Q1 Echocardiography and full lab investigations especially lipid profile
Q2 smoking cessation
Q3 aortoiliac occlusion from infra renal till CFA, tasc d
Q4 kissing stent, CERAB and open surgery
Q5 in this case I would recommend open surgery either aorto bi fem if the patient fit, or trial endovascular if not
A1 cbc , s CRT , ecg , cardiology and chest fitness. LVEF and PFT.
A 2 smoking cessation and hypertension control
A3 aortoiliac oclussion from the intrarenal aorta till both CIA CTO and opacification of bot CFA
A 4 BMT smoking cessation, htn control and supervised exercise program, antiplatelet and statin
Endovascular repair witb CERAB as there’s involvement of distal aorta , open repair with aorto bi fem graft
A5 i would choose open repair in this case due to the long segment CTO and distal aortic occulsio. Task c/d
Aortobi fem if anesthesia fit
Or otherwise axillo bi fem.
Q1:
this female patient with bilateral disabling claudication
full blood count and lipid profile kidney function tests and ECG
duplex assessment
CTA
Q2:
smoking cessation and lipid lowering drug and control of hypertension and life style modification with supervised programmed exercises
Q3:
juxtarenal occlusion of the aorta extended to both common iliacs and diseased stenosed external lilacs with refill both CFA
Q4:
TASC D lesion for either open surgical repair with aortobifemoral bypass if patient is fit for anesthesia and aortic cross clamping
or endovascular repair with CERAB
Q5:
i would prefer CERAB with covered stents
A1
Full lab(cbc, pt ptt inr, Urea, creat, lipid profile)
…..
A2
HTN
Smoking
Dislipidemia (if its found)
……
A3
Total occlusion of infrarenal aortoiliac oculsion bilaterally
…..
A4
BMT ( anticoagulant-antiplt-statin-vasodilator)
…..
A5
This is tasc d for open is the best
I will do aorto bi fem
Or axillo fem fem
Q1
Lap investigation
S creat
Lipid profile
Hba1c
Radiology:
Echo
Stress echo
Pulm function
CTA
Q2
Control htn, smoking, dyslipedemia
Q3
Total occlusion of
juxta renal aorta
Both CIA
Both EIA
Q4
1-life style modification
2-stop smoking
3-control BP
4- BMT ( anticoagulant-antiplt-statin-vasodilator)
Q5
If failed medical ttt
…this case of TASC D classification
TAsC D recommended for endovascular 1st as ESVS 2017 guide lines
Chimney aortic stent with both iliac A covered stent
If failed
Aorto bi fem if pt fit for surgery
If not axillo bi fem recommended
Q1
Q2
Q3
Q4
Q5
…this case of TASC D classification
Q1 Echocardiography and full lab investigations especially lipid profile
Q2 smoking cessation
Q3 aortoiliac occlusion from infra renal till CFA, tasc d
Q4 kissing stent, CERAB and open surgery
Q5 in this case I would recommend open surgery either aorto bi fem if the patient fit, or trial endovascular if not
A1 cbc , s CRT , ecg , cardiology and chest fitness. LVEF and PFT.
A 2 smoking cessation and hypertension control
A3 aortoiliac oclussion from the intrarenal aorta till both CIA CTO and opacification of bot CFA
A 4 BMT smoking cessation, htn control and supervised exercise program, antiplatelet and statin
Endovascular repair witb CERAB as there’s involvement of distal aorta , open repair with aorto bi fem graft
A5 i would choose open repair in this case due to the long segment CTO and distal aortic occulsio. Task c/d
Aortobi fem if anesthesia fit
Or otherwise axillo bi fem.
Q(1):
Investigations:
Labs: CBC, coagulation profile, lipid profile, CRP, Renal functions
ABPI, arterial duplex U/S
Q(2):
Cessation of smoking, control of HTN, walking to improve claudication distance.
Q(3):
Juxta-renal Aorto-iliac occlussive disease with occlusion of both CIA.
