Ischemia And Injury Flashcards
Falsely high ABI is found in……
Calcified vessels (DM, renal failure)
MC site of acute uschemia dt embolism is…..
Superficial femoral art, aorta
MC cause of of embolism is…..while that of thrombosis is…..
AF
Atherosclerosis
Differentiate clinically between acute embolism & thrombosis
Differentiation based on:
-Onset (throm is acute but less dramatic)
-Trophic changes
-Presence of collaterals
-History of claudications
List 5 most common sites of arterial embolism in descending order of frequency
Bifurcation of:
1. Superficial femoral artery
2. Aorta
3. Politeal a
4. Brachial a
5. CCA
Describe heparin therapy in acute limb ischemia
I.V. heparin. Start with 5000 IU bolus followed by 1300 IU / hour by continuous drip. The dose is controlled by checking activated partial thromboplastin time (APTT) every 12 hours, which should be maintained at 2 - 3 times the baseline level.
Definitive ttt of emoblism is…..
Urgent embolectomy using Fogarty catheter
Best thrombolytic is….
TPA
Systemic manifestations of reperfusion injury is….
Rhabdomyolysis, renal failure, ARDS, myocardial dysfunction & clotting disorders
List hard signs of peripheral arterial injury
- Pulsatile hge
- Shock with ongoing bleeding
- Expanding or pulsatile hematoma
- Papable thrill or bruit at or distal to injury
- No distal pulse
- Signs of acute limb ischemia
Mention indications of fasciotomy in ac limb ischemia
- Late cases
- Muscle edema
- Development of swelling/paralysis after revascularization
List causes of compartment $
Fractures, crush injuries, revascularization following ac ischemia, intramuscular bleeding, severe burns & shock
Systolic bruit indicates…..while continuous indicates….
Aneurysm
AV fisula
Mention special tests for claudication
- Capillary refilling time
- Disappearing pulse test
Buerger’s angle: the angle at which blanching of limb occur
Harvey’s venous refilling time: detect delayed venous refilling
Describe claudication ttt
- Best is medical: risk factor modification, antiplatelets, vaso-active drugs, care of feet, exercise
- If not improved angiography
Site of rest pain is…..because of….
Edge of ulcer in critical limb ischemia is….
Never above ankle, ischemic neuritis
Punched out
The ttt for long segment stenosis in critical limb ischemia is…..
Above inguinal ligament….is used but below….is used
Arterial bypass
Synthetic graft
Saphenous graft
List indications for surgery in critical limb ischemia
Starting & pre-gangrene, severe claudication pain, ulcer resistant for healing, long segment occluded >12 cm
Mention indications for amputation
- Severe spreading gangrene
- Spreading infection
- Severe uncontrollable pain
Mention indications for endovascular & open revascularization
- Critical limb ischemia: rest pain, ischemic ulcers, gangrene
- Incapacitating claudication
Mention the triad of Leriche
Buttock claudicaytion, impotence, absent femoral pulses
Portwine hemangioma may be part of….., ttt is…..
Sturge Weber $
Laser: pulsed dye in children under GA, YAG in adults
Surface of capillary malformation is….., while that of venous is……
Flat
Elevated, lobulated
Mention ttt of cavernous malformation
Compression, percutaneous sclerosis, laser (YAG, argon), excusion after embolization
Describe etiology of cystic hygroma
Failure of lymphatics to communicate w/ venous system
Mention comp of cystic hygroma
Obstructed labor, recurrent infection, RD dt compression of fibrosis
Describe ttt of cystic hygroma
Complete surgical excision, intracystic injection of Borylate leads subsequent shrinkage
If discovered prenatal, delivery should be in 3ry center to deal with postnatal dyspnea & airway should be secured before cord clamping in huge lesions.
Cercoid aneurysm is…….most common site is…..
Congenital AV fistula
Temporal (forehead) in relation superficial temporal artery
In neuropathic DF, pulse is…., veins are….
