Temporal Arteritis

Question: How do you diagnosis and why start steroids?

Answer: 2cm bilateral temporal artery biopsy - steroids are started to reduce the incidence of potential blindness

Carotid Disease

Carotid DiseaseStroke Risk:
-Asymptomatic with stenosis (ACAS Study) >60%: CEA decreases 5yr stroke rate from 11% to 5%.
-Symptomatic with stenosis >70% (NASCET Study) : CEA reduces 5yr stroke rate from 26% to 9%.
-SAPPHIRE Study for carotid stenting in HIGH RISK patients showed decreased morbidity relative to CEA due to decreased MI rate with equivalent stroke prevention outcomes at two years.
Question: When do you preform a CEA?

Answer: 50-70% = medical therapy, CEA if symptoms refractory to medical care, >70% with symptoms, or > 80% stenosis
Question: When do you not preform a CEA?

Answer: If 100% in neuro-intact patient

Question: Most commonly injuried nerve during CEA?

Answer: Vagus - causes hoarseness

Question: Buldging mass 6 months after CEA is?

Answer: Pseudoaneursym - needs reoperation

Question: What is amaurosis fugax?

Answer: atheroemboli to ophthalmic artery

Aneurysms (not abdominal aortic aneursyms)

rupture risk above inguinal ligament, thrombosis/emboli below inguinal ligament - bypass and exclude
Question: When do you operate:
Answer:
    - Splanchnic - repair all (50% rupture risk)
    - Splenic - > 2cm, symptomatic, pregnant or child bearing years
    - Iliac - > 3cm, symptomatic, mycotic
    - Femoral - > 2.5cm, symptomatic, mycotic
    - Popliteal - > 2cm, symptomatic, mycotic, often bilateral, most common complication is embolism (not thrombosis or rupture), screen for AAA
    - Renal - > 1.5cm, symptomatic, mycotic, women who want pregnancy