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RCSI SURGERY COPY > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

causes of chronic limb ischema

A
  1. ATheroSCLeroSIS

other rare
1. FMD
2. radiation induced vascular injury
vasculides (Bueger disease and takayasu )

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2
Q

Rutherford (Fontaine ) system e

A 
I - asymptomatic 
II - I.C 
    a - claudication >200m
    b - claudication <200 m 
III - rest pain 
IV - ulcers , gangrene
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3
Q

definition of rest pain

A

SEVERE pain, typically in the sole of foot that is relieved at night and relieved by swinging the foot over the edge of the bed

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4
Q

critical limb ischemia

A

patient with rest pain >2 weeks and ulcers and gangrene

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5
Q

Leriche syndrome

A

occlusion at bifurcation of aorta causing TRAID

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

what is the most common spot for I.C

A

distal superficial femoral artery - upper calf

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7
Q

Locations of I.C

A 
distal superficial femoral artery - upper calf 
popliteal artery - lower calf 
common femoral - thigh pain 
Aortoiliac - buttock and thigh pain 
Tibial / peroneal - foot pain
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8
Q

DDX of I.C

A
  1. Spinal stenosis
  2. Osteoarthritis
  3. Nerve root compression - sciatica
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9
Q

investigation of i.C

A
  1. ABI - < 0.8 in the affect limb
  2. Duplex US
  3. CT angio
  4. MRA
  5. Digital subtraction angiography - GOLD STANDARD - used only if surgery or endovascular intervention is considered
  6. AAA
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10
Q

what type of surgery can be used to unresponsive medical management of I.C or if they develop critical ischemia

A

Endarterectomy - isolated common femoral occlusion
Fem - fem bypass graft - unilateral femoral occlusion
Fem-pop bipass
Fem- distal bypass
Porto-bifem bypass

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11
Q

definition of acute lower limb schema

A

abrupt decrease in perfusion that threatens viability to the lower limb

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12
Q

Blue toe syndrome

A

Painful ischemic lesions of LL with intact pulses

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13
Q

Paradoxical emboli

A

from intracardiac shunts *PFO or AV malformation

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14
Q

Causes of acute limb ischema

A
  1. EMBOLI
  2. direct arterial damage
  3. Intra-arterial drug injection
  4. popliteal aneurysm
  5. iatrogenic
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15
Q

complication of reperfusion in acute lower limb ischemia

A
  1. Reperfusion injury
  2. Rhabdomyolysis
  3. Compartment syndrome
  4. Complicatiosn related to catheter
    - AV fistula
    - pseudoanneurysm
    - arterial dissection
    - arterial perforation
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16
Q

AAA

A

abnormal localized dilatation of aorta extending normal diameter by >50% or diameter > 3cm

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17
Q

screening for AAA

A

<5.5cm - US every 6 months

>5.5cm - Diameter repaired electively

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18
Q

AAA investigation

A
  1. US
  2. X-ray - calcification
  3. CT abdo
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19
Q

what are the findings you see on CT angio

A
  1. IV contrast with highly accurate in determining size and extent of aneurysm
  2. relation to renal artery
  3. presence of a leak
  4. if suitable for endovascular repair
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20
Q

Open surgery repair for AA

A

Dacron graft to repair the aneurysm

  • midline laparotomy
  • Aorta is clamped BELOW the renal artery to prevent renal ischema
  • graph is placed
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21
Q

Complication of AAA early

A 
EARLY 
- death, haemorrhage 
- MI , cardiac arythmies, cardiac failure 
- BOWL ischemia , abdominal compartment syndrome 
- Atelectasis , LRTI , ARDS 
- Endoleak 
- Renal dysfunction 
Limb ischemia, foot emboli 
Would infection 
Sexual impairment
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22
Q

Late complication of AAA

A
  1. Graft infection
  2. Graph occlusion
  3. graph migration
  4. Aortoembolic fistula
  5. Endoleak
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23
Q

Endoleak types

A

TYPE 1: leak at attachment site of graph
TYPE 2: filling / aneurysmal sac by collateral vessels
TYPE 3: leak through defect in graph
TYPE 4: leak through the fabric of graph due to porosity
Type 5: expansion of aneurysm sac w/o evidence of leak on imaging

24
Q

how does a patient with thoraco-abdominal anneyrsm present

A

Chest pain , back pain ,acute aortic regard and acute cardiac failure

WIDEN mediastinum on CXR

25
Q

how does a patient with femoral anneyrsm present

A

pulsate groin swelling ± lower limb ischemia

26
Q

visceral anneursm

A

Splenic artery aneurysms

27
Q

RIND

A

reversible ischaemic neurological deficit - last > 24 hours from which recovery is complete

28
Q

contraindication to carotid endarterectomy

A

Severe neurological deficit after cerebral infraction
Occluded carotid artery
severe comorbidities

29
Q

carotid endarterectomy

A

LA or GA

  1. incision along anterior boarder of SCM
  2. smooth plane in the media of the artery
  3. smooth tappering endpoint on internal carotid is obtained
  4. endarterectomy is closed primarily OR with a patch
    - technical results is verified with angiography or duplex
30
Q

Complication of surgical treatment

A 
CVA OR MI - increase risk in stenting or endartectomy 
Death 
Would hematoma --> airway obstruction 
Recurrent stenosis 
CN 9,10,11 damage
31
Q

cause of aterial ulcers

A
  1. ARTHEROSCLEROSIS
  2. ARTERIAL EMBOLIZATION

Rarer:

  • vasospasm
  • trauma
  • prolonged exposure to cold

Leads to; schema and ulcerations of the skin

32
Q

cause of venous ulcers

A

Valvular impotence + adequate muscle pump action –> venous HTN

  1. Venous stasis - capillaries distension and leakage of fibrin around surrounding vessels and prevents Oxygen and nutrients getting to the tissue
  2. Increase Venous pressure –> damage of endothelial –> release of free