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

      • 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

Splenic artery aneurysm

      • 25% mortality with rupture

      • Risk rupture:

        • >2cm

        • increase size

        • pregnancy

        • liver transplant

      • Tx: repair in pregnancy (IR, or ligate)

Heparin and ACT dosing

  • 5000 U standard dose for PVD (50U/kg) and check ACT after 3min and every 30min (goal ACT 200-250)

    • may need redosing

  • 10,000U standard dose for carotids (100U/kg)

    • may need redosing (5000U if ACT < 200)

  • protamine given at completion if ACT > 180

    • within 30min of heparin dose give 1mg/100U

    • within 30-60 min of heparin dose give .5mg/100U

    • >2hr min since heparin dose give 0.25mg/100U