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CORE SURG > peripheral vascular disease > Flashcards

peripheral vascular disease Flashcards

1
Q

what is peripheral arterial disease?

A

chronic insufficiency of the arterial blood supply due to stenosis or occlusion of the vessels

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2
Q

primary cause of peripheral arterial disease?

A

atherosclerosis

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3
Q

definition of critical limb ischemia

A
  • rest pain > 2 weeks
  • tissue loss (ulcers, gangrene, necrosis)
  • ABI < 0.5
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4
Q

where is the occlusion in leriche syndrome?

A

bifurcation of the aorta

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5
Q

triad of symptoms in leriche sydnrome?

A
  • buttock/thigh claudication
  • absent/reduced femoral pulses
  • erectile dysfunction
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6
Q

what is the name of the classification of peripheral arterial disease?

A

rutherford-fontaine classification

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7
Q

rutherford-fontaine classification GRADE I

A

asymptomatic

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8
Q

rutherford-fontaine classification GRADE II

A

intermittent claudication (IIA = > 200m, IIB = < 200m)

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9
Q

rutherford-fontaine classification GRADE III

A

rest pain

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10
Q

rutherford-fontaine classification GRADE IV

A

tissue loss - ulcers, gangrene, necrosis

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11
Q

normal ABPI ?

A

0.9-1.0

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12
Q

ABPI 0.9 - 0.5 =

A

intermittent claudication

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13
Q

ABPI <0.5 =

A

rest pain

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14
Q

ABPI < 0.3 =

A

tissue loss

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15
Q

ABPI > 1.1 =

A

calcified arteries (typically seen in diabetes) - false elevation

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16
Q

investigations for peripheral vascular disease

A
  • ABPI
  • duplex ultrasound
  • CT angiogram/MR angiogram
  • digital subtraction angiography (DSA)
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17
Q

conservative management of PVD

A
  • smoking cessation
  • physical exercise
  • diet modification
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18
Q

medical management of PVD

A
  • Antiplatelet therapy (aspirin, clopidegrel)
  • Statins
  • BP control
  • Glycemic control
  • Cilostazol
  • Pentoxifylline
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19
Q

Endovascular management of PVD

A

Angioplasty +- stenting

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20
Q

Surgical management of PVD

A
  • synthetic graft
  • vein graft
  • amputation
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21
Q

examples of grafts for PVD

A

-fem-pop bypass, fem-distal bypass, aorto-bifem bypass, axillo-bifem bypass, fem-fem cross-over

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22
Q

causes of ACUTE lower limb ischemia

A
  • acute thrombus on preexisting atherosclerosis

- embolus

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23
Q

most common source of embolus?

A

cardiac

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24
Q

6 P’s

A
  • pallor
  • parasthesias
  • perishingly cold
  • pulselessness
  • pain
  • paralysis
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25
Q

Management of acute limb ischemia

A
  • IV access and fluids
  • O2
  • Bloods - U&E, FBC, coag, troponin, glucose, group and save
  • CXR
  • ECG
  • Analgesia
  • unfractionated heparin

-depending on cause: embolectomy, amputation

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26
Q

Complications of reperfusion treatment

A
  • reperfusion injury
  • rhabdomyolysis
  • compartment syndrome
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27
Q

AAA of 3cm - 4.4 cm managment?

A

annual surveillance USS

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28
Q

AAA 4.5 cm - 5.4 cm management?

A

3 month USS surveillance

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29
Q

> 5.5 cm AAA management?

A

surgery

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30
Q

The rate of expansion of an AAA is directly related to…

A

the size of the AAA

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31
Q

presentation of aneurysm expansion?

A
  • abdominal/back/flank pain
  • distal peripheral embolization or ischemia
  • upper GI bleed from aortoenteric fistula
  • syncope or shock with large pulsatile mass, echymosis or death
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32
Q

Benefits of US for AAA?

A
  • best initial modality
  • non invasive
  • 98% accurary
33
Q

Cons of US for AAA?

A
  • does not determine extend of AAA

- inadequate for planning repair

34
Q

imaging modalities for AAA?

A
  • US

- CT with IV contrast

35
Q

pros of CT for AAA?

A
  • defines extent of aneurysm
  • defines relationship of AAA to renal arteries
  • can tell if AAA is leaking
  • determines eligibility for AAA repair
36
Q

what are the types of elective repair for an AAA?

A
  • open surgical repair

- endovascular aneurysm repair

37
Q

open surgical repair for AAA procedure

A
  • long midline incision
  • aorta clamped (below renal arteries to prevent ischemia)
  • graft from iliac arteries
38
Q

endovascular aneurysm repair of AAA procedure

A
  • small groin incisions
  • NO cross clamping of aorta
  • insertion of stent with radiological guidance (high doses of neprhotoxic contrast)
39
Q

EARLY complications of AAA repair

A
  • death
  • renal injury
  • hemorhage
  • MI
  • bowel ischemia
  • abdominal compartment syndrome
  • limb ischemia
  • wound infection
  • atelectasis
40
Q

LATE complications of AAA repair

A
  • graft infection
  • graft limb occlusion
  • aortaenteric fistula
  • endoleak
41
Q

how many types of endoleak are there?

