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Gen Surg (Vascular) > Limb Ischaemia & DVT > Flashcards

Limb Ischaemia & DVT Flashcards

1
Q

What is the key clinical feature of chronic limb ischaemia (i.e. peripheral arterial disease)? What is meant by this?

A

Intermittent claudication: calf/leg/buttock pain which occurs after a predictable amount of exercise, and settles with rest

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2
Q

The development of what symptom suggests that chronic limb ischaemia has progressed to critical limb ischaemia?

A

Severe ischaemic pain at rest

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3
Q

What are some complications of critical limb ischaemia?

A

Ulceration and/or gangrene

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4
Q

What investigation is used to diagnose and assess severity of chronic limb ischaemia?

A

ABPI calculation

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5
Q

What ABPI score would indicate intermittent claudication?

A

0.5 - 0.95

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6
Q

What ABPI score would indicate ischaemic pain at rest?

A

0.3 - 0.5

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7
Q

What ABPI score would indicate gangrene and ulceration?

A

< 0.2

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8
Q

What investigation is most useful in chronic limb ischaemia for confirming an occlusion?

A

Duplex US

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9
Q

What investigation is most useful in chronic limb ischaemia for surgical planning?

A

MR angiography

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10
Q

Most management of chronic limb ischaemia is conservative, and involves management of risk factors. When would interventional management be considered?

A

If symptoms are disabling, or if critical limb ischaemia occurs

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11
Q

What are some interventional management options for chronic limb ischaemia? If a patient isn’t suitable for these options, what should be done?

A

Angioplasty and stenting, resection or bypass grafting - if these can’t be done then amputation is necessary

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12
Q

What is acute limb ischaemia?

A

The sudden loss of blood supply to a limb

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13
Q

What are the two main causes of acute limb ischaemia? How common is each?

A

Thrombus formation from an existing atherosclerotic plaque (80%), or embolism, usually in AF (15%)

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14
Q

What are the 6Ps of acute limb ischaemia?

A

Pain, pallor, paraesthesia, perishingly cold, pulseless, paralysis

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15
Q

What investigations can be used to locate the occlusion in acute limb ischaemia?

A

Duplex US or CT

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16
Q

Describe the management options for acute limb ischaemia?

A

Thrombolysis, embolectomy, bypass surgery

17
Q

What are some complications of acute limb ischaemia?

A

Irreversible ischaemia, gangrene, compartment syndrome

18
Q

What condition may cause the ABPI to be falsely elevated, even with significant vascular disease?

A

Diabetes

19
Q

What are some risk factors for DVT due to them causing stasis of blood flow?

A

Immobility, varicose veins, compression

20
Q

What are some risk factors for DVT due to them causing hypercoagulability of blood?

A

Pregnancy, malignancy, inflammation, smoking, thrombophilias

21
Q

What are some risk factors for DVT due to them causing endothelial damage?

A

Trauma and surgery

22
Q

How can DVT be prevented in hospital patients?

A

LMWH injections and compression stockings

23
Q

Half of cases of DVT are asymptomatic. How do they present if they are symptomatic?

A

Red, hot, swollen, tender calf

24
Q

What are some differentials of a DVT?

A

Cellulitis, trauma, ruptured Baker’s cyst

25
Q

What is the name of the scoring system used to assess the likelihood that a patient has a DVT?

A

Well’s score

26
Q

A Well’s score of 3 or more suggests a 50% likelihood of DVT. What investigation is required?

A

Duplex US

27
Q

A Well’s score of 2 or less suggests a 5-20% likelihood of DVT. What investigation is required?

A

D-Dimer

28
Q

In all patients, regardless of Well’s score, what investigation investigation should be done if a D-Dimer comes back positive?

A

Duplex US

29
Q

Describe the initial management of a DVT?

A

Therapeutic dose LMWH while receiving loading doses of warfarin, until the INR is within an acceptable range

30
Q

How long should warfarin be given for after a DVT?

A

3-6 months

31
Q

What are some potential complications of a DVT?

A

PE, post-thrombotic syndrome, venous ulcers

32
Q

What are some signs of chronic venous insufficiency?

A

Leg swelling, increased pigmentation, lipodermatosclerosis, eczema and ulceration

33
Q

What is the investigation of choice for confirming venous insufficiency?

A

Duplex US

34
Q

What is the most common management option for chronic venous insuffiency?

A

Compression stockings

35
Q

What is the gold standard investigation for diagnosing varicose veins?

A

Duplex US

36
Q

When should patients with varicose veins be referred to surgery?

A

If they are symptomatic / if there are any skin changes

37
Q

What medication is used to manage primary Raynaud’s?

A

Ca channel blockers

Gen Surg (Vascular) (2 decks)

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