, CT angio or MRI angio
If Doppler studies reveal no pressure gradient in the workup of disabling intermittent claudication, what does that mean?
Disease is in the small vessels and is not amenable to surgery
In arteriosclerotic occlusive disease, short stenotic segments can be treated with ____________, while more extensive disease requires bypass grafts, sequential stents, or longer stents.
angioplasty and stents
When multiple sclerotic lesions are present in a lower extremity, (proximal/distal) lesions are repaired first.
Proximal
Which type of vascular grafts are repaired with prosthetic material? Which with reversed saphenous vein grafts?
Prosthetic: aortobifemoral (grafts originating at aorta)
Reversed saphenous vein grafts: between more distal vessels, like femoropopliteal or beyond
What are the penultimate and ultimate stages of arteriosclerotic occlusive disease?
penultimate: rest pain (patient cannot sleep because of calf pain)
ultimate: ulceration and gangrene
What helps relieve rest pain?
Sitting up and dangling legs
What does physical exam reveal in patients with rest pain of the leg?
Shiny atrophic skin without hair and no peripheral pulses
In cases of arterial embolization from a distant source occluding vessels in the extremity, what do you see?
painful, pale, poikilothermic, pulseless, paresthetic and paralytic extremity
Early incomplete occlusion from arterial embolization can be treated with ________, while complete obstructions are treated with ___________. If several hours have passed, what should be added before revascularization?
incomplete, early: clot buster
complete: embolectomy with Fogarty catheter
late: fasciotomy should be performed prior to revascularization
What imaging can diagnose an aortic dissection?
best option: spiral CT
can also use MR angiogram or TEE.
Noninvasive is preferred
As a rule (riddled with exceptions), which dissections are treated surgically and which medically with control of the hypertension?
surgically: ascending dissections
medically (control of HTN): descending dissections
