PACES > Vascular > Flashcards

Vascular Flashcards

(35 cards)

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1
Q

What 2 vascular procedures may result in a midline laparotomy scar?

A

Aortobifemoral bypass

Open AAA repair

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2
Q

Risk factors for AAA

A

Modifiable

  • Hypertension
  • Diabetes
  • Hypercholesterolaemia
  • Smoking

Non-modifiable

  • Age
  • Ethnicity
  • Sex
  • Connective tissue disorders
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3
Q

Screening for AAA

A

One off USS scan for all males at 65yo

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4
Q

Monitoring of incidental AAAs

A

If 3-4.5cm and asymptomatic: See vascular team within 12w, then USS every year

If 4.5-5.5cm and asymptomatic: USS every 3 months

If grows to more than 5.5cm, or grows >1cm in 1 year or is symptomatic but unruptured, needs elective surgical intervention

Old/frail = EVAR
Young/healthy = open AAA repair
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5
Q

Risk factors for varicose veins

A

Obesity
Pregnancy
Standing for long periods
Age

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6
Q

Skin changes associated with chronic venous insufficiency

A

Lipodermatosclerosis - extravasation of lipids leads to immune cell recruitment and fibrotic response
Venous eczema - venous stasis causes cutaneous inflammatory dermatitis
Atrophie blanche - angular white scar developing as a result of ulceration
Haemosiderin deposition

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7
Q

Indications for referral for varicose veins

A

Severe symptoms
Skin changes (haemosiderin, lipodermatosclerosis)
Venous ulceration
Superficial vein thrombophlebitis

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8
Q

Mx of varicose veins

A

Conservative

  • Avoid prolonged standing
  • Full length graduated compression (if no PAD)
  • Weight loss
  • Exercise

Surgical

  • Band ligation of saphenous vein
  • Injection sclerotherapy
  • Radiofrequency ablation
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9
Q

Management of superficial vein thrombophlebitis

A

Conservative + avoid DVT

  • NSAID analgesia
  • Compression stockings
  • Exercise

Refer for varicose vein Tx

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10
Q

Venous ulcer features

A

Located in gaiter area (superior to medial malleolus)
Painless
Sloped edge, margins not well defined (as chronically healing
Associated skin changes of venous insufficiency, and varicose veins

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11
Q

Arterial ulcer features

A

Punched out well defined lesions
Painful
Found distally in between toes or on soles of feet

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12
Q

Neuropathic ulcer features

A

Found on pressure points e.g. balls of feet
Occur as a result of repetitive unrecognised trauma
Gradually deepens with time, may develop associated gangrene

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13
Q

Bypass types, indications, procedure and complications

A 
Thoraco-femoral
Aorto-femoral
Aorto-bifemoral
Iliofemoral
Femoro-popliteal
Femoro-femoral

For larger vessels artificial (Dacron, PTFE) grafts may be used, for smaller vessels the long saphenous vein is generall used in an autologous graft

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14
Q

Presentation of intermittent claudication

A

Leg pain on exertion - distance normally reproducible, progressively shortens as disease worsens
Relieved by rest

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15
Q

Definition of critical limb ischaemia

A

Rest pain/tissue loss
Claudication lasting >2 weeks
Ankle pressure <40mmHg

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16
Q

Management of intermittent claudication

Study These Flashcards
A

RF modification + CV prevention

Conservative

  • Weight loss
  • Exercise programmes
  • Stop smoking

Medical

  • Diabetes control
  • Hypertension control
  • High dose statin
  • 75mg clopidogrel lifelong

Surgery

  • Open/endovascular bypass surgery
  • Amputation (last resort)
17
Q

Ix for peripheral vascular disease

Study These Flashcards
A
  • ABPI
  • Duplex US
  • Digital subtraction angiography
18
Q

ABPI figures

Study These Flashcards
A 
0.9-1.2 = normal
>1.2 = vascular calcification
0.5-0.9 = Moderate ischaemia
0.3-0.5 = Severe ischaemia 
<0.3 = Critical limb ischaemia
19
Q

Indications for limb amputation

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A
  • Dead (severe PAD, thromboangiitis obliterans)
    • Dangerous (sepsis, malignancy)
    • Damaged (trauma, burns, frostbite)
    • Damned nuisance (intractable pain, neurological damage)
20
Q

Causes of thoracic outlet syndrome

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A
  • Hyperextension injuries
    • Repetitive stress
    • Extrinsic compression (e.g. poor posture)
    • Anatomical abnormalities e.g. cervical rib
21
Q

Symptoms of thoracic outlet syndrome

Study These Flashcards
A 
- Venous
		○ DVT
		○ Limb swelling
	- Nervous
		○ Paraesthesia
		○ Motor weakness
		○ Muscle wasting
	- Arterial (common in patients with bony abnormalities)
                 - Claudication Sx
22
Q

Causes of SVCO

Study These Flashcards
A

Malignant

  • Lung cancer
  • Lymphoma

Non-malignant

  • Aortic aneurysm
  • Benign mediastinal tumours
  • Thrombosis
23
Q

Arterial ulcer Mx

Study These Flashcards
A

Conservative
- Exercise programmes

Medical

  • Pain relief
  • CV prevention (statin, antiplatelet, BP, DM)

Surgical

  • Angioplasty
  • Bypass grafting
24
Q

Venous ulcer Mx

Study These Flashcards
A

Conservative

  • Full length graduated compression (clean and dress ulcer first)
  • Exercise
  • Weight reduction

Medical
Pentoxifylline

Treat varicose veins: Ligation/Sclerothearpy

25
What are the standard diagnostic Ix that are used in vascular pathology
Bedside ABPI ``` Imaging Duplex US (2D USS + doppler) Digital subtraction angiography MR angiography CT angiography ```
26
Definitive Ix for acute limb ischaemia
CT angiography
27
Mx of acute limb ischaemia
Immediate Morphine Oxygen IV heparin Prep for threatre (G+S, clotting) Definitive Embolectomy with fogarty (if embolic disease) Thrombolysis (if thrombotic)
28
Fontaine staging of PVD
1: Asymptomatic 2: Intermittent claudication (mild, moderate and severe) 3: Rest pain 4: Minor tissue loss (ischaemic ulcers on digits) 4b: Major tissue loss
29
Types of amputation
Above knee Below knee Transmetatarsal Hallux/toe Decision depends on disease process, co-morbidity of patient etc.
30
True aneurysm vs pseudoaneurysm
True aneurysm: Bulging of all layers of vessel wall Pseudoaneurysm: Damage to the wall allows blood to extravasate and pool in surrounding tissue
31
Most common AAA locations
90% infrarenal Juxtarenal Suprarenal
32
Referral time for incidental AAA
>5.5cm = within 2w | 3 - 5.5cm = within 12w
33
Varicose Veins Ix
ABPI (compression contraindicated in severe PVD) Duplex US Superficial veins: Visualise and measure size of incompetent segments Deep veins: Rule out DVT
34
Complications of DVT
PE Chronic venous insufficiency: Post-thrombotic syndrome (valvular damage from DVT leads to long term incompetence) Bleeding from anticoagulation/HIT
35
Compression stockings vs full length graduated compression
Both can be used for the Tx of venous ulcers and varicose veins Graduated compression gives better oedema control, and is more suitable for active ulceration Graduated compression has to be applied by a trained professional; compression stockings are preferred in people who are able to self-care
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