Vascular Surgery Flashcards
Intermittent Claudication (IC)
- Reduction of arterial perfusion to an extent that it is inadequate to meet the needs of working muscles
- Common in Gastrocnemius-soleus muscle group
- Never at rest, occurs post exertion of specific amount, disappears quickly after cessation
- Burning, aching, cramping
- No trophic lesions
- Ischemic neuropathy (A delta and C fibers), lactic acidosis
Management of risk factors
- Smoking cessation, if necessary supported
- Weight reduction
- Management of hyperlipidaemia
- Agressive treatment of hypertension
- Antiplatelet therapy
Arterial Ulceration (non-diabetic pt)
- Shallow, nonhealing, pallid erosion of skin
- Unremitting and severe pain
- Tx: urgent revascularization or amputation
- Diffuse, poorly localized aching/burning in distal foot
Gangrene
- Tissue death
- Pain: ischemic neuropathy, skin and subcutaneuous tissue necrosis, osteomyelitis, and ascending infection
- Paradoxically less pain than expected as distal feet may be insensate
Blue toe syndrome
- Atheroembolism to toes or distal foot occurs b/c of digital or branch artery occlusion from clot/atheroma that has embolized into the distal circulation from a proximal source
- Pain is uncommon until digital ischemia is severe
Diabetic foot
- foot pain, nonhealing ulceration, toe gangrene
- underlying pathology
o diabetic neuropathy - structural changes
o inability to fight bacterial infections
o not ischemia
Treatment of the Ruptured Abdominal Aortic Aneurysm
- Diagnosis o Clinical o Imaging - Resuscitation - Surgery o Different options - Complications
Diagnosis – Clinical Presentation of Abdominal Aortic Aneurysm
“Classic triad:” 1. Severe abdominal pain 2. Hypotention - An episode of syncope may be a hint 3. Pulsatile mass - Large girth may obscure Less common symptoms: - Groin/flank pain, hematuria, groin hernia all secondary to increased intra-abdominal pressure - Congestive Heart Failure with JVD and abdominal bruit if patient has ruptured into the Vena Cava
Surgery
OPEN TRANSPERITONEAL OPEN RETROPERITONEAL ENDOVASCULAR AORTO_BIILIACAL BYPASS MESENTERIAL STEAL
Atherosclerotic Disease of the Supra-Aortic Trunks
- 50-61yo mean age (younger than other occlusive atherosclerotic lesions)
- Smoking
- Hypertension
- Diabetes
- CAD concomitant
- Radiation
Something about Atherosclerotic Disease of supra aortic trunk
Atherosclerotic diseases of the aortic trunk generally occur at a younger age than atherosclerotic diseases of other body regions, particularly in those with single vessel supra aortic trunk disease. There may be a more even distribution between the sexes than in other body regions. However, the risk factors are similar, including smoking, hypertension and diabetes, and not unexpectedly, concomitant coronary artery disease is common. Radiation performed for the treatment of cancers, such as breast and hodgkin’s, accelerates the formation of atherosclerotic lesions in a dose dependent fashion.
Diseases of the Supra-Aortic Trunks
- Atherosclerotic disease
- Inflammation
o Takayasu’s Arteritis
o Radiation - Dissection
- Aneurysm
- Thoracic outlet syndrome
- Congenital lesions
Diseases of Supra Aortic Trunks facts
Onto diseases of the supra-aortic trunks. The most common diseases are atherosclerotic which cause an equal number of occlusive and embolic symptoms. Occlusive lesions from inflammation due to takayau’s aryteritis or those due to radiation are far less common. The carotids and subclavians are also subject to dissection and aneurysmal dilation. The more distal subclavians can be affected by thoracic outlet syndrome with permanent focal changes. Congenital abnormalities account for less than 20% of lesions.
Diagnosis of SAT
- Physical examination: o Bilateral brachial cuff pressures o Auscultation for bruits o Palpate pulses carotid, superficial temporal and upper extremity - Duplex - Digital Subtraction Angiography - MRI, CT Angio Diagnosis of the described lesions begins with physical examination, including cuff pressures, palpation of pulses and listening for bruits. Some centers perform duplex of the arch but because of the air and bone in the vicinity, this is challenging and not commonly used as a screening tool. Angiography with late view to look for steal filling vessels retrograde is still the standard. Gadollinium enhanced MRI and CT Angio are now becoming more used.
