67 yrs female
C/O:
bilateral short distance IC, 20-30 yards, struggling to do her daily activities
No CLTI
PMH:
HT, smoker
What investigations will you ask for?
What risk factors would you control?
What are the findings of the CT?
What treatment options would you consider?
What interventions would you recommend?
CBC inr kft lft lipid profile ecg echo
2 stop smoking diet statins exercise
3 aorto iliac occlosin level of renals
4 bmt endovascular osr
5 open
1 CBC inr kft lft lipid profile ecg echo
2 stop smoking diet statins exercise
3 aorto iliac occlosin level of renals
4 bmt endovascular osr
5 open
What investigations will you ask for?
full lab including renal function lipid profile .
Stress Echo or Cardio pulmonary exercise test.
CTA on the whole aorta with both lower libs to detect any femoral or popliteal occlusion
What risk factors would you control?
Hyper lipidemia with maximum dose statins
Dual anti platlet
What are the findings of the CT?
total occlusion of infra renal aorta with oclusion of both CIA
What treatment options would you consider?
there’s two options OSR or Endovascular
OSR include Aorto-bifemoral if the patient is fit
Axillo bifemoral
Endovascular include kissing stent- CERAB- or AFX graft
What interventions would you recommend?
both Aorto bifemoral and CERAB are good options and according to the patient preference as long as the patient is fit for OSR and there’s available facility for endovascular with ESVS 2024 guidlines recommending OSR
Q1: full bloods including renal function and lipid profile, CTA abdominal Aorta and both LL
Q2: smoking cessation, control HTN, hyperlipidemia if present
Q3: CTO of infrarenal aorta and both CIA with run off in both EIA, patent both CFA, SFA, and profunda
Q4: treatment option
BMT and exercise program
surgical: aorto bifemoral bypass, axillo bifemoral bypass
endovascular: CERAB
Q4: first I will recommend control risk factor, BMT and exercise program. (ESVS 2024 Recommendation 45 class I level B), (ESVS 2024 Recommendation 46 class I level A)
If still limb disabling claudication i will go for revascularization
(ESVS 2024 Recommendation 51 class IIa level B)
according to her fitness and surgical risk
if fit for surgery; I will go for Aorto bifemoral bypass (ESVS 2024 Recommendation 58 class IIb level B)
if no fit; I will recommend CERAB
Q1: Full labs, CPET, Echo and CTA
Q2: stop smoking and control HTN
Q3: Aotro-bi-iliac occlusion
Q4: aortobifem bypass or CERAB
Q5: Iwill recommend Aortobifem bypass as the occlusion flush with the ranal arteries and any endovascular management will prevent any future open repair
Q1.CBC KFT LFT PT INR RBS FBS HbA1C lipid profile. Duplex for ABI PSV
ECG ECHO pulmonary function
Q2. HTN and stop smoking
Q3. Occluded infra renal AA both CIA and EIA
Q.4 BMT, lifstyle modification, and exscise
Endo CERAB with protection of renal arteries
Open surgery if pt fit
Q.5
I will started by BMT if no response open surgery if pt fit ( aorto bifem)