vascular surgery Flashcards
taking a vascular history
Where do you have pain?
locating the source of the pain
How long have you been in pain?
How long can you walk before
–> helps look at the progression of a disease
you become symptomatic?
Does it resolve with rest?
–> rest pain OR claudication
Does the pain wake you up at night?
–> if they have to get up or dangle their foot that is rest pain
Do you have any wounds/gangrene
Smoker, DM2, HTN, CAD, hyperlipidemia
PAD spectrum
claudication
chronic limb ischemia
acute limb ischemia
calf cramping think problem with
superficial femoral or politeal artery
claudication
Cramping/tiredness in the calves or thighs that comes on with ambulation and is relieved with rest.
Where the pain is located helps to differentiate where the disease is.
Symptoms tend to be just distal to the lesion is. Pain in the thighs/buttocks corrolates with aortio-iliac disease
disabling or non disabling
typically these symptoms have been present for months to years
non-disabling picture
Does not interfere with desired activities
Symptoms have been present for months to years
Pulse exam - Typically palpable pulses, may be diminished
No wounds/gangrene
2+ pulses
treatment of non -disabling claudication
Baseline ABI/TBI
Smoking cessation,
ASA,
statin,
Beta blocker,
control DM
Exercise Regimen
Consider Pletal (anti-platelet)
what is Pletal (Cilostazol)
relaxes muscles in your blood vessels to help them dilate as well as keep platelets from sticking together. Can help patients walk longer without pain
mild to moderate peripheral artery disease ABI
.41-.90
disabling claudication picture
Still not having pain at rests
but symptoms interefe with ADLS
no wounds
treatment for disabling claudication
Smoking cessation, ASA, statin,
Beta blocker
control DM
Arterial Duplex with an ABI
CT Angiogram**
Angiogram
post angiogram pt needs to
Patient to remain flat with the treated leg straight for 6 hours.
Monitor for hematoma, distal perfusion
Check Cr due to the contrast given
Post op check and new baseline ABI/TBI
if a stent is placed what is the management of a patient after
– Plavix load 300mg and then daily Plavix 75 mg for at least three months
chronic limb ischemia
Unable to walk short distances without pain
Forefoot pain that wakes them up at night (Rest Pain)
Cyanosis, dependent rubor, elevation pallor
Decreased pulses, doppler signals
Ulceration, gangrene
diagnostic for chronic limb ischemia
Arterial Duplex with ABI
Vein mapping
CT Angiogram – surgical planning
treatment for chronic limb ischemia
Endovascular Intervention – Angiogram with PTA/stent
Femoral Endarterectomy-router rooter
Lower Extremity Bypass
when would a LE bypass be used
Indications are for a total occlusion we can’t get through during an angio
distal target to sew to
–> need to have something for bipass
Preference is to use a reversed greater saphenous vein. (greatest longevity wiht vein)
bypass grafting with veins involves
reverse the vein so that the valves are not functioning
acute limb ischemia
acute pain
you have 6 hours
5 p’s in order
pain, pulselessness, pallor
followed by parathesias and paralysisi
two sources of acute limb ischemia (which is the most common)
60% caused by a thrombosis – hx of PAD
30% caused by an embolic source – A. fib, recent MI, proximal aneurysm
classes of acute limb ischemia
who is a candidate for thrombolysis
I and II a
Typically done with each other where we will pull out the major clot and leave a catheter in place overnight dripping TPA to break up any little emboli that have traveled distally.
why would you do a 4 compartment fasciotomy folowing a thrombectomy
complications can include compartment syndrome because of the sudden increase in blood flow
typical picture of arterial ulcers
Located on the outer ankles, feet, toes
Painful
Irregularly shaped, punched out appearance
Necrotic tissue present
Little to no bleeding
treatment of arterial ulcers
Treat underlying PAD to improve blood flow
Ulcers – debride necrotic tissue
