Repair AAA >5cm
Repair fem/iliac aneurysm >3cm
Repair popliteal aneursm >2cm
Repair splenic aneurysm >2cm, symptomatic, anticipating pregnancy
AAA rupture risk is higher in women
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.
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 stent for lesion higher than C2, reoperative neck, prior radiation, high medical risk.
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
25% mortality with rupture
Risk rupture:
>2cm
increase size
pregnancy
liver transplant
Tx: repair in pregnancy (IR, or ligate)
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