Bounding
Distended
Describe ttt of diabetic vasculopathy
- Macro: short segment: PTA, long segment:bypass
- Micro: debridemnet, Abx, daily dressing, flap when wound is untidy
List consequences of DF
- Persistent ulcer
- Osteomyelitis
- Spread of infection & gangrene if foot
- Infection spread ro leg & thigh
- Septicemia & septic shock
List causes of inc susceptibility to inf in DM
Peripheral neuropathy, vascular affection, immunocompromised, glycosylation of tissues
New deck
Mention drugs used in TTT of 1ry Raynaud
VDs, baby aspirin, CCB
CP of 2ry Raynaud
May affect LL, unilateral asymmetrical, +ve trophic changes, no peripheral pulsations, progressive
Describe TTT of 2ry Raynaud
TTT of cause, VDs, BBs
Sympathectomy has limited benefit due to vascultitis & cryo-Abs
Describe PDFs & etiology of Buerger’s disease
Unknown, males 20-40 yrs, SMOKERS: may becallergic reaction to nicotine, associated w/ interdigital fungal infection
Describe TTT of Buerger’s
Stop smoking, conservative med therapy w/ addition of steroids during episodes of activity.
Sympathectomy in non-healing ischemic ulcer, persistent rest pain, acrocyanosis
List causes of thoracic outlet $
Cervical rib, scalene $, hyperabduction $, malunion of clavicle, pancoast tumor, tumor or inflammation of 1st rib, post-fixation of brachial plexus, costoclvicular $
Mention most common presentation of thoracic outlet $
Neural: compression of lower trunk of brachial plexus
Sensory on ulnar side, motor small muscles of hand atrophy & weakness
Buerger’s disease affects….., diagnosis is based on…….
Distal vessels usually to popliteal artery
Clinical exam & duplex scan
What is Addison’s test?
In thoracic outlet $, radial pulse becomes weak or disappears when asking pt to brace his shoulders backwards turns head upward & toward side of affected limb & takes a deep breath
List INV for thoracic outlet $
- Angiography in abduction, compression of subclavian a on arm elevation, there’s post-stenotic dilatation
- Plain X ray: cervical rib or prominent C7 transverse process
- Nerve conduction veolcity & EMG
- Venous duplex or contrast venography
TTT of severe thoracic oulet
Affecting artery
1. Resection of cervical rib or 1st rib
2. Scalenotomy of ant scalene
3. Osteotomy & internal fixation of clavicle
4. Radio & chemo for pancoast
Describe etiology of 1ry VV
Idiopathic, congenital mesenchymal weakness (Marfan, Ehler Danlos, Askar $)
Congenital valvular incompetence, agg factors (female, high parity, obese, prolonged standing, OCP, +FH)
Describe INV for VV
1ry: doppler, venous duplex (gold standard, reversal of bloodflow w/ vaksalva or muscle squeeze OR thrombosis OR dilated veins w/incompetent valves), venography, X-ray: periostitis, biopsy for malignancy
2ry as before + arteriography
Describe etiology of 2ry VV
DVT (MC), AVF (Klipple trenaury $, butcher’s thigh), aneurysm, buerger disease, pelvic tumors, pregnancy
Mention differentiating symptoms bet 1ry & 2ry VV
1ry: mild pain, relieved by walking, mild swelling
2ry: marked pain relieved by elevation, persistent diffuse swelling
Mention signs of 2ry VV
As 1ry +
Arranged haphazardly, veins crossing inguinal ligament, massive edema, MC of skin CCC: pigmentation, dermatitis, eczema, ulcer, LDS
Stripping of superficial veins is CI in…
DVT
List indications of injection in VV
Small superficial telangiectasia, useful for small localized VV, recurrent VV after surgery
List comp of VV
- Venous comp; LL edema, post-traumatic hge, superficial thrombophelbitis
- Skim CCC: pigmentation, dermatitis, eczema, ulcer, LDS.
- Others: marjolin ulcer, talipus equniavorus
Mention CI to sclerotherapy
Septic thrombophlebitis, 2ry VV, injection of long saphenous v, avoid injection of all veins at same time
Mention indications of surgical intervention in VV
Patients w/ clear evidence of long or short saphenous incompetence or a combination of the two shoukd be treated by saphenofemoral or -popliteal disconnection combined w/ stripping of the vein
Mention etiology of venous ulcer
MC DVT, AVF, 1RY VV (rarely)
Describe conservative management
Rest & elevation of limb, compression by graduated elastic stockings or crepe bandage, compression stockings, dressing w/saline, NOT anti-septic, debidement. Medications (pentoxyphilline, PGE1, Diosmin)
