Finals - Surgery > Vascular > Flashcards

Vascular Flashcards

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1
Q

Abdominal Aortic Aneurysm - Definition

A

Dilatation of abdominal aorta >3cm

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2
Q

Abdominal Aortic Aneurysm - Demographics

A

Men > Women

More common >65yrs

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3
Q

Abdominal Aortic Aneurysm - Risk factors

A
  • Smoking
  • Hypertension + Hyperlipidaemia
  • Family History
  • Male gender
  • Increasing age

DIABETES IS A NEGATIVE RISK FACTOR

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4
Q

Abdominal Aortic Aneurysm - Clinical features

A
  • Can be asymptomatic

- Can present with: abdo/back/loin pain+ distal embolism

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5
Q

Abdominal Aortic Aneurysm - Investigations

A
  • Abdo USS: Diagnostic test

- CT with contrast: for measuring diameter

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6
Q

Abdominal Aortic Aneurysm - Screening

A
  • Abdo Ultrasound for Men aged 65
  • Detected AAA will have regular surveillance
  • Usually under surveillance for 3-5 years before intervention
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7
Q

Abdominal Aortic Aneurysm - Management

A

Non-surgical

  • Monitoring (3-4.4cm yrly, 4.4-5.4cm 3 monthly)
  • Address CVD risk factors (incl. statin + aspirin therapy)

Surgical

  • Considered if: >5cm, symptomatic or growing +1cm/yr
  • Unfit patients left until 6cm
  • Open or Endovascular (EVAR)
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8
Q

Ruptured AAA - Risk factors

A

Risk grows exponentially with aneurysm diameter

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9
Q

Ruptured AAA - Types

A

Posterior rupture - 80%
- bleed into retroperitoneal space

Anterior rupture - 20%

  • bleed into peritoneal cavity
  • worse prognosis
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10
Q

Ruptured AAA - Clinical Presentation

A
  • Abdo/back pain
  • Syncope
  • Vomiting
  • Haemodynamically compromised
  • Mass in abdomen
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11
Q

Ruptured AAA - Management

A

ABCDE approach

  • High flow O2 + 2x large bore cannula access
  • Urgent bloods (incl clotting group + save)
  • At least 6 units of blood

Surgical repair

  • If unstable: immediately
  • If stable: imaging first to assess EVAR viability
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12
Q

What is permissive Hypotension

A

In ruptured AAA/aortic dissection systolic kept at 100 to prevent clots being dislodged

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13
Q

Thoracic Aortic Aneurysm - Pathophysiology

A

Degradation of tunica media (middle arterial layer)

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14
Q

Thoracic Aortic Aneurysm - Causes

A
  • Connective tissue disorder (common)
  • Bicuspid aortic valve (common)
  • Trauma/aortic dissection/arteritis/syphilis
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15
Q

Thoracic Aortic Aneurysm - Risk factors

A

Reversible: smoking, HTN, BMI,

Non-reversible: increasing age, male, FH

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16
Q

Thoracic Aortic Aneurysm - Clinical features

A

Pain (depending on which part of aorta)

  • ascending: anterior chest
  • aortic arch: neck
  • descending: between scapulae
Back pain (spinal compression)
Hoarse voice (recurrent laryngeal compression)
SVC compression
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17
Q

Thoracic Aortic Aneurysm - Investigations

A
  • CT with contrast: definitve

- Transoesophageal USS: look for underlying pathology

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18
Q

Thoracic Aortic Aneurysm - Management

A

Depends on area

  • Ascending or arch (>5.5): excise region + replace
  • Descending (>6): Open or EVAR
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19
Q

Aortic Dissection - Definition

A

Tear in intimal (inner) layer of aortic wall

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20
Q

Aortic Dissection - Direction of propagation

A

Tear can propagate

  • Anterograde dissection: propagate towards iliacs
  • Retrograde dissection: propagate towards aortic valve
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21
Q

Aortic Dissection - Classification (Stanford)

