Vascular Surgery Flashcards
Amaurosis fugax
Sudden onset transiet ulinateral blindness - shade pulled over one eye
Related to TIA
Define Sx carotid stenosis
TIA or stroke in past 6 months
If pt with carotid stenosis is Sx, what is Tx
Stenosis >70-99% = CEA
50-60% = CEA if man, >75 yrs, recent stroke (not TIA), pts w/ hemispheric Sx rather than transiet monocular blindness
If pt w/ carotid stenosis is asymptomatic, what is Tx
stenosis 60-99% CEA is indicated
<60% medical management
Medical management carotid stensosi
AntiHTN meds
Statins
Antiplatelet Tx
ABI normal
ABI mild disease
ABI moderate disease
ABI severe disease
- 9-1.2
- 8-0.9
- 5-0.8
<0.5
Tx claudication
Smokeing cessation
Exercise
Control Chol, DM< HTN
Antiplatelet: ASA or clopidogrel
Cilastazol if intermittent
Beta blockers may worsen but some may need (prior MI)
When to consider revascularization in PVD?
Rest pain in forefoot at night relieved with foot over bed, cannot continue current lifestyle
Gold standard eval PVD
CT angio
Leriche syndrome
claudication buttocks, buttock atrophy, importence in men
Aortoiliac occlusive disease
Need bypass graft or stent or endograft
Postprandial abdominal pain related to vascular problem
Meseneric ischemia
Cause subclavian steal syndrome
Left subcalvian artery obstruction proximal to origin of vertebral artery
TO get blood to arm, steals from vertebrobasilar system - CNS Sx (Vertigo, syncope, confusion, ataxia) w/ UE claudication during exercise
Tearing or ripping chest pain
Aortic dissection
Localized leg pain, varicose veins, superficial cordlike induration, reddish discoloration, mild fever
Tx
Superficial thrombophlebitis
NSAIDS
Do not need anticoagulation
UE paresthesias, weakness, cold extremities, edema, venous distension
Thoracic outlet syndrome
Absence of CNS sx = not subclavian steal
