Vascular Surgery Pearls

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Vascular Surgery Pearls
2010-09-20 22:00:19
Vascular Surgery Pearls

Vascular Surgery Pearls
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  1. Why Should a Beta Blocker be used in Treating an Acute Aortic Dissection?
    • Medical therapy for acute aortic dissection is aimed at decreasing shear stress within the aorta.
    • Although there are many agents to choose from when treating hypertension in patients with acute aortic disease, all regimens should include a beta blocker (like esmolol) unless contraindicated.

    Initiation of a beta blocker before another antihypertensive agent is added is crucial as this will prevent reflex tachycardia associated with vasodilators and other afterload reducers. Reflex tachycardia may worsen the dissection.
  2. Thrombotic occlusion of the IVC is a well-recognized complication of inferior vena cava filter placement. It occurs in what portion of patients, with the most commonly used filters?
    It occurs in up to 11% of patients

    (Annals of EM, Vol. 52, pg. 104).
  3. Can patients develop pulmonary embolism if an IVC filter is already in place?

    1. Clot burden
    at the site of cava-filter insertion (below the filter). Clots can dislodge at this site and slip through the filter.

    2. Embolization around the IVC filter via retroperitoneal collaterals.