General Surgery - Vascular Flashcards
When should warfarin be stopped before an angiogram/ angioplasty?
5 days prior to procedure.
+ patient should make appointment with GP for the day before procedure to have their INR checked.
When should DOACs (direct oral anticoagulants) be stopped prior to an angiogram/ angioplasty?
DOACs e.g. Rivaroxaban, Apixaban, should be stopped 2 days before procedure.
When should aspirin or clopidogrel be stopped before an angiogram/ angioplasty?
They should not, patient should continue taking them as normal.
Explain the angiogram procedure to a patient.
- Lying flat on your back an area - usually your groin - will be swabbed with antiseptic and draped.
- Then local anaesthetic is injected into the skin.
- After a couple of minutes another needle and tube is injected into your artery and dye injected.
- You have to hold your breath for a few seconds while images are taken.
- Afterward you will remain lying flat for two to four hours (if angioplasty/ stenting).
What causes varicose veins?
Impaired valves allow back flow of blood increasing pressure on veins and causing swelling.
Describe stripping of varicose veins.
Surgeon under GA strips saphenous (greater or small) veins that have reflux causing varicose veins.
Risk factors for AAA.
- Male.
- > 60 y/o.
- FHx of aneurysm.
- PMHx of angina, HTN, atherosclerosis.
- Smokers.
What causes intermittent claudication?
Narrowing of the arteries in the legs causes pain - usually in the calf when walking - particularly when walking uphill.
Exercise advice for patients with intermittent claudication.
- Walk every day for half an hour, or at least 3 times/ week, aiming to increase the distance walked within that time.
- Try to walk through the initial pain and continue to near maximal tolerable pain.
- Then rest until the pain eases before walking again, while trying to increase the distance walked between each rest.
- Continue for at least 6 months.
Example exercises for patients with intermittent claudication.
- Marching on the spot.
- Heel raises.
- Sit to stand.
- Step ups.
- Squats/ wall slides.
- Exercise bike/ cycling.
Risk factors for venous reflux.
- Female.
- Ageing.
- FHx.
- Heavy lifting.
- Multiple pregnancies.
- Obesity.
- Prolonged standing.
What are perforating veins?
Veins connecting superficial veins to deep veins.
Signs and symptoms of venous reflux?
- Varicose veins.
- Aching.
- Swelling.
- Cramping.
- Heaviness or tiredness.
- Itching.
- Restlessness.
- Open skin sores.
Symptoms / signs of varicose veins?
- Bulging veins on legs.
- Heaviness, aching, cramp, swelling.
Treatment options for varicose veins?
- Stockings, surgery, laser, radiofrequency ablation, foam sclerotherapy.
- Dependent on size and distribution of veins.
What causes venous ulcers?
Trophic skin changes and underlying venous stasis.
Characteristics of venous ulcers?
- Indolent, shallow and moist granulating floor.
- Associated varicosities and surrounding pigmentation.
- Induration and pitting oedema results in poor skin nutrition.
How are venous ulcers managed?
- Limb elevation.
- Wound toilet + non-stick dressing.
- 4 -layer compression bandaging.
- Split-skin grafting may be required.
How may venous ulcer recurrence be prevented?
Surgical management of varicose veins following healing of ulcer.
Ischaemic ulcers occur as a result of?
- Poor tissue perfusion as a result of pressure (decubitus ulcers).
- Atherosclerotic disease.
- Diabetic vascular occlusive disease.
Neuropathic ulcers occur as a result of?
They are anaesthetic and caused by peripheral nerve degeneration (e.g. leprosy, diabetic neuritis).
Tropical ulcers occur as a result of?
Chronic bacterial or fungal skin infections.
- Bacterial: mycobacterium ulcerans in Buruli ulcer.
- Fungi: actinomycosis, mycetoma.
