Vascular Disease

Medical Student Small Group Discussion Topics

Suggested Reading

Current Diagnosis and Treatment: SurgeryChapter 34. ArteriesChapter 35. Veins & Lymphatics

Schwartz's Principles of Surgery, 9eChapter 23. Arterial DiseaseChapter 24. Venous and Lymphatic Disease

Current Diagnosis & Treatment: Surgery, Thirteenth EditionEdited by Gerard M. DohertyCopyright © 2010 by The McGraw-Hill Companies, Inc.

Schwartz's Principles of Surgery, 9e F. Charles Brunicardi, Dana K. Andersen, Timothy R. Billiar, David L. Dunn, John G. Hunter, Jeffrey B. Matthews, Raphael E. Pollock Copyright © 2010, 2005, 1999, 1994, 1989, 1984, 1979, 1974, 1969 by The McGraw-Hill Companies, Inc.

Vascular Disease

Medical Student Small Group Discussion Topics

A 58 year-old lawyer is referred to you for a painful right foot.

Vascular Disease

Medical Student Small Group Discussion Topics

He is an obese male. The foot pain has been present for six months and is painful mostly in the forefoot, especially at night. It is improved if he hangs it over the side of the bed or if he gets up and walks around. He has a two-year history of progressive calf, thigh, and buttock claudication and can now walk only 20 yards.

Vascular Disease

Medical Student Small Group Discussion Topics

?What are other risk factors and history you

should assess in this patient?

Vascular Disease

Medical Student Small Group Discussion Topics

Physical examination reveals an obese male in no distress. BP 180/100 in both arms. A left carotid and bilateral femoral bruits are noted. No peripheral pulses are palpable in the lower extremities below weak femorals. The right foot is reddened with dependency and pallid on elevation. There are no ulcers on the foot or between the toes. Doppler signals are barely audible in his feet.

Vascular Disease

Medical Student Small Group Discussion Topics

?What is your preliminary diagnosis?

Vascular Disease

Medical Student Small Group Discussion Topics

?What if he had a palpable pedal pulse and normal vascular

studies?

Vascular Disease

Medical Student Small Group Discussion Topics

?What further diagnostic studies are indicated?

Vascular Disease

Medical Student Small Group Discussion Topics

?What are your initial recommendations?

Vascular Disease

Medical Student Small Group Discussion Topics

?What is the etiology of this foot pain?

Vascular Disease

Medical Student Small Group Discussion Topics

?What treatment options would you consider if further studies revealed angina pectoris or a positive cardiac stress test

Vascular Disease

Medical Student Small Group Discussion Topics

?• What treatment options would you consider if further studies revealed: • An asymptomatic 70% left

carotid stenosis? • What if symptomatic?

Vascular Disease

Medical Student Small Group Discussion Topics

?What treatment options would you consider if further studies revealed a

50% stenosis of the right renal artery?

Vascular Disease

Medical Student Small Group Discussion Topics

?What treatment options would you consider if further studies revealed

diffuse femoral-popliteal-tibial occlusive disease without complete

occlusion?

Vascular Disease

Medical Student Small Group Discussion Topics

?What treatment options would you consider if further studies revealed

Aorto–iliac occlusive disease?

Vascular Disease

Medical Student Small Group Discussion Topics

A 67 year-old man presents in the ER with the sudden onset of severe back and abdominal pain and a syncopal episode.

Vascular Disease

Medical Student Small Group Discussion Topics

BP 100/60, P 110, R 24. Physical examination reveals a pale, diaphoretic anxious man with a tender pulsatile abdominal mass.

Vascular Disease

Medical Student Small Group Discussion Topics

?What is your preliminary differential diagnosis?

Vascular Disease

Medical Student Small Group Discussion Topics

?Describe your initial management of this patient,

both diagnostic and therapeutic.

Vascular Disease

Medical Student Small Group Discussion Topics

?What is the definitive treatment for this condition? What options

might be considered?

Vascular Disease

Medical Student Small Group Discussion Topics

?Describe any differences, if any, in management if the

patient was completely asymptomatic.

Vascular Disease

Medical Student Small Group Discussion Topics

?What are the major complications which may occur following operation

for this condition?

Vascular Disease

Medical Student Small Group Discussion Topics

?Are there any other medical problems commonly

associated with this condition?

Vascular Disease

Medical Student Small Group Discussion Topics

A 44 year-old woman presents with a swollen left leg with an ulcer over the left medial malleolus.

Vascular Disease

Medical Student Small Group Discussion Topics

She has had a moderately swollen leg for many years following a knee injury. The ulcer began with an abrasion from a minor injury six months ago, which has progressed to a large, very painful ulcer measuring 8 x 15 cm over the lower medial aspect of the leg, with fibrinous exudate over the entire ulcer and a surrounding cellulitis. In addition to the ulcer, there are numerous varicose veins in the left leg which is 5 cm greater in circumference compared to the right leg at both the ankle and calf level. She has palpable pedal pulses.

Vascular Disease

Medical Student Small Group Discussion Topics

?List the possible causes of chronic unilateral leg edema.

Vascular Disease

Medical Student Small Group Discussion Topics

?Which is the most likely cause in this patient?

Vascular Disease

Medical Student Small Group Discussion Topics

?What is Virchow’s Triad?

Vascular Disease

Medical Student Small Group Discussion Topics

?Describe the pathophysiology that results in chronic leg

edema.

Vascular Disease

Medical Student Small Group Discussion Topics

?What prophylactic measures can be employed to prevent

DVT in surgical patients?

Vascular Disease

Medical Student Small Group Discussion Topics

?What patients are at an especially high risk for development of DVT?

Vascular Disease

Medical Student Small Group Discussion Topics

?What is the treatment of acute DVT?

Vascular Disease

Medical Student Small Group Discussion Topics

?What is the treatment of chronic venous insufficiency?

Vascular Disease

Medical Student Small Group Discussion Topics

?When is an Inferior Vena Caval filter indicated?

Vascular Disease

Medical Student Small Group Discussion Topics

?List the differential diagnosis of leg ulceration. What is the

probable cause in this case?What diagnostic tests are

indicated?

Vascular Disease

Medical Student Small Group Discussion Topics

?What is essential therapy in this case? What are surgical options

and when might they be indicated?

Vascular Disease

Medical Student Small Group Discussion Topics

?Differentiate between primary and secondary

varicose veins. What are treatment options for each?

Vascular Disease

Medical Student Small Group Discussion Topics

?What is your recommended

management for this particular patient?

?