Vascular Surgery Flashcards
What is atherosclerosis?
Systemic disease that has multiple manifestations (stroke, TIA, CAD, MI, mesenteric ischemia, AAA, PVD); presence of any one of these should raise suspicion for the others
How do you manage a stroke?
Carotid duplex study, observation for improvement, CEA is not indicated until patient has stabilized
What is a TIA?
Brief neurological deficit that fully resolves within 24 hours; due to thromboembolus from internal carotid arteries
How do you manage a TIA?
Physical exam and carotid duplex
TIA + amaurosis fugax: emboli from carotid travels to retina causing transient blindness. Dx by fundoscopic exam reveals Hollenhorst plaque (a bright shiny spot in a retinal artery)
TIA + aphasia: emboli from left carotid travels to speech center located in the left hemisphere
When do you do a CEA?
Indicated for >70% carotid stenosis with either neurologic symptoms or asymptomatic bruits; complications include 1-3% risk of perioperative stroke, or injury to facial, vagus, or hypoglossal nerve
What is subclavian steal syndrome?
Presents as nothing at rest, but arm claudication and CNS sx with arm activity due to subclavian artery atherosclerosis
Dx: arteriogram
Tx: bypass surgery
How does an arterial embolus present?
6 P’s: pain, pallor, paresthesias, poikilothermia, pulselessness, paralysis, clot source is usually Afib or recent MI
How do you treat an arterial embolus?
Requires urgent revascularization within six hours; give heparin and go to OR for balloon catheter embolectomy +/- fasciotomy
What is compartment syndrome?
Revascularization of acutely ischemic limb results in ischemia-reperfusion injury, causing muscle edema within fascial compartment and the 6 P’s. Treated with a fasciotomy
What is the ankle-brachial index?
Ratio of BP in arm vs. leg; ABI >1.0 is normal, ischemic ABI is 0.6-0.8 (claudication) or 0.3-0.5 (rest pain)
How do you manage claudications?
Exercise-induced ischemia that causes reversible calf pain, MCC is an atherosclerotic SFA
If mild, not indicated for surgery, so exercise and lifestyle changes are recommended
If severe, get Doppler tracing, then arteriogram to localize
What is aortoiliac stenosis and how do you treat it?
Presents as triad of claudication + absent femoral pulse + impotence
Treatment depends on case;bilateral loss of femoral pulse –> aortofemoral bypass graft, single segment iliac stenosis–> angioplasty, high risk pt –> lifestyle changes
What is a severe claudication?
Presents as claudication + rest pain or foot ulcers, common in diabetics; get a vascular workup and arteriogram to determine level of occlusion, and assess general medical status
SFA treatment:
SFA stenosis: reverse GSV to SFA graft
Iliac stenosis: surgical revascularization or balloon dilation
SFA + iliac stenosis: both of the above
SFA + popliteal stenosis: femoropopliteal bypass to the best artery continues with the foot
Multiple obstruction: reconstruction may not be possible, limb amputation indicated
What is post-op management of a bypass?
Daily duplex studies to check for graft stenosis, give aspirin, educate on lipid control and foot care, MCC death is CAD