[16] Surgery for PVD Flashcards
(30 cards)
Most Common Location of an Aneurysm
Abdominal Aorta
Growth Rate of an AAA
3.3-4mm/year
Good Cheap Diagnostic Test for Aneurysms
Ultrasound
Do you operate on all aneurysms?
Risk of rupture is 1%
Risk of major surgery 1-2%
Up to you DJ Villeza
Gold Standard for Diagnosing Carotid Artery Stenosis
Contrast Angiography
Define: Claudication
Pain experienced in a functional muscle unit, usually when blood flow is insufficient during activity
How to Relieve Claudication
Rest
Formula: Ankle-Brachial Index
ABI = Ankle Systolic Pressure / Brachial Artery Systolic Pressure
[Example: Ankle-Brachial Index]
Right Arm: 150 mmHg
Right Ant Tib: 68
Right Post Tib: 75
Left Arm: 143
Left Ant Tib: 120
Left Post Tib: 100
ABI = 75/150 = 0.50
ABI = 120/150 = 0.80
ABI is important for diagnosing?
What is its diagnostic value?
How sensitive is it? How specific is it?
Peripheral Arterial Diseases
ABI <= 90
95% Sensitivity and 99% Specificity
Indications for Intervention with Chronic Limb Ischemia
Rest Pain
Tissue Loss
Severe, life-limiting Claudication
Cause of Sudden Onset of Limb Ischemia
Embolism
Embolus vs. Thrombus in an Angiogram
Embolus blockage would cause no collateral circulation to flow either
[T/F] Soft plaques are more prone to embolization
T
Higher chance of chipping off if plaques are soft
Important clinical clue in diagnosing renovascular hypertension
Onset before 30y/o without any risk factors (hypertension in the young)
Which of the following is not a risk factor for AAA? A. Family history B. Diabetes C. Smoking D. Hypercholesterolemia
(c/o Salem, Salliman, Sambo)
B
75% of atherosclerotic aneurysms occurs in the?
c/o Salem, Salliman, Sambo
Distal Abdominal Aorta (infrarenal artery)
Usual presentation of AAA in PE
c/o Salem, Salliman, Sambo
Pulsatile mass on abdomen (do not confuse with transmitted pulse)
Which is the current standard for quick diagnosis and screening for patients with suspected AAA?
(A) Abdominal X-ray
(B) Ultrasound Duplex
(C) CT Aortogram
(c/o Salem, Salliman, Sambo)
B. Ultrasound duplex is also the most practical diagnostic test in our local setting.
CT Aortogram is still the gold standard, more accurate than Ultrasound duplex but more EXPENSIVE.
Abdominal X-ray doesn’t give much for diagnosis
Approach and management of AAA with a diameter >5.5 cm
c/o Salem, Salliman, Sambo
Evaluate for repair
AAA <5.5 cm: do only ultrasound surveillance
Most commonly used method for open surgery of AAA
c/o Salem, Salliman, Sambo
Midline Laparotomy
Common finding/s in the history and PE of patient with Carotid Artery Disease EXCEPT: (A) Bruit (B) Murmur (C) Absence of carotid pulse (D) Hollenhorst plaque
(c/o Salem, Salliman, Sambo)
B
What is the syndrome of increased arterial pressure due to decreased kidney perfusion
(c/o Salem, Salliman, Sambo)
Renovascular Hypertension
What physical examination finding will be definitive for an abdominal aneurysm?
(A) Pulsatile abdominal mass
(B) Transmitted pulses from a pulsatile mass in the abdomen (C) Presence of a palpable abdominal expansile tumor
(c/o Salem, Salliman, Sambo)
C
