Vascular Surgery

 

AAA

  • Dx: Patients present with incidental finding, pulsatile mass, leak, infection, or ischemia.
    • CT scan is best to determine size and anatomy of aneurysm.
    • Ultrasound can follow.

Carotid Artery Disease

  • Dx: Patients present asymptomatic, with TIA's, or with stroke.
    • Ultrasound is first line stud
    •  Normal ICA PSV < 125 ICA EDV < 40
       50-70% ICA PSV 125-230 ICA EDV 40-100
       >70% ICA PSV > 230 ICA EDV > 100
    • CTA can be used to better determine location of stenosis
  • Tx: Management is based on symptoms and stenosis
    • Carotid endarterectomy
    • Carotid stent for lesion higher than C2, reoperative neck, prior radiation, high medical risk.

Peripheral Vascular Disease

  • Popliteal exposure above knee:
    • Medial thigh incision.
    • Sartorious muscle is retracted posteriorly.
    • Adductor magnus m. is retracted anteriorly.
    • Enter popliteal fossa.
  • Popliteal exposure below the knee:
    • Medial lower leg incision 1cm below the medial border of the tibia.
    • Gastrocnemius is retracted posteriorly.
    • Enter the popliteal fossa.
  • Toe pressure > 30mmHg is associated with good healing
  • TBI < 0.64 is abnormal, indicateding arterial disease