29 Questions
What is the preferred treatment for symptomatic infected (mycotic) EVAR in elderly and high-risk patients?
Endovascular repair
What is the recommended size threshold for delaying repair in high-risk, non-symptomatic patients?
5.5 cm
Which artery should be reimplanted during the technical aspects of repair?
Inferior mesenteric artery
What should aorto-bifemoral repair ensure to avoid complications?
Flow to at least one internal iliac artery
What are the major complications of aortic aneurysm repair?
Vein injury, impotence, and mortality
What may diarrhea after AAA repair indicate?
Ischemic colitis due to sacrifice of the inferior mesenteric artery
What is a common cause of aortic graft infections?
Staphylococcus and E. coli
Which condition can lead to hyperkalemia, myoglobinemia, myoglobinuria, and renal failure?
Rhabdomyolysis
What is the most likely cause of blue toe syndrome?
Flaking atherosclerotic emboli off abdominal aorta or branches
What is the most common site of peripheral obstruction from emboli?
Common femoral artery at bifurcation of SFA and profunda
Which condition presents with symptoms such as intermittent claudication and changes in symptoms with knee flexion/extension?
Adventitial cystic disease
What is the most common cause of extremity ischemia evolution?
Atrial fibrillation
What is the recommended treatment for threatened limb due to acute arterial thrombosis?
Give heparin and go to OR for thrombectomy
Which condition can result in renovascular hypertension characterized by bruits, diastolic blood pressure > 115, and resistance to drug therapy?
Renal atherosclerosis
What is the most common indication for nephrectomy in cases of renal hypertension?
Atrophic kidney < 6 cm with persistently high renin levels
Which procedure is recommended for treating renal artery stenosis due to fibromuscular dysplasia?
PTA without stent (percutaneous transluminal angioplasty)
What is the most common cause of abdominal aortic aneurysms?
Atherosclerosis
What is the leading cause of death without an operation in cases of abdominal aortic aneurysm rupture?
Hemorrhage
What are the symptoms that may indicate a ruptured abdominal aortic aneurysm?
Back or abdominal pain
What is the emergency management approach for ruptured abdominal aortic aneurysm before proximal control?
Allowing permissive hypertension
At what size does duplex ultrasound surveillance become necessary for abdominal aortic aneurysms?
> 4.0 cm yearly
For which patients is repair indicated at a size of ≥5.5 cm for abdominal aortic aneurysms?
Patients with rapid aneurysm growth
What is the best predictor of long-term patency in lower extremity bypasses?
Graft material
What is the most common site for atherosclerotic occlusion in the lower extremities?
Hunter's canal
What is the treatment for Leriche syndrome?
Aorto-bifemoral bypass graft
What is used to assess Peripheral Arterial Disease (PAD)?
Ankle-brachial index (ABI)
What can give falsely elevated Ankle-brachial index (ABI) in diabetics?
Noncompressible vessels
What are the surgical indications for PAD?
Rest pain, ulceration, gangrene, and severe lifestyle limitations despite medical therapy
What is involved in postnatal angiogenesis?
Budding from preexisting vessels with angiogenin playing a role
Study Notes
Peripheral Arterial Disease (PAD) and Vascular Surgery
- Leriche syndrome is characterized by absent femoral pulses, buttock or thigh claudication, and impotence due to decreased blood flow in the internal iliac arteries.
- Aorto-bifemoral bypass graft is the treatment for Leriche syndrome.
- Hunter's canal is the most common site for atherosclerotic occlusion in the lower extremities, covered by the sartorius muscle.
- Collateral circulation forms from abnormal pressure gradients, such as from circumflex iliacs to subcostal and circumflex femoral arteries to gluteal arteries.
- Postnatal angiogenesis involves budding from preexisting vessels, with angiogenin playing a role.
- Ankle-brachial index (ABI) is used to assess PAD, with values below 0.9 indicating claudication, below 0.5 indicating rest pain, and below 0.3 leading to tissue loss.
- Noncompressible vessels, often in diabetics, can give falsely elevated ABIs, requiring the use of toe pressures or Doppler waveforms.
- Diabetics tend to have disease of trifurcation vessels and feet microvasculature, limiting intervention options.
- Surgical indications for PAD include rest pain, ulceration, gangrene, and severe lifestyle limitations despite medical therapy.
- Vein quality is the best predictor of long-term patency in lower extremity bypasses.
- Duplex ultrasound is the best technique for graft surveillance.
- Complications of reperfusion of ischemic tissue include compartment syndrome, lactic acidosis, hyperkalemia, myoglobinuria, and technical problems with grafts.
Test your knowledge about Leriche syndrome, a condition characterized by absence of femoral pulses, buttock or thigh claudication, and impotence due to reduced flow in the internal iliac arteries. Explore the most common atherosclerotic occlusion in lower extremities and collateral circulation pathways.
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