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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
EARLIEST SYMPTOM OF LERICHE SYNDROME
CLAUDICATION in GLUTEAL REGION (Buttocks, Thigh)
26
Features of ARTERIAL ULCER
1. Absent Pulsations 2. Shiny Skin 3. Loss of Hair 4. Punched out ulcer
27
Identify
Arterial ulcer
28
🩺 IOC for CHRONIC ARTERIAL OCCLUSION
Duplex scan Handheld doppler scan
29
ABPI
30
NORMAL value of ABPI
0.9-1.3
31
High Value of ABPI seen in
Calcified Vessels in Diabetic Nephropathy
32
Low Values of ABPI
INTERMITTENT CLAUDICATION ⬇️ Rest pain ⬇️ Critical LIMB ischemia / Eminent necrosis
33
Patient becomes 2 times MORE LIKELY progress to deterioration, if ABPI is
< 0.5
34
In patients with NORMAL resting ABPI with suspected arterial compromise 🎯 NEXT STEP
Post exercise ABPI
35
Usually after EXERCISE, ABPI
Increases ⬆️ ⬆️
36
Patients with rate-limiting Arterial Disease, POST-EXERCISE
ABPI decreases ⬇️ ⬇️ (By almost 20%)
37
For every, 0.1% decrease in ABPI below 0.9, risk of cardiac mortality ⬆️ ⬆️ by
10%
38
INVESTIGATION for visualising ILIAC BLOCK in Obese patients
MR ANGIOGRAPHY (OR) Digital Subtraction ANGIOGRAPHY
39
Buerger's disease vs BERGER'S Disease ⭐ Buerger's Test
⭐ 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
Cause of CHRONIC ARTERIAL OCCLUSION
1. Buerger's disease 2. Atherosclerosis
41
Thromboangitis obliterans
Buerger's disease
42
Difference between BUERGER'S vs ATHEROSCLEROSIS
43
⭐ Spread of BUERGER'S Disease ⭐ Spread of ATHEROSCLEROSIS
⭐ Spread of BUERGER'S Disease 🎯 DISTAL TO PROXIMAL ⭐ Spread of ATHEROSCLEROSIS 🎯 PROXIMAL TO DISTAL
44
⭐ Vessels affected in BUERGER'S Disease ⭐ Vessels affected in ATHEROSCLEROSIS
⭐ Vessels affected in BUERGER'S Disease 🎯 Small to MEDIUM Vessels ⭐ Vessels affected in ATHEROSCLEROSIS 🎯 Large to MEDIUM Vessels
45
Corkscrew COLLATERALS are seen in
ANGIOGRAPHY of BUERGER'S disease
46
Identify
Corkscrew COLLATERALS
47
💊💉 MANAGEMENT of BUERGER'S DISEASE 🧠⚡V-SAFOLA ⚡
V: Vasodialators S: Smoking cessation A: Analgesics & Rest F: Fatty food avoid O: Omentoplasty L: Lumbar sympathectomy A: Amputation CONSERVATIVE Pentoxyphylline
48
Effect of PENTOXYPHYLLINE 🧠⚡used in VENOUS ULCER, BUERGER'S DISEASE ⚡
✨ Reduce Viscosity ✨ ⬆️ Microperfusion
49
Why BYPASS GRAFTING CAN'T BE DONE in BUERGER'S disease?
⭐ Involves SMALL-MEDIUM vessels ➡️ small diameters ⭐ No distal target vessels
50
INDICATIONS of SYMPATHECTOMY 🧠⚡BARA CHEF ⚡
51
Why LUMBAR SYMPATHECTOMY is 🚫 CONTRAINDICATION in INTERMITTENT CLAUDICATION in BUERGER'S DISEASE?
⭐ 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
⚡⚡ MOST COMMON STRUCTURE WHICH CAN BE MISTAKEN FOR SYMPATHETIC CHAIN
Genitofemoral nerve
53
If B/L LUMBAR SYMPATHECTOMY is fone, which structure should be preserved?
L1 GANGLION ⬇️ To prevent IMPOTENCE
54
💊💉 MANAGEMENT of CHRONIC ARTERIAL OCCLUSION IN ATHEROSCLEROSIS
1. Angioplasty & Stenting 2. Bypass GRAFTING
55
BEST TREATMENT FOR CHRONIC ARTERIAL OCCLUSION IN ATHEROSCLEROSIS ⭐ ABOVE KNEE ⭐ BELOW KNEE 🧠⚡A for A & B for B ⚡
⭐ ABOVE KNEE 🎯 Angioplasty & Stenting ⭐ BELOW KNEE 🎯 BYPASS GRAFT
56
COMPLICATIONS of ANGIOPLASTY
1. Failure 2. Hematoma 3. Bleeding 4. Thrombosis
57
BEST GRAFT MATERIAL FOR ARTERIAL GRAFTING ⭐ ABOVE INGUINAL LIGAMENT ⭐ BELOW INGUINAL LIGAMENT 🧠⚡ D comes 1st then R⚡
⭐ ABOVE INGUINAL LIGAMENT 🎯 DACRON ⭐ BELOW INGUINAL LIGAMENT 🎯 REVERSED SAPHENOUS VEIN GRAFT
58
GRAFT MATERIAL FOR INFRA-INGUINAL ARTERIAL GRAFTING ⭐ BEST GRAFT ⭐ BEST SYNTHETIC GRAFT
⭐ BEST GRAFT 🎯 Reversed SAPHENOUS VEIN GRAFT ⭐ BEST SYNTHETIC GRAFT 🎯 PTFE
59
Why SAPHENOUS VEIN is Reversed before GRAFTING
Valves don't interfere in the circulation
60
Gangrene: TYPES
Microscopic & Microscopic death of tissue
61
Line of DEMARCATION
🎯 Seen in DRY GANGRENE ⭐ Junction BETWEEN Dead & Living Tissue ⭐ Lined by GRANULATION TISSUE ⭐ HYPER-AESTHESIA ➕
62
How DRY gangrene can convert into WET Gangrene?
Super-added infection
63
Amputation INDICATIONS
Dead: Gangrene Deadly: Gas gangrene, Sarcoma, Cancer Damn nuisance: Contracture, sinus/fistula, deformity
64
In Diabetes, Amputation done is
Local Amputation of Digits
65
Ray Amputation done if
Metatarso-phalangeal joint involvement
66
Trans metatarsal Amputation done if
Several Toes affected
67
Size of AMPUTATION STUMP for BELOW KNEE Amputation
10-12 cm Not < 8cm
68
2 ways to do BELOW KNEE AMPUTATION
1. Long POSTERIOR flap 2. Skew Flap
69
Early COMPLICATION following Amputation
1. Hemorrhage 2. Infection 3. Flap Necrosis 4. DVT
70
Late COMPLICATION following Amputation
✨ Pain ✨ Phantom Limb Syndrome

VASCULAR SYSTEM (5 decks)

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