Q(4):
Pharmacological treatment: BMT
Open: Aorto- bifem or Axillo-bifem
Endo: CERAB or chimney aortic stenting with bilateral iliac covered stents.
Q(5):
I would recommend open: Aorto-bifem
then, CERAB in case she couldn’t tolerate open repair.
A1 investogations
labs cbc -urea – creat – inr
hba1c – esr -crp
ABI – duplex asessment + CTA
A2 we should control HTN – if there is hyperlipedemia and smoking
A3 total occlusion of infrarenal aorta and total occlusion of Lt and RtCIA and EIA
TASC D
A4 either surgical by bypass
or endovascular angioplasty and stenting
A5 i would recommend open approach if she can tolerate open surgery
and if not , i recommend CERAB over kissing stenting
ABI
CTA
Smoking cessation
HT control
Ttt of dyslipidemia
Aoroiliac oclusive disease juxtrarenal
Surgery Vs endovascular according to patient fitness
If patient fit surgery aorotbifem
If patient fitness is questionable cerab+renal protection
A1:
Full lab (CBC, lipid profile, renal)
ECG
A2:
Smoking cessation
Control HTN
A3:
Occlusion of Aorta juxtarenal with occlusion of boh CIA
A4:
Lifestyle modification
BMT
A5:
Chimney aortic stent with both iliac covered stent
A1:
Prepare for anesthesia fitness cardio respiratory functions
A2:
Control htn stop smoking adjust the modifiable risk factors
A3:
TASC d total occlusion aorta juxta renal
With bilat CIA occlusion
A4:
CERAB with bilat renal a baloon securing the renals during theaortic stent debloyment
OS aorto bi iliacs
A5:
For the patient age i will cosider CERAB
Q1:
this female patient with bilateral disabling claudication
full blood count and lipid profile kidney function tests and ECG
duplex assessment
CTA
Q2:
smoking cessation and lipid lowering drug and control of hypertension and life style modification with supervised programmed exercises
Q3:
juxtarenal occlusion of the aorta extended to both common iliacs and diseased stenosed external lilacs with refill both CFA
Q4:
TASC D lesion for either open surgical repair with aortobifemoral bypass if patient is fit for anesthesia and aortic cross clamping
or endovascular repair with CERAB
Q5:
i would prefer CERAB with covered stents
A1
Full lab(cbc, pt ptt inr, Urea, creat, lipid profile)
…..
A2
HTN
Smoking
Dislipidemia (if its found)
……
A3
Total occlusion of infrarenal aortoiliac oculsion bilaterally
…..
A4
BMT ( anticoagulant-antiplt-statin-vasodilator)
…..
A5
This is tasc d for open is the best
I will do aorto bi fem
Or axillo fem fem
A1.. I will ask for full lab(CBC, LFT,and KFT) .
Serological markers
ECG , ECHO and pulmonary function test
A2.. DM,
HTN, DYSLIPIDEMIA and smoking cessation and life style modification
A3.. in CTA there is occlusion of Aorta from just below renal vessels with occlusion of both CIA and EIA
A4.. multiple options are available as
KISSING STENTS ,
CERAB, and
aortobifem bypass
Axillo bifemiral bypass
5..
for this old aged patient I will prefer to start with endo vascular options as CERAB with chimny for both renal vessels
Q1
Lap investigation
S creat
Lipid profile
Hba1c
Radiology:
Echo
Stress echo
Pulm function
CTA
Q2
Control htn, smoking, dyslipedemia
Q3
Total occlusion of
juxta renal aorta
Both CIA
Both EIA
Q4
1-life style modification
2-stop smoking
3-control BP
4- BMT ( anticoagulant-antiplt-statin-vasodilator)
Q5
If failed medical ttt
…this case of TASC D classification
TAsC D recommended for endovascular 1st as ESVS 2017 guide lines
Chimney aortic stent with both iliac A covered stent
If failed
Aorto bi fem if pt fit for surgery
If not axillo bi fem recommended