Q1 Echocardiography and full lab investigations
Q2 DM, smoking and dyslipidemia if found
Q3 diseased infra renal aorta plus CTO of Rt CIA with stenosis of the left CIA
Q4 kissing stent, CERAB, and open aorto bi fem
Q5 I will consider CERAB in this case
A 1 inv as s crt , hba1c , cardiology and chest fitness , ecg, cbc
A 2 smoking cessation with tight glycemic control,
A3 long segment CTO from left CIA tp lt EIA with contrast opacification of CFA.
A4 there could be BMT with supervised execise program and antiplatelet, Statin. As pt has disabling claudication he is kndicated for intervention either endovascular stenting pr open fem fem bypass
A5 i recommend endovascular ttt with kissing stent
As pt is Diabetiv and has IHD, indicated for intervention due to rest pain. Endovascular intervention doesnot preclude future open repair
Q(2):
Cessation of smoking, control D.M, control HTN, cardiology consultation.
Q(3):
Calcification of infrarenal aorta, total occlusion of LT CIA and EIA (TASC D).
Q(4):
Pharmacological treatment: Vasodilators, Antiplatelets and Statins.
Surgical: either Aorto-bifem bypass or Aorto-unifem
Endo: bilateral iliac kissing stents or CERAB
Q(5):
According to the general condition of the patient and surgical fitness (IHD, IHD),then I would recommed CERAB.
A3:
Total occlusion of LT CIA EIA TASC c
Calssification of rt Cia just above iliac bifurcation
A4:
Options for ttt
CERAB
Kissing stents covered
OS aorto unifem plus rt cia angioplasty with or without BMS trying to preserve IIA
Fem fem cross over but low patency only if the patient is unfit for major surgery
A5:
Regarding the patient age 56 for patency but CERAB to be considered in a good hands and it will preserve the surgical option for the future intervntion
Q1:
this male patient is presenting with Bilateral disabling claudication more in the left side
i will order Full blood count , kidney function tests, HBA1c, Lipid profile, ECG
examination of his pulsations bilaterally
duplex assessment of his arterial system lower limb
CTA if the lesion is expected to be above the inguinal ligament
Q2:
glycemic control , smoking cessation , lipid lowering drugs, supervised programmed exercises
Q3:
diseased infra renal aorta and occlusion of the left common iliac artery from the ostium and external iliac artery occlusion with refill in the CFA left side
Q4:
this cosidered TASC D with options to be treated with either open aortobifemoral or endovascular CERAB or kissing stents
Q5:
i would prefer CERAB especially with this patient with IHD and impaired respiratory reserve from smoking
A1
Cbc Urea creat
Pt ptt inr
ECG
Echo
Serologlipid profile
…
A2
Life style modification
DM
HTN
Smoking cessation
Optomize lipid profile
…….
A3
Infra renal aortic atheroscerosis
With
Total rt CIA occlusion
And Lt CIA stenosis
…….
A4
multiple options are available as KISSING STENTS ,CERAB, and Open aortobifem bypass
……
A5
For this young male
I would prefer
Open aortobifem as its more durable
Q1
Lap investigation
Hba1c
Lipid profile
S creat
Radiological
CTA
Echo
Stress echo
Pulmonary function tests
Q2
Dm
Htn
Dyslipedemia
Obesity
Q3
Lt cIA total occlusion
Stenosis at RT cIA
Atheromatous plaque at aortic bifurcation ( causing stenosis)
Q4
Ttt
1-life style modification
2- control risk factors
3- improvement of general condition
4- startig medical ttt till intervention asap
Using statin , anticoagulant,anti plt, vasodilators, metformin
5- endovascular intervention
Q5
This cases is TASC c classification
Unilateral iliac artery occlusion + ext iliac artery occlusion
Favor of endovascular 1st as ESVs 2017 guidelines
CERAB is recommended to decrease haemodynamic disturbsnce , BES recommended if Covered stent not available
If failed aorto uni fem if pt is properly fit for operation
Axillo fem if pt not fit for open surgery
Q1 What investigations will you ask for?
Q2 What risk factors would you control?
Q3 What are the findings of the CT?
Q4 What treatment options would you consider?
Q5 What interventions would you recommend?
Q1 Echocardiography and full lab investigations
Q2 DM, smoking and dyslipidemia if found
Q3 diseased infra renal aorta plus CTO of Rt CIA with stenosis of the left CIA
Q4 kissing stent, CERAB, and open aorto bi fem
Q5 I will consider CERAB in this case
A 1 inv as s crt , hba1c , cardiology and chest fitness , ecg, cbc
A 2 smoking cessation with tight glycemic control,
A3 long segment CTO from left CIA tp lt EIA with contrast opacification of CFA.
A4 there could be BMT with supervised execise program and antiplatelet, Statin. As pt has disabling claudication he is kndicated for intervention either endovascular stenting pr open fem fem bypass
A5 i recommend endovascular ttt with kissing stent
As pt is Diabetiv and has IHD, indicated for intervention due to rest pain. Endovascular intervention doesnot preclude future open repair
Q(1):
Investigations:
Labs: CBC, Coagulation profile, Renal functions, electrolytes, HgbA1C
Radio: Arterial Duplex UlS, ABPI
Q(2):
Cessation of smoking, control D.M, control HTN, cardiology consultation.
