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Acute ARTERIAL OCCLUSION Flashcards

1
Q

Cause of ACUTE ARTERIAL OCCLUSION

A

Embolism
Causes:
Atrial Fibrillation

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2
Q

6Ps of ACUTE ARTERIAL OCCLUSION

A

Pain
Pallor
Paresis
Paresthesia (Complete loss of sensation)
Poikilothermia
Pulselessness (LATE Sign)

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3
Q

🩺 IOC of ACUTE ARTERIAL OCCLUSION

A

Duplex Scan

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4
Q

Duplex finding in NORMAL VESSELS

A

Triphasic Flow

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5
Q

💊💉 MANAGEMENT of ACUTE ARTERIAL OCCLUSION
⭐ EARLY presentation (within 6-8hrs)

A

⭐ THROMBOLYSIS
⭐ EMBOLECTOMY: FOGARTY’S BALLON

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6
Q

Identify

A

FOGARTY’S BALLON
⬇️
For EMBOLECTOMY

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7
Q

Why FASCIOTOMY should be done with EMBOLECTOMY?

A

Done to prevent COMPARTMENT SYNDROME

Reperfusion
⬇️
Excess Free Radicles
⬇️
Swelling of Muscles
⬇️
Compartment syndrome

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8
Q

Ps of COMPARTMENT Syndrome

A

Pain (excessive)
Pain on passive stretch
Pulsations can be ➕

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9
Q

Adequate FASCIOTOMY

A

Incise till DEEP FASCIA

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10
Q

💊💉 MANAGEMENT of ACUTE ARTERIAL OCCLUSION
⭐ LATE presentation (> 6-8hrs)

A

Amputation

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11
Q

DISTAL RUN-OFF seen in?

A

Chronic ARTERIAL OCCLUSION
⬇️
DUE TO: Development of COLLATERALS

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12
Q

🧑🏻‍⚕️ Clinical Features of CHRONIC ARTERIAL OCCLUSION

A
  1. Intermittent CLAUDICATION Pain
  2. REST Pain (severe disease)
  3. Sensations ➕
  4. Temperature maintainance ➕
  5. Arterial ulcer
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13
Q

REST PAIN in CHRONIC ARTERIAL OCCLUSION

A

⭐ Worse AT NIGHT
⭐ Patient feels RELIEF when the Leg is HUNG DOWN

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14
Q

As the Block (THROMBUS) ⬆️, CLAUDICATION distance

A

⬇️ ⬇️

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15
Q

BOYD CLASSIFICATION USED FOR

A

Intermittent CLAUDICATION

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16
Q

BOYD CLASSIFICATION

A
  1. Pain on walking, but Pain reduces as patient continues to walk
  2. Pain on walking ➕ Continues to walk despite pain
  3. Pain forces patient to stop
  4. Pain at REST
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17
Q

Why: Pain on walking, but Pain reduces as patient continues to walk

A

Dilution of Substance P

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18
Q

Classifications used for INTERMITTENT CLAUDICATION

A
  1. Boyd classification
  2. Fontaine classification
  3. Rutherford classification
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19
Q

DIFFERENCE BETWEEN INTERMITTENT CLAUDICATION, NEUROGENIC CLAUDICATION & OSTEOARTHRITIS

A
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20
Q

NEUROGENIC CLAUDICATION seen in

A

Lumbar Canal Stenosis

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21
Q

Which CLAUDICATION is relieved when patient BENDS forward

A

NEUROGENIC CLAUDICATION

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22
Q

Site of PAIN in CHRONIC ARTERIAL OCCLUSION

🧠⚡Pain is felt in the muscle group, distal to the block ⚡

A
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23
Q

⚡⚡ MOST COMMON SITE OF PAIN IN CHRONIC ARTERIAL OCCLUSION

A

Calf

DUE TO:
⚡⚡ MOST COMMON ARTERY involved: FEMORAL ARTERY

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24
Q

LERICHE SYNDROME

A

Aortoiliac ARTERIAL OCCLUSION

⭐ Femoral & Distal pulses absent in BOTH LIMBS
⭐ BRUIT over Aorto-iliac region
⭐ IMPOTENCE

