Internal Medicine

P1: SBT

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

Atherosclerotic Occlusive Disease 185

➣Absolute

➣No distal reconstitution of target vessel

■Lower extremity revascularization

➣Contraindications

➣Absolute

➣No distal reconstitution of target vessel

➣Relative

➣Gangrene too extensive to allow limb salvage

➣Heel gangrene extending to bone

➣Gangrene of thigh or upper calf

➣Inability to ambulate for other reasons

➣Prior stroke or other neurological disease

➣Musculoskeletal disease preventing ambulation

➣Contracture of knee joint greater than 15 degrees

follow-up

Carotid Stenosis

■Lesions (both primary and post-endarterectomy): follow by duplex

scan every 6 months and then yearly if 2 serial scans demonstrate no

change.

■All patients: anti-platelet therapy

Renal and Mesenteric Lesions

■Renal artery lesions (primary and after revascularization): scan with

either duplex (technically difficult) or MRA every year for restenosis

■Mesenteric revascularization: post-revascularization MRA or angio;

follow clinically for recurrent symptoms

Lower Extremity Occlusive Disease

■Claudication: yearly ABI.

■Post stenting: ABI every 6 months.

■Lower extremity bypass graft: duplex studies yearly to detect focal

stenosis before graft thrombosis occurs.

complications and prognosis

Carotid Endarterectomy

■Stroke (<3% in asymptomatic patients, <5% in symptomatic)

■Myocardial infarction (1–4%)

■Perioperative death (1–2%)

■Cranial nerve injury (5–15% transient, <5% permanent)