Vascular Surgery

- ABI: normal 1 or more; claudication <0.6; rest pain <0.4.

- DBI is the upper extremity equivalent of the lower extremity ankle-brachial index. A DBI under 0.7 denotes obstruction to flow.

- False ABI readings seen in Pts with calcified arteries, especially old diabetics.

Intermittent claudication DDx:

- Neurogenic: nerve entrapment, PIVD

- Arthritis

- Coarctation of aorta

- Popliteal a. aneurysm

- Chronic compartmental synd

- Neuromas

- Anemia

- Diabetic neuropathy

Tx for Claudication:

Conservative: excercise, stop smoking, HTN control, diet, ASA with or without Trental

Surgical: rest pain, tissu necrosis, inf, severe claudication refractory to conservative Tx and affecting quality of life.

Cardiac clearance: check for CAD, AAA. MI is the most common cause of death

Surgical options: bypass graft, angioplasty, endarterectomy, surgical patch angioplasty,

Fem-pop bypass: can use vein or prosthetic graft

Fem-distal bypass: must use vein graft. (peroneal, ant. post. tibial)

LE Amputations: AKA, BKA, Syme's, TMT, Toe, Ray (removal of toe and head of metatarsal)