VESAP Study Guide
VESAP Study Guide
VESAP Study Guide
Optimal imaging modality to determine the etiology of his symptoms? CT angiogram C/A/P
Patient with recent surgery has an acute thrombus is his external iliac with reconstitution. Wire is easily
crossed through the occluded segment.
- Use of covered stents allows for immediate restoration of flow when thrombolysis is
contraindicated
- No bare-metal stents --- risks “cheese -grating” of thrombus with distal embolization
- Distal external iliac is an area of repetitive motion self-expanding stent is better
- ** For such scenarios, use of embolic protection devices may be warranted
Absolute contraindications for catheter-directed thrombolysis for treatment of acute limb ischemia
- Absolute contraindications
o Recent GI bleed
- Relative contraindications
o Recent eye surgery
- Thromboangiitis obliterans
- Adventitial cystic disease
- Popliteal artery entrapment
- Chronic exertional compartment syndrome
- Lower Extremity Trauma
- Infectious embolism
- FMD
- Vasculitis
- Middle Aortic Syndrome
- Persistent Sciatic Artery
Adventitial Disease
- Classically associated with loss of distal pulses with knee flexion (Ishikwawa’s Sign)
- Characterized by mucin-containing (eccentric proteohyaluronic acid-containing cysts)
- Can affect the popliteal, iliac, radial, ulnar arteries, and peripheral veins
- CTA or MRA --- differentiate between adventitial cystic disease from popliteal entrapment
-
External Iliac Artery Endofibrosis
- Inflammatory vasculopathy that affects small and medium-sized arteries and veins
- Strongly associated with heavy tobacco use
- Most patients between 20-40 years of age
- More common in male (3:1)
- Patients typically present with claudication that can progress to limb ischemia
- Tx: Complete abstinence from tobacco
- Symptomatic compression of the popliteal artery due to abnormal relationship with medial head
of the gastrocnemius muscle or a popliteus or fibrous band
- Seen in up to 3% of the population
- Types:
o Type 1: Popliteal artery is in abnormal anatomical position
o Type 2: Medial head of gastrocnemius muscle and compresses popliteal (normal
position)
o Type 3: Accessory component of gastric muscle compresses popliteal (normal position)
o Type 4: Popliteus muscle or fibrous band compresses the popliteal (normal position)
o Type 5: Types 1-4 and the popliteal vein is also impinged
- cessation of warfarin
- IV vitamin K
- Fresh frozen plasma (fastest way to replace vit K dependent factors)
- Alternative anticoagulant
Patient may have HIT. Which labs are you looking for?
- Platelets:
o Drop of 50% of greater or absolute count of < 100,000
- ** Typically present 3-14 days after initiation of heparin therapy (but can present sooner if
patient has already been exposed to heparin)
- Dx: ELISA assay for heparin antibody
Dialysis Access