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Flashcards in Pestana Vascular Surgery Deck (26)
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1

Patient comes in complaining of sudden onset of visual changes and dizziness and arm claudication when he is bench pressing

subclavian steal syndrome - arteriosclerotic plaque at the origin of the subclavian (right before the vertebral artery branches off) causes reversal of flow in the ipsilateral vertebral artery to supply the exercising arm -> results in posterior neurologic sx (visual ∆, equilibrium problems) + arm claudication since there is insufficient blood flow to the arm

2

What condition predisposes one to the subclavian steal syndrome?

arteriosclerotic plaque at the origin of the subclavian (right before the vertebral artery branches off)

3

Diagnosis and treatment of subclavian steal syndrome?

diagnosis: duplex scanning
treatment: bypass surgery

4

asymptomatic, pulsatile abdominal mass in a 65 yo M

AAA

5

management of an asymptomatic, pulsatile abdominal mass in a 65 yo M

AAA - observe - chances of rupture is almost 0

6

management of an asymptomatic, pulsatile abdominal mass in a 65 yo M >5 cm

AAA - elective repair (endovascular stent) because chances of rupture is very high

7

management of an asymptomatic, pulsatile abdominal mass in a 65 yo M that has increased from 1cm -> 3cm in the last year

AAA - elective repair (endovascular stent) because chances of rupture is very high

8

management of a tender, pulsatile abdominal mass in a 65 yo M

AAA - immediate repair indicated since the pain indicates an imminent rupture

9

management a patient with excruciating back pain in a patient with a known pulsatile abdominal mass

Leaky AAA resulting in a retroperitoneal hematoma is an indication that a blowout into the peritoneum is imminent - emergency surgery

10

management of intermittent claudication that does not interfere with patient's lifestyle

management of intermittent claudication that is disabling

not disabling: no workup indicated

disabling: surgery - relieves disabling symptoms and/or saves the extremity from impending necrosis

11

long-term management of patients with intermittent claudication 3

1) stop smoking
2) regular exercise program
3) cilostazol

12

w/u of patient is disabling intermittent claudication 2

1) doppler to look for pressure gradient; if there is a significant gradient, then proceed to
2) CTA or MRA to identify specific stenotic or obstructed areas and to look for good distal vessels to which a graft can be hooked

13

management of a patient with intermittent claudication that is found to have a short stenotic segment

angioplasty + stenting

14

management of a patient with intermittent claudication that is found to have extensive disease

bypass grafting, sequential stents, or longer stents

15

managmenet of symptomatic atherosclerotic occlusive disease at the aortobifemoral junction

bypass with synthetic grafts

16

managmenet of symptomatic atherosclerotic occlusive disease of vessels distal to the aortobifemoral junction

bypass with saphenous vein grafts

17

Patient that complains of calf pain that is relieved by sitting up and dangling the feet off the bed. Physical exam shows shiny atrophic skin without hair and decreased peripheral pulses

peripheral vascular disease/rest pain

18

management of a patient who suddenly developed painful, pale, cold, pulseless, paresthetic, and paralytic lower extremity

think arterial embolization (likely secondary to a-fib or recent MI). Get a doppler study immediately!

19

management of a patient who suddenly developed painful, pale, cold, pulseless, paresthetic, and paralytic lower extremity; doppler study shows incomplete occlusion

treat with clot busters

20

management of a patient who suddenly developed painful, pale, cold, pulseless, paresthetic, and paralytic lower extremity; doppler study shows complete occlusion

embolectomy with fogarty catheter

21

management of a patient who developed painful, pale, cold, pulseless, paresthetic, and paralytic lower extremity several hours ago; doppler study shows complete occlusion

embolectomy using a fogarty catheter and fasciotomy
(catheter with balloon is inserted into the blood vessel through a clot. The balloon is then inflated to extract the clot from the vessel)

22

risk of dissecting aortic aneurysms of the thoracic aorta is highest in which patient population

poorly controlled HTN

23

XRay shows widened mediastinum

dissecting aortic aneurysm

24

management of patient with suspected dissecting aortic aneurysm

EKG and cardiac enzymes to r/o MI
Spiral CT scan

25

treatment of patient with definitive dissection of the ascending aorta

surgery

26

treatment of patient with definitive dissection of the descending aorta

medical management to control HTN