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25
Q

EARLIEST SYMPTOM OF LERICHE SYNDROME

A

CLAUDICATION in GLUTEAL REGION (Buttocks, Thigh)

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26
Q

Features of ARTERIAL ULCER

A
  1. Absent Pulsations
  2. Shiny Skin
  3. Loss of Hair
  4. Punched out ulcer
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27
Q

Identify

A

Arterial ulcer

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28
Q

🩺 IOC for CHRONIC ARTERIAL OCCLUSION

A

Duplex scan
Handheld doppler scan

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30
Q

NORMAL value of ABPI

31
Q

High Value of ABPI seen in

A

Calcified Vessels in Diabetic Nephropathy

32
Q

Low Values of ABPI

A

INTERMITTENT CLAUDICATION
⬇️
Rest pain
⬇️
Critical LIMB ischemia / Eminent necrosis

33
Q

Patient becomes 2 times MORE LIKELY progress to deterioration, if ABPI is

34
Q

In patients with NORMAL resting ABPI with suspected arterial compromise
🎯 NEXT STEP

A

Post exercise ABPI

35
Q

Usually after EXERCISE, ABPI

A

Increases ⬆️ ⬆️

36
Q

Patients with rate-limiting Arterial Disease, POST-EXERCISE

A

ABPI decreases ⬇️ ⬇️
(By almost 20%)

37
Q

For every, 0.1% decrease in ABPI below 0.9, risk of cardiac mortality ⬆️ ⬆️ by

38
Q

INVESTIGATION for visualising ILIAC BLOCK in Obese patients

A

MR ANGIOGRAPHY (OR) Digital Subtraction ANGIOGRAPHY

39
Q

Buerger’s disease vs BERGER’S Disease

⭐ Buerger’s Test

A

⭐ Buerger’s Test: done to assess severity of PERIPHERAL VASCULAR Disease
⬇️
In NORMAL individual, elevation of lower limb to 90deg does not produce any pallor

In abnormal, 20deg elevation produces PALLOR & venous guttering

40
Q

Cause of CHRONIC ARTERIAL OCCLUSION

A
  1. Buerger’s disease
  2. Atherosclerosis
41
Q

Thromboangitis obliterans

A

Buerger’s disease

42
Q

Difference between BUERGER’S vs ATHEROSCLEROSIS

43
Q

⭐ Spread of BUERGER’S Disease

⭐ Spread of ATHEROSCLEROSIS

A

⭐ Spread of BUERGER’S Disease
🎯 DISTAL TO PROXIMAL

⭐ Spread of ATHEROSCLEROSIS
🎯 PROXIMAL TO DISTAL

44
Q

⭐ Vessels affected in BUERGER’S Disease

⭐ Vessels affected in ATHEROSCLEROSIS

A

⭐ Vessels affected in BUERGER’S Disease
🎯 Small to MEDIUM Vessels

⭐ Vessels affected in ATHEROSCLEROSIS
🎯 Large to MEDIUM Vessels

45
Q

Corkscrew COLLATERALS are seen in

A

ANGIOGRAPHY of BUERGER’S disease

46
Q

Identify

A

Corkscrew COLLATERALS

47
Q

💊💉 MANAGEMENT of BUERGER’S DISEASE

🧠⚡V-SAFOLA ⚡

A

V: Vasodialators
S: Smoking cessation
A: Analgesics & Rest
F: Fatty food avoid
O: Omentoplasty
L: Lumbar sympathectomy
A: Amputation CONSERVATIVE

Pentoxyphylline

48
Q

Effect of PENTOXYPHYLLINE
🧠⚡used in VENOUS ULCER, BUERGER’S DISEASE ⚡

A

✨ Reduce Viscosity
✨ ⬆️ Microperfusion

49
Q

Why BYPASS GRAFTING CAN’T BE DONE in BUERGER’S disease?

