Arterial.5.chronic ischemia (Investigations and treatment) Flashcards

Question

List of Conservative treatment in Lines of treatment of chronic L.L ischaemia

Answer 1

1. Mild exercises not causing pain "as regular walking for 1/2 to 1 hr/day 2. Complete abstinence from smoking. 3. Correction of anaemia as this helps tissue oxygenation. 4. D.M, HTN and hyperlipidaemia should be corrected. 5. Care of the feet 6. Medications

Answer 2

they help to open the collateral circulation & improve claudication distance

Answer 3

* The reason why It's important | * Procedures

Answer 4

as a patient with chronic ischemia has a compromised circulation and any minor injury to the foot can precipitate gangrene

Answer 5

* Clean the feet daily and keep them dry * Avoid feet trauma, e.g: during nail trimming. * The patient should not walk bare-footed. * Any interdigital fungal infection should be treated * In winter he should wear woolen socks to avoid cold injury. * The patient should not apply external heat.

Answer 6

a. Dipyridamole (persantin) & clopidogrel b. Baby aspirin : c. Pentoxifylline * vasodilators have no role in atherosclerotic vessels

Answer 7

* Trade name of Dipyridamole | * Mechanism of action

Answer 8

Prevents platelets aggregation.

Answer 9

* Dose | * Mechanism of action

Answer 10

150 mg/day

Answer 11

Prevents platelet adhesiveness.

Answer 12

* Trade name | * Mechanism of action

Answer 13

* Improves RBCs deformability | * allowing them to negotiate their way through narrowed small vessels.

Answer 14

1. Critical ischaemia : As denoted by rest pain, ischaemic ulcers or minor gangrene. 2. Severe incapacitating claudication : That interferes with the patient's work and style of life

Answer 15

Surgery in a case of critical ischemia aiming at saving the limb

Answer 16

can be investigated to check if reconstructive vascular surgery can be performed.

Answer 17

* Indications | * Modalities

Answer 18

* Localized segment stricture in large or medium sized artery * Localized ( < 2 cm) * Large medium sized ( aorta ~~ superficial femoral)

Answer 19

1. Percutaneous transluminal angioplasty (PTA) | 2. Intravascular stents :

Answer 20

* Procedures * Success rate * Complications

Answer 21

* A special balloon catheter is introduced percutaneously along a guide wire until it lodges in the stenotic segment * The balloon is then inflated and kept for about one minute to dilate the stenosed segment

Answer 22

Success rate is about 95%

Answer 23

1. Hematoma 2. A-V fistula 3. Restenosis

Answer 24

After balloon angioplasty a stent can be inserted to prevent the elastic recoil of the arterial wall and keep the lumen patent.

Answer 25

1. By-pass surgery : | 2. Thromboendarterectomy

Answer 26

* The idea | * Modalities

Answer 27

The idea is to bypass the obstruction by inserting a graft from the healthy artery above to another healthy artery below the obstruction

Answer 28

* Anatomical By-pass surgery | * Extra-anatomical By-pass surgery

Answer 29

1. Aorto-bifemoral bypass surgery is done using dacron or Gortex 2. Femoro-popliteal bypass using the saphenous vein (best) or Gortex graft 3. Femoro-distal bypass using the long saphenous vein in site or Gortex graft

Answer 30

For aorto-iliac disease

Answer 31

For superficial femoral artery block

Answer 32

For occlusive disease below popliteal artery

Answer 33

Aorto-bifemoral bypass surgery is done using dacron or Gortex

Answer 34

femoro-popliteal bypass using the saphenous vein (best) or Gortex

Answer 35

Femoro-distal bypass using the long saphenous vein in site or Gortex graft

Answer 36

Easy to be handled at time of operation.

Answer 37

It is a knitted (wide bores) graft & thus needs to be pre-clotted to avoid massive hemorrhage when blood flow is established. Liable for degeneration & aneurysmal dilatation. Recently dacron grafts are woven OR coated with albumin or collagen eliminating the need for pre-clotting but increasing the cost of the graft.

Answer 38

polytetraflourethylene "PTFE"

Answer 39

It is a woven (narrow bores) graft & thus does not need pre-clotting. Not liable for aneurysmal dilatation

Answer 40

* Reversed saphenous venous graft | * In situ saphenous venous graft with valvotomy

Answer 41

A segment of the long saphenous vein is harvested and reversed so that the valves do not interfere with blood flow.

Answer 42

The upper and the lower ends of a suitable segment of the long saphenous are used for anastomosis while the vein is left in situ. The valves are destroyed by a valvulotome, and the vein tributaries are ligated.

Answer 43

* Indications | * Modalities

Answer 44

1. Patients unfit for major surgery but with a good run-off. 2. Patients in whom a prosthesis has become infected or thrombosed.

Answer 45

1. femoro-femoral crossover graft (or axillo-femoral) | 2. axillo bifemoral graft

Answer 46

* Indication | * Procedures

Answer 47

To relieve an iliac artery occlusion when the other iliac is patent with a strong femoral pulse.

Answer 48

An 8 mm Dacron graft is tunneled subcutaneously above the pubis & anastomosed to the common femoral arteries on each side

Answer 49

for leriche syndrome

Answer 50

* Procedures | * Indication

Answer 51

This means removal of the thrombus, intima and the inner media leaving a patent lumen that becomes rapidly endothelialized.

Answer 52

* This procedure is applicable for large arteries with localized obstruction, e.g. a localized narrowing in an iliac artery. * Usually not done nowadays due to feasibility of PTA.

Answer 53

Little can be done for these patients Lumbar sympathectomy : Amputation :

Answer 54

* Indications * Disadvantages * Contraindications * Ganglia removed

Answer 55

Persistent ulcer patient with rest pain and ischemic ulcer

Answer 56

Does not improve blood supply of the muscles "worsens muscle ischemia

Answer 57

1. Intermittent claudication | 2. Diabetic patient

Answer 58

as Surgery Cause V.D of skin more than that of muscle

Answer 59

as he is already suffering from peripheral neuropathy.

Answer 60

L2,3&4. L1 is preserved to avoid retrograde ejaculation.

Answer 61

* The proper policy * Indications * Mechanism of Recognition of the proper level * A common mistake performed by a beginner on treating A patient with a limited dry gangrene of a toe

Answer 62

The proper policy is to wait until spontaneous separation occurs or an amputation at the proper level is performed Minimal dry gangrene is not an emergency.

Answer 63

a. Spreading or massive gangrene. b. Spreading infection. c. Severe uncontrollable pain, the patient himself asks for amputation

Answer 64

Palpable popliteal pulse )> Below knee amputation "BKA" Absent popliteal pulse)> Above knee amputation "AKA".

Answer 65

amputation of the toe.

Answer 66

as spread of gangrene may follow the operation.

Arterial.5.chronic ischemia (Investigations and treatment) Flashcards

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