1 / 12

History & Physical

History & Physical. 58 yo obese male (VA hospital employee) c/o 6 mo worsening hip, buttock, thigh claudication. Requires 30 minutes to walk 1.5 blocks. Denies rest pain, tissue loss, impotence. PMH: IDDM x 10 years, HTN, morbid obesity (BMI=37), smoking 1ppdx40 years PSH: appy

keenan
Télécharger la présentation

History & Physical

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. History & Physical • 58 yo obese male (VA hospital employee) c/o 6 mo worsening hip, buttock, thigh claudication. Requires 30 minutes to walk 1.5 blocks. Denies rest pain, tissue loss, impotence. • PMH: IDDM x 10 years, HTN, morbid obesity (BMI=37), smoking 1ppdx40 years • PSH: appy • Meds: HCT, lisinopril, atenolol, metformin, aspirin, lovastatin • Exam: diminished femoral pulses bilateral, non-palpable popliteal or distal pulses • Non-invasive labs: monphasic waveforms B ankles, ABI R=0.72, L=0.65

  2. Severe aortic narrowing IMA 4 CM LENGTH

  3. Options • Aorto-femoral bypass • Aortic endarterectomy • Bare-metal stent • Covered stent

  4. ZENITH AAA STENT-GRAFT ILIAC EXTENDER CUFF IS TOO LONG

  5. EXTENDER CUFF IS DEPLOYED ON A SIDE TABLE, CUT IN 1/3, AND REMOUNTED PRIOR TO REENTRY INTO PATIENT’S AORTA

  6. 10mm balloon

  7. 12mm balloon

  8. PATENT IMA

  9. Follow-up • Strong femoral pulses • No further pain with ambulation up to 3 blocks • Discharged home 16 hours post procedure • ABI increased to 0.9 bilaterally

More Related