A

⭐ Involves SMALL-MEDIUM vessels ➡️ small diameters

⭐ No distal target vessels

50
Q

INDICATIONS of SYMPATHECTOMY

🧠⚡BARA CHEF ⚡

51
Q

Why LUMBAR SYMPATHECTOMY is 🚫 CONTRAINDICATION in INTERMITTENT CLAUDICATION in BUERGER’S DISEASE?

A

⭐ In REST PAIN: Muscles are dead
⭐ In INTERMITTENT CLAUDICATION: Muscles are VIABLE, but have ⬇️ blood supply

Lumbar SYMPATHECTOMY
⬇️
Cutaneous vasodilation
⬇️
Steals Blood from Muscles
⬇️
Rest Pain

52
Q

⚡⚡ MOST COMMON STRUCTURE WHICH CAN BE MISTAKEN FOR SYMPATHETIC CHAIN

A

Genitofemoral nerve

53
Q

If B/L LUMBAR SYMPATHECTOMY is fone, which structure should be preserved?

A

L1 GANGLION
⬇️
To prevent IMPOTENCE

54
Q

💊💉 MANAGEMENT of CHRONIC ARTERIAL OCCLUSION IN ATHEROSCLEROSIS

A
  1. Angioplasty & Stenting
  2. Bypass GRAFTING
55
Q

BEST TREATMENT FOR CHRONIC ARTERIAL OCCLUSION IN ATHEROSCLEROSIS

⭐ ABOVE KNEE
⭐ BELOW KNEE
🧠⚡A for A & B for B ⚡

A

⭐ ABOVE KNEE
🎯 Angioplasty & Stenting

⭐ BELOW KNEE
🎯 BYPASS GRAFT

56
Q

COMPLICATIONS of ANGIOPLASTY

A
  1. Failure
  2. Hematoma
  3. Bleeding
  4. Thrombosis
57
Q

BEST GRAFT MATERIAL FOR ARTERIAL GRAFTING

⭐ ABOVE INGUINAL LIGAMENT
⭐ BELOW INGUINAL LIGAMENT

🧠⚡ D comes 1st then R⚡

A

⭐ ABOVE INGUINAL LIGAMENT
🎯 DACRON

⭐ BELOW INGUINAL LIGAMENT
🎯 REVERSED SAPHENOUS VEIN GRAFT

58
Q

GRAFT MATERIAL FOR INFRA-INGUINAL ARTERIAL GRAFTING

⭐ BEST GRAFT
⭐ BEST SYNTHETIC GRAFT

A

⭐ BEST GRAFT
🎯 Reversed SAPHENOUS VEIN GRAFT

⭐ BEST SYNTHETIC GRAFT
🎯 PTFE

59
Q

Why SAPHENOUS VEIN is Reversed before GRAFTING

A

Valves don’t interfere in the circulation

60
Q

Gangrene: TYPES

A

Microscopic & Microscopic death of tissue

61
Q

Line of DEMARCATION

A

🎯 Seen in DRY GANGRENE

⭐ Junction BETWEEN Dead & Living Tissue
⭐ Lined by GRANULATION TISSUE
⭐ HYPER-AESTHESIA ➕

62
Q

How DRY gangrene can convert into WET Gangrene?

A

Super-added infection

63
Q

Amputation INDICATIONS

A

Dead: Gangrene
Deadly: Gas gangrene, Sarcoma, Cancer
Damn nuisance: Contracture, sinus/fistula, deformity

64
Q

In Diabetes, Amputation done is

A

Local Amputation of Digits

65
Q

Ray Amputation done if

A

Metatarso-phalangeal joint involvement

66
Q

Trans metatarsal Amputation done if

A

Several Toes affected

67
Q

Size of AMPUTATION STUMP for BELOW KNEE Amputation

A

10-12 cm
Not < 8cm

68
Q

2 ways to do BELOW KNEE AMPUTATION

A
  1. Long POSTERIOR flap
  2. Skew Flap
69
Q

Early COMPLICATION following Amputation

A
  1. Hemorrhage
  2. Infection
  3. Flap Necrosis
  4. DVT
70
Q

Late COMPLICATION following Amputation

A

✨ Pain
✨ Phantom Limb Syndrome

VASCULAR SYSTEM (5 decks)

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