PVD: Aortic. PAD

Question 1

Most common site for thoracic Ao aneurysm?

Answer 1

Desc thoracic Ao

Question 2

Timing of Ascending TAA repair

Answer 2

> 5.5cm for most patients

>4.5cm for bicuspid AV, Marfans or Ehlers-Danlos

Question 3

Timing of descending TAA repair

Answer 3

> 6.5cm

Question 4

Can you do endovascular repair for an ascending Ao aneurysm?

Answer 4

No

Question 5

Surgical morbidity for descending TAA repair

Answer 5

Paraplegia

Question 6

Is open surgery or endovascular preferred for AAA repair?

Answer 6

Endovascular

Question 7

What is difference in mortality b/w endovascular or open AAA repair? Morbidity?

Answer 7

None

Lower morbidity with endovascular

Question 8

Timing of repair of AAA

Answer 8

> 5.5cm

Question 9

What to do with pt with AAA 4-5.4cm?

Answer 9

U/S or CT every 6-12 months

Question 10

What to do for pt with AAA <4cm?

Answer 10

U/S every 2-3 yrs

Question 11

When do you repair a AAA regardless of diameter?

Answer 11

sxs

Question 12

Guidelines for management of AAA

Answer 12

4cm- U/S every 2-3 yrs
4-5.4cm- U/S or CT every 6-12months
5.5cm- repair

Any sxs = repair

Question 13

USPSTF recs for AAA screening

Answer 13

Screen any man age 65-75 who ever smoked

No routine screening for women (even with family hx)

Question 14

When can you screen a person for AAA if they have a first degree relative with AAA?

Answer 14

When it is a MAN 60 yrs old or older (not women)

Question 15

When do you intervene on a lower ext aneurysm?

Answer 15

> 2cm

Question 16

Where are lower ext aneurysms most commonly found?

Answer 16

Popliteal 80%

Iliac 20%

Question 17

50% rule for lower ext. aneurysms

Answer 17

50% bilateral
50% assoc. w/ AAA (should screen)
50% asymptomatic

Question 18

What to do if a pt has lower ext aneurysm?

Answer 18

Imaging of contralateral ext and AAA screen
If lesion >2cm, repair
If lesion <2cm, annual imaging

Question 19

Which medication increases functional capacity in claudication?

Answer 19

Cilostazol

Question 20

How to calculate ABI

Answer 20

Take ipsilateral Highest ankle pressure. Divide it by HIGHEST brachial pressure on EITHER side.

Question 21

What is a normal ABI?

Answer 21

.91-1.3

Question 22

What is an abnormal ABI?

Answer 22

< .9

Question 23

ADA rec for screening diabetics for PAD

Answer 23

Do ABI in diabetics > 50 y/o, if normal, repeat in 5yr

Question 24

What med can you use for an asymptomatic pt with PAD?

Answer 24

Aspirin

Question 25

Class I recs for patients with PAD

Answer 25

ASA
Antihypertensives, DM, smoking cessation
High dose statins

Question 26

Do you use DAPT for PAD?

Answer 26

No. Single therapy.

Question 27

When do you use Plavix in PAD?

Answer 27

As alternate to ASA

Question 28

What is the most high yield Rx for pt’s with PAD and intermittent claudication?

Answer 28

Home exercise

Question 29

What is the blackboard warning for cilostazol

Answer 29

Do not give in CHF

Question 30

What is the class of recommendation for prophylactic endovascular intervention on an asymptomatic pt with lower ext PAD?

Answer 30

III

Question 31

When can you do intervention on PAD?

Answer 31

Sxs are LIFESTYLE limiting AND inadequate response to exercise and meds and favorable risk of procedure.

Question 32

Can you put a stent in femoral, popliteal, tibial arteries?

Answer 32

No

Question 33

If pt has CLI, which lesion should you fix first?

Answer 33

Inflow (Ao, femoral or iliac)

Question 34

What diameter Ao is considered a AAA?

Answer 34

> 3cm or 50% inc in size c/w prox segment