Q(3):
Calcification of infrarenal aorta, total occlusion of LT CIA and EIA (TASC D).
Q(4):
Pharmacological treatment: Vasodilators, Antiplatelets and Statins.
Surgical: either Aorto-bifem bypass or Aorto-unifem
Endo: bilateral iliac kissing stents or CERAB
Q(5):
According to the general condition of the patient and surgical fitness (IHD, IHD),then I would recommed CERAB.
A1 investogations
labs cbc -urea – creat – inr
hba1c – esr -crp
ABI – duplex asessment + CTA
A2 we should control DM – cardiac condition and if there is hyperlipedemia and smoking
A3 total occlusion of Lt CIA and Lt EIA and diseased infrarenal aorta segment just above bifurcation
TASC D
A4 either surgical by bypass
or endovascular angioplasty and stenting
A5 i would recommend endovascular approach as patient has IHD and cant tolerate open surgery
and i recommend CERAB over kissing stent
Abi assessment
CTA assessment
Control
DM HT dyslipidemia Smoking cessation
Finding Lt common iliac oclusive disease
Endovascular intervention
Dilatation plus stenting
A1:
Labs
Cbc lipid profile hba1c inr virology kft lft for anesthesia fitness
Imaging
Echo
A2:
Diabetes htn cardiac condition continues smoking cessation diet
A3:
Total occlusion of LT CIA EIA TASC c
Calssification of rt Cia just above iliac bifurcation
A4:
Options for ttt
CERAB
Kissing stents covered
OS aorto unifem plus rt cia angioplasty with or without BMS trying to preserve IIA
Fem fem cross over but low patency only if the patient is unfit for major surgery
A5:
Regarding the patient age 56 for patency but CERAB to be considered in a good hands and it will preserve the surgical option for the future intervntion
Q1:
this male patient is presenting with Bilateral disabling claudication more in the left side
i will order Full blood count , kidney function tests, HBA1c, Lipid profile, ECG
examination of his pulsations bilaterally
duplex assessment of his arterial system lower limb
CTA if the lesion is expected to be above the inguinal ligament
Q2:
glycemic control , smoking cessation , lipid lowering drugs, supervised programmed exercises
Q3:
diseased infra renal aorta and occlusion of the left common iliac artery from the ostium and external iliac artery occlusion with refill in the CFA left side
Q4:
this cosidered TASC D with options to be treated with either open aortobifemoral or endovascular CERAB or kissing stents
Q5:
i would prefer CERAB especially with this patient with IHD and impaired respiratory reserve from smoking
A1
Cbc Urea creat
Pt ptt inr
ECG
Echo
Serologlipid profile
…
A2
Life style modification
DM
HTN
Smoking cessation
Optomize lipid profile
…….
A3
Infra renal aortic atheroscerosis
With
Total rt CIA occlusion
And Lt CIA stenosis
…….
A4
multiple options are available as KISSING STENTS ,CERAB, and Open aortobifem bypass
……
A5
For this young male
I would prefer
Open aortobifem as its more durable
A1.. I will ask for full lab .
Serological markers
ECG , ECHO and pulmonary function test
A2.. DM, HTN, optimizing lipid profile and smoking cessation and life style modification
A3.. in CTA there is atherosclerotic stenosis of infra-renal aorta and RT CIA with CTO of LT CIA and EIA
A4..for this lesion multiple options are available as KISSING STENTS ,CERAB, and Open aortobifem bypass
5..
for this young aged patient I will prefer open ABF as more durable option
1 Full lab … CBC , Creat , INR , LFT , Serology
ECG , Echocardiography
2 Diabetes
Smoking
Dyslipidemia
Obesity and lack of exercise
3 stenosis of distal aorta and Rt common illiac a
Occlusion of lt common illiac a
4 open ABF bypass
Endovascular kissing stent
CERAB
5 CERAB
Q1
Lap investigation
Hba1c
Lipid profile
S creat
Radiological
CTA
Echo
Stress echo
Pulmonary function tests
Q2
Dm
Htn
Dyslipedemia
Obesity
Q3
Lt cIA total occlusion
Stenosis at RT cIA
Atheromatous plaque at aortic bifurcation ( causing stenosis)
Q4
Ttt
1-life style modification
2- control risk factors
3- improvement of general condition
4- startig medical ttt till intervention asap
Using statin , anticoagulant,anti plt, vasodilators, metformin
5- endovascular intervention
Q5
This cases is TASC c classification
Unilateral iliac artery occlusion + ext iliac artery occlusion
Favor of endovascular 1st as ESVs 2017 guidelines
CERAB is recommended to decrease haemodynamic disturbsnce , BES recommended if Covered stent not available
If failed aorto uni fem if pt is properly fit for operation
Axillo fem if pt not fit for open surgery