A

5

42
Q

endoleak type I

A

leak at attachment sites of graft

43
Q

endoleak type II

A

filling of aneurysmal sac by collaterol vessels

44
Q

endoleak type III

A

leak through defect in graft

45
Q

endoleak type IV

A

leak through fabric of graft due to porosity

46
Q

endoleak type V

A

expansion of aneurysm sac without evidence of leaking

47
Q

what are the three groups of veins in the legs

A
  • superficial veins
  • deep venous system
  • perforators
48
Q

Blood in the legs pass through superficial to deep systems via ____

A

perforators

49
Q

where do most varicose veins come from?

A

long and short saphenous systems

50
Q

risk factors for varicose veins

A
  • age
  • prolonged standing
  • elevated BMI
  • smoking
  • female
  • sedentary lifestyle
  • high oestrogen states
  • pregnancy
  • pelvic masses
  • previous DVT
  • ligamentous laxity
  • lower limb trauma
51
Q

symptoms of varicose veins?

A
  • pain
  • itchiness
  • dry skin
  • heaviness
  • oedema - worse in evening, hot weather
  • tightness
52
Q

complications of varicose veins?

A
  • stasis dermatitis
  • eczema
  • phlebitis
  • lipodermatosclerosis
  • skin pigmentation
  • ulceration
  • bleeding
53
Q

diagnosis and investigations for varicose veins

A
  • clinical diagnosis
  • examine abdomen for masses
  • trendelenberg and perthes test
  • ultrasound duplex of superficial and deep veins - to define anatomy
54
Q

Conservative management of varicose veins

A
  • leg elevation
  • exercise
  • weight loss
55
Q

Medical management of varicose veins

A
  • compression stockings
  • sclerotherapy
  • topical agents for skin changes
56
Q

Surgical management of varicose veins

A
  • radiofrequency ablation
  • laser ablation
  • local stab avulsions
57
Q

What is virchows triad?

A
  • stasis of blood flow
  • endothelial injury
  • hypercoagulabilty
58
Q

Risk factors for DVT

A
  • Trauma, travel
  • Hormones (OCP, HRT)
  • Road traffic accidents (fracture)
  • Operations
  • Malignancy
  • Blood disordeers
  • Obesity, old age
  • Serious illness (prolonged hospital stay)
  • Immobilization
  • Smoking
59
Q

what is homans sign?

A

calf pain on dorsiflexion of foot

60
Q

investigations for DVT?

A
  • d-dimer
  • duplex scan
  • CTPA
61
Q

DVT prophylaxis

A
  • low molecular weight hepain
  • TEDS
  • mobilization
  • hydration
  • smoking cessation
  • stop OCP 4-6 weeks pre-op
62
Q

what is the name of the scoring system for DVT?

A

wells score

63
Q

criteria in wells score

A
  • active malignancy (1)
  • paralysis, paresthesis, recent immobilization (1)
  • localized tenderness along deep venous system (1)
  • entire leg swollen (1)
  • calf swelling >3cm than other leg (1)
  • pitting edema (1)
  • collateral superficial veins (1)
  • previously documented DVT (1)
  • other diagnosis more likely (-2)
64
Q

wells score 2 or more =

A

DVT likely

65
Q

wells score 1 or less

A

DVT UNlikely

66
Q

treatment of uncomplicated DVT

A

therapeutic LMWH then warfarin for 4-6 months

67
Q

treatment of complicated DVT

A
  • LMWH then warfarin

- thrombolysis/thrombectomy or IVC filter

68
Q

risks of IVC filter

A
  • air embolism
  • arythmia
  • hemothorax/pneumothorax
  • IVC obstruction
  • bleeding
69
Q

indications for thrombolysis

A
  • acute limb ischemia
  • venous thrombosis
  • acute graft thrombosis
  • thromboses popliteal artery aneurysm
70
Q

contraindications to thrombolysis

A
  • bleeding disorders
  • peptic ulcer current
  • recent hemorhagic stroke
  • recent major surgery
  • evidence of muscle necrosis (may cause reperfusion injury)
71
Q

complications of thrombolysis

A
  • allergy
  • bruising
  • major bleed or stroke
  • catheter leak, occlusion
72
Q

what is a CVA?

A

rapidly developing neurological deficit lasting > 24 hrs

73
Q

what is a TIA?

A

acute episode of focal neurological deficit <24 hrs

74
Q

what is amaurosis fugax

A

transient monocular vision loss - curtain coming down

75
Q

Diagnosis and investigations for CVA

A
  • carotid duplex scan
  • carotid MR angiography
  • cranial CT/MR angiography
  • cardiac echo/telemetry
76
Q

Management of CVA

A
  • antiplatelet agent - aspirin, clopidegrel
  • anticoagulants
  • smoking cessation
  • BP control
  • tight glucose control
  • statin
77
Q

indications for carotid endarterectomy

A
  • 50-99% stenosis with recent CVA or TIA

- consider if asymptomatic with >70% in younger patients/low risk surgery patients

78
Q

contraindications to carotid endarterectomy?

A
  • severe neurological deficit
  • occluded carotid artery
  • severe comborbidities

CORE SURG (14 decks)

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