Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
24 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
MC sites of atherosclerosis
|
Aortic bifurcation (proximal common iliac arteries)
Adductor (Hunter's) Carotid bifurcation Where is the MC place for stenosis of these sites? |
Superficial femoral artery (SFA): MC place of stenosis is adductor (HUNTER'S) canal
|
|
|
workup of peripheral arterial occlusive dz
|
Continuous - wave doppler (duplex U/S)
ABI CT angiography (CTA - only for candidates of invasive intervention - stent placement what are results indicative of claudication vs. rest pain/necrosis on ABI |
normal: >1
claudication: < 0.8 rest pain/necrosis < 0.4 |
|
|
where would you expect stenosis in a smoker with HTN & hyperlipidemia have stenosis?
|
aortoiliac
what about a 70 yo pt with DM, ESRD |
tibial - DISTAL Dz
|
|
|
intermittent claudication is most improved by?
|
smoking cessation & exercise
how is ischemic rest pain relieved during physical exam? |
dependent positioning of leg
|
|
|
ulcer on toes & heels with pale necrotic base?
|
ischemic ulcer from arterial insufficiency
tx? |
pt needs offloading with a boot protecting area & keeping the pressure off of it.
|
|
|
ulcer on medial/lateral malleolus
associated findings: brown discoloration, itching, scaly skin |
venous ulcer.
with stasis dermatitis what if the associated findings were edema and scarring of skin? |
venous stasis ulcer w/ lipodermatosclerosis from longstanding edema & venous congestion.
venous ulcers result from venous insufficiency --> venous pooling --> increased capillary pressure --> and pressure necrosis of the skin |
|
|
presentation of diabetic neuropathic ulcer
|
plantar or lateral foot
foot becomes atrophic & deformed (CHARCOT FOOT*), dry, insensate deforminity results in new pressure points Ulcer is PAINLESS & cannot detect further injury what does a Mal perforans ulcer refer to? |
result from pressure of the deformed, insensate portions of foot
|
|
|
difference btw wet and dry gangrene
|
dry: mummification
wet: infected, malodorous, etiology of SEPSIS tx? |
removal followed by revascularization
|
|
|
Treatment of PAD?
|
stop smoking, control HTN, exercise, statins, cilostazol, ASA, clopidogrel
when would PTA be used |
best in high flow vessels (carotids, iliacs, renals)
|
|
|
indications for surgical treatment of PAD
|
lifestyle limiting claudication, ischemic rest pain, or tissue loss.
pre op? |
imaging to plan procedure:
MRA or contrast angiography (angiogram) |
|
|
bypass for Arteroiliac occlusive dz?
|
artobifemoral bypass
what are the extra - anatomic bypass options? |
axillobifemoral bypass
femorofemoral bypass |
|
|
femoropopliteal dz?
|
FEM POP bypass (use saphenous vein)
bypass for tibial dz? |
femorotibial or popliteal-tibial bypass
|
|
|
foot only amputation?
|
TMA or BKA
knee? |
AKA
|
|
|
toe only for amputation?
|
may be able to do toe only if necrosis is isolated.
amputation of bed - ridden pt? |
AKA!
due to permanent knee contracture/ulceration |
|
|
presentation of acute arterial occlusion?
|
pain
pallor paresthesia pulselessness paralysis poikilothermia (cold) what is the immediate treatment? |
heparinization with postop coags
AGGRESSIVE fluid resuscitation |
|
|
tx if AAO is caused by arterial embolus?
|
embolectomy
|
use fogarty cath.
remove ALL of the clot then send for pathologic exam! (atrial myxoma) |
|
|
treatment if AAO is caused by diffuse PAD and in - situ thrombosis?
|
BYPASS!
|
|
|
|
duration of limb ischemia over 4 - 6 hrs?
|
perform FASCIOTOMY of the 4 compartments of the lower leg
why? |
prevents compartment syndrome
|
|
|
amaurosis fugax, TIA or CVA on presentation would make you suspect what?
|
carotid stenosis
when would you do a carotid duplex US? |
symptoms (TIA)
carotid bruit pt undergoing CABG or other major procedures |
|
|
medical tx for carotid stenosis?
|
HTN, lipids, ASA/clopidogril
what about if pt is asymptomatic w/ >60% occlusion or symptomatic > 70%? |
carotid endarterectomy (CEA) -
**CAN NOT be done 1/ complete occlusion |
|
|
when would carotid angioplasty or carotid stenting be indicated?
|
High risk pt.
risk compared to a CEA? |
lower risk of MI
|
|
|
AAA < 5cm tx?
|
follow up CT every 6 - 12 months
indications for AAA repair? |
>5cm
sxs (pain) growth rate >1cm per year |
|
|
open vs. endovascular repair of AAA?
|
open is shorter, cheaper, and proven.
EVAR: shorter recovery, less morbidity, more expensive, extensive f/u care complications of EVAR? |
graft migration, ENDOLEAK, graft kink/thombosis, aneurysm rupture
|
|
|
risks of popliteal aneurysms?
|
50% contralateral popliteal & 50% AAA
SxS: thromboembolism, compression of vein/nerve - tx? |
ligate aneurysm proximally and distally.
DO FEM POP or POP POP bypass. high amputation rate if thromboembolism |
