Internal Medicine

P1: SBT

0521779407-04a CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:48

182 Atherosclerotic Occlusive Disease

➣Used if discrepancy between duplex and MRA findings

➣Risk of stroke (1%)

■Angiogrophy: Aortogram+runoff (lower extremities)

➣Often required to confirm diagnosis of mesenteric or renal steno-

sis

➣Lateral aortogram needed to visualize mesenteric orifices

➣Used only as a preoperative study (not for diagnosis) in lower

extremity occlusive disease

➣Can be done with gadolinium (MRA constrast) to minimize renal

risk in patients with renal insufficiency

differential diagnosis

Carotid Artery Occlusive Disease (TIA or Stroke)

■Intracranial tumors (often causes global neuro Sx (headache) r/o

with CT or MRI)

■Intracranial vascular lesion (i.e. aneurysm, AVM) (may need intracra-

nial views on angio to exclude)

■Arrhythmia causing neuro symptoms (rarely causes unilateral ocular

symptoms or focal neuro changes)

■Other source of embolic stroke (usually cardiac) (difficult to prove

origin of cerebral embolus if patient has multiple possible sources

i.e. aortic and carotid lesions)

Visceral Occlusive Disease (Intestinal Angina)

■Gastroesophageal reflux

■Gallbladder disease

■Variant angina

■Intra-abdominal malignancy

■Chronic pancreatitis

Renal Artery Occlusive Disease (Hypertension, Renal Insufficiency)

■Parenchymal renal disease (appropriate serum and urine tests)

■Diabetic nephrosclerosis (difficult to differentiate from ischemic

nephropathy)

■Hypertensive nephrosclerosis (difficult to differentiate from ische-

mic nephropathy)

■Essential hypertension (usually well-controlled by medications)

Lower Extremity Occlusive Disease

■Neurogenic claudication (requires sitting for relief, brought on by

prolonged standing)