Doctors academy - Vascular COPY Flashcards
What is Leriches syndrome and what are the common features
Leriches syndrome is aortoileac occlusive disease
Features
- Buttock and thigh claudication
- no femoral pulse
- erectile dysfunction
if patient has multiple comorbidities and frail and wants relief of symptoms what is the most appropriate procedure?
Axillo-femoral bypass
What are the features of Takyasu’s Arteritits?
- Affects asian women <45yrs old
- it is a large cell arteritis
Features:
- aortic arch and its vessels are affected
- Upper limb claudication
- Elevated ESR
What are the features of Buergers disease?
- Affects young male smokers
- Medium cell arteritis
Features:
- Causes clots in lower limb vessels + fingers and toes
- loss of peripheral pulses
- Tortuous corkscrew collateral vessels often seen
- they present with lower limb claudication
What are the features of Giant Cell Arteritits
- Affects older women
- Large cell arteritis
Features:
- Pain on eating / brushing hair
- granuomas form
- it is a segmental disease
What are the features of Polyarteritis nodosa?
- Transmural inflamation
- A necrotising vasculitis
- causes mulitple small aneurysms
- renal disease seen in 70% of cases
What are the freatures of Wegners granulomatosis?
- Affects middle aged males
- A systemic necrotising granulomatous vasculitis
- may get skin lesiosn / ulcerations
- affects nasopharynx, lungs and kidneys
What vessels does kawsaki disease affect?
coronary arteries
What do the following values for ABPI represent and what symptoms would be present?
- 1 - 1.3
- 1.3
- 0.7-0.9
- 0.5
- <0.3
1 - 1.3 = normal
>1.3 = calcification
- 7-0.9 = mild disease. Intermittant claudication
- 5 - 0.7 = moderatte disease. Possible Rest pain
<0.5 = severe disease. Rest pain
<0.3 = critical limb ichaemia
What are the contraindications of a stent?
- Long section
- crosses a joint
- involving osetum
what are the contraindications for an EVAR?
Not enough landing zone:
- min 5mm above
- min 1.5cm below
What are the risk an abdominal aneurysm?
- HTN
- Smokers
- Connective tissue disorders e.g. marfans
What are the indications for a aortic aneurysm repair?
- Symptomatic aneurysms
- Size >5.5cm
- Rupture
What are some of the complications following a AAA repair?
- Embolism to foot or gut
- cardiac problems??
- fraft infection
- aorto-enteric fistula
- renal failure if it was a suprarenal AAA
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where is the most common site for AAA rupture?
Retroperitoneal (80%)
Where is a Gritti Stokes amputation
through the knee
where is a symes amputation
through the ankle
what is the treatment for raynauds disease
calcium agnoists
Which patients is subclavian steel sydnrome common in?
Subclavian Steal Syndrome occurs in patients who have undergone an Internal Mammary Artery (IMA) Graft
What is subclavian steel syndrome
this is where you have a narrowing of the subclavian artery, commonly on the left.
This means you get retrograde blood flow from the vertibral arteries to supply the upper arm
What are the symptoms fo sub clavian steel syndrome
- Most often Males
- Most often Left sided
Symtpoms occur on use of arm:
- upper arm claudication
- Syncopy, vertigo and neurological defects
- numbness and tingling upper arm and fingers
- BP difference between arms
- weakness of affected side
- weak pulse in affected arm
What are the features of Sturg Webber syndrome
arteriovenous malformation affecting the face and CNS
What are the features of Klippel-Trenaunay-Weber syndrome
- varicose veins and port wine staining affecting one limb, commonly the leg
- varicose veins often spare the saphenous distribution
Also:
- Hypertrophy of bony and soft tissues, that may lead to local gigantism or shrinking.
- An improperly developed lymphatic system
What malignancy can arise from an area of chronic lymphoedema?
Lymphangiosarcoma
what is the difference between millroys and meiges lymphoedema
millroys is confenital
meiges develop after birth
what different operations can be offered for lymphoedema?
Homans operation - Reduction procedure with preservation of overlying skin (which must be in good condition)
Charles operation - All skin and subcutaneous tissue around the calf are excised down to the deep fascia. Split skin grafts are placed over the site. May be performed if overlying skin is not in good condition. Larger reduction in size than with Homans procedure.
Lymphovenous anastamosis - Identifiable lymphatics are anastomosed to sub dermal venules. Usually indicated in 2% of patients with proximal lymphatic obstruction and normal distal lymphatics.
what is the treatment of an axillary vein thromboisis?
- catheter directed tPA is first line
- Heparin and Warfarin prevent clot propergation
What dose of heparin should be given during bypass surgery? And when should this be given?
3,000 units of unfractionated heparin should be given 3-5 mins prior to claiming of the vessels
What vessels are commonly used as grafts for coronary bypasses
Internal mammary artery (this is the preferred option)
long saphenous Vein
radial artery
