The Absite Review by Fiser Steven M

Author:Fiser, Steven M.
Language: eng
Format: epub
ISBN: 978-1-4511-8690-1
Publisher: Lippincott Williams & Wilkins
Published: 2013-06-23T16:00:00+00:00

ACUTE ARTERIAL THROMBOSIS

These patients usually do not have arrhythmias

Do have a history of claudication and have signs of chronic limb ischemia and poor pulses in the contralateral leg

Tx: threatened limb (loss of sensation or motor function) → give heparin and go to OR for thrombectomy; if limb is not threatened → angiography for thrombolytics

Thrombosis of PTFE graft → thrombolytics and anticoagulation; if limb threatened → OR for thrombectomy

RENAL VASCULAR DISEASE

Right renal artery runs posterior to IVC

Accessory renal arteries in 25%

Renovascular HTN (renal artery stenosis) – bruits, diastolic blood pressure > 115, HTN, in children or premenopausal women, HTN resistant to drug therapy

• Renal atherosclerosis – left side, proximal ⅓, men

• Fibromuscular dysplasia – right side, distal ⅓, women

• Dx: angiogram

• Tx: PTA (percutaneous transluminal angioplasty); place stent if due to atherosclerotic disease

Indications for nephrectomy with renal HTN → atrophic kidney < 6 cm with persistently high renin levels

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