A

Type A - involves ascending aorta

Type B - does not involve ascending aorta

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22
Q

Aortic Dissection - Risk factors

A

Reversible: HTN, atherosclerosis

Non-reversible: male, biscuspid aortic valve, connective tissue disorder

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23
Q

Aortic Dissection - Clinical features

A

Tearing chest pain - radiating to back

Examination - tachycardic, hypotensive, new murmur

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24
Q

Aortic Dissection - Investigations

A

CT angiogram - first line
Bloods
Crossmatch: 4 units
ECG

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25
Aortic Dissection - Management
ABCDE approach - High flow O2, IV access Type A (worse prognosis) - immediate surgical management - remove + replace ascending aorta Type B - Uncomplicated: medical (IV beta blockers) Long-term - Life-long anti-hypertensives - Surveillance imaging
26
Chronic Limb Ischaemia - Definition
Symptomatic reduced blood supply to limbs
27
Chronic Limb Ischaemia - Cause
Typically atherosclerosis
28
Chronic Limb Ischaemia - Risk factors
Modifiable - smoking, DM, HTN, hyperlipidaemia | Non-modifiable - age, FH, obesity, inactivity
29
Chronic Limb Ischaemia - Fontaine classification
Stage I - asymptomatic Stage II - intermittent claudication Stage III - ischaemic rest pain Stage IV - ulceration, gangrene or both
30
Chronic Limb Ischaemia - Special test
Buerger's test
31
Chronic Limb Ischaemia - Investigations
ABPI: Gold standard - Normal >0.9 - Moderate 0.5-0.8 - Severe <0.5 CVD risk assessment Thrombophilia screen (for <50s)
32
Chronic Limb Ischaemia - Management
Conservative - smoking cessation, exercise, weight loss Medical - statins, anti-platelet, diabetic control Surgical - angioplasty or bypass surgery
33
Chronic Limb Ischaemia - When to operate
- Very short claudication distance - Rest pain - Poor QoL
34
Critical Limb Ischaemia - Definition
Advanced chronic limb ischaemia Three ways to define 1. Rest pain for 2+ weeks 2. Ischaemic lesions (or gangrene) 3. ABPI <0.5
35
Critical Limb Ischaemia - Investigations
Doppler ultrasound: gold standard - assess severity + locate occlusion Can do CT/MR angiogram
36
Critical Limb Ischaemia - Management
Urgent surgical referral | Potentially amputation
37
Acute Limb Ischaemia - Definition
Sudden decrease in limb perfusion threatening viability of the limb
38
Acute Limb Ischaemia - Cause
1. Embolisation (most common) 2. Thrombosis in situ 3. Trauma (least common - e.g. compartment syndrome
39
Acute Limb Ischaemia - Clinical Presentation
The 6 P's 1. Pale 2. Pulseless 3. Painful 4. Paralysis 5. Paraesthesia 6. Perishingly cold
40
Acute Limb Ischaemia - Rutherford score
Assessment of severity of ischaemia + viability of limb
41
Acute Limb Ischaemia - Investigations
- Routine bloods - ECG - Doppler (both limbs) - CT angiogram
42
Acute Limb Ischaemia - Management
Initial management - high flow O2 + heparin Non-surgical - prolonged heparin (for low rutherford score) Surgical - embolectomy (embolus) or angioplasty (thrombus) Treat underlying cause Rehab
43
Acute Mesenteric Ischaemia - Definition
Sudden decrease in blood supply to bowel
44
Acute mesenteric Ischaemia - Causes
1. Embolism (50%) 2. Thrombus (25%) 3. Non-occlusive (20%) - i.e. shock 4. Venous occlusion (<10%)
45
Acute mesenteric ischaemia - Risk factors
- Smoking - HTN - Hyperlipidaemia
46
Acute mesenteric ischaemia - Clinical Features
- Abdo pain out of proportion to findings - Nausea + vomiting - Signs of peritonism (late stage)
47
Acute mesenteric ischaemia - Investigations
CT scan with contrast: diagnostic test | - shows oedmatous bowel --> loss of bowel wall definition
48
Acute mesenteric ischaemia - Management
Initial - ABCDE approach - ITU input - Broad-spectrum abx - Emergency surgery: revascularisation or resection
49
Varicose Veins - Definition
Tortuous, dilated segment of a superfical vein
50
Varicose Veins - Cause
1. Idiopathic (98%) | 2. Secondary (2%)
51
Varicose Veins - risk factors
1. Prolonged standing 2. Obesity 3. Pregnancy 4. Family History
52
Varicose Veins - Clinical Features
Typically present for cosmetic issues Potential Symptoms: pain, itching, aching, swelling - Worse at night
53
Varicose Veins - Investigations
Duplex ultrasound - Gold Standard
54
Varicose Veins - Management
``` Non-invasive: compression stockings (mainstay) Invasive: - Foam sclerotherapy - Thermal ablation - Vein ligation, stripping + avulsion ```
55
Deep Venous Insufficiency - Definition
Chronic disease caused by failure of the venous system
56
Deep Venous Insufficiency - Causes
Primary: underlying vein defect (connective tissue) Secondary: due to damage - Post-thrombotic/Post-phebelitic - Trauma - Outflow obstruction
57
Deep Venous Insufficiency - Clinical Features
Chronic swollen limb/limbs - can become aching/puritic/painful Venous claudication - bursting pain + tightness on walking
58
Deep Venous Insufficiency - Investigations
Doppler USS - primary investigation | ABPI - assess viability of compression stockings
59
Deep Venous Insufficiency - Management
Conservative: compression stockings + analgesia Surgical: valvuloplasty (less successful)
60
What are the managements for different ulcers
Arterial - C: lifestyle changes, M: statins, S: angioplasty/bypass Venous - C: compression bandaging, M: abx, S: treat varicose veins Neuropathic - C: improve diabetic control + foot hygeine - S: amputation if severe/gangrenous
61
Varicose Veins - Classification
CEAP classification - Clinical features - aEtiology - Anatomical location - Pathological aspects
62
Ulcers - Investigations
- ABPI: for venous this is to assess compression viability - Swabs: for infection - Neurological exam: esp. neuropathic + arterial - Full PVE: for neuropathic
63
Hyperhidrosis - Definition
Sweating in excess of that required for thermoregulation
64
Hyperhidrosis - Causes
Primary: No underlying Cause Secondary: - Pregnancy - Anxiety - Infections (esp TB) - Malignancies (esp lymphoma) - Endocrine (hyperthyroidism, phaeochromocytoma) - Medication
65
Hyperhidrosis - Clinical Features
Primary - Usually focal (hands, feet etc) - Bilateral - Typical onset before 25yrs - >6 months Secondary - Widespread - Worse at night - Look for features of underlying cause (e.g. weight loss)
66
Hyperhidrosis - Investigations
Clinical diagnosis | Blood tests - for underlying cause
67
Hyperhidrosis - Management
Conservative - Lifestyle advice: loose clothing, pads, avoid spice Medical - Aluminium chloride: at night, can cause painful erythema - Anticholinergic agents Surgical - Iontophoresis: electrical current - Botox injections: 2-6monthly - Sympathetectomy
68
Chronic Mesenteric Ischaemia - Pathophysiology + risk factors
Same as chronic limb ischaemia - Athersclerosis causing gradual build up + worsening symptoms - CVD risk factors
69
Chronic Mesenteric Ischaemia - Clinical features
- Post-prandial pain (~10-40 mins after) | - Weight loss
70
Chronic Mesenteric Ischaemia - Investigations
- CT angiogram - gold standard | - CVD risk profile
71
Chronic Mesenteric Ischaemia - Management
- Conservative: modify risk factors - Medical: Statins + antiplatelet therapy - Surgical: angioplasty or bypass
Finals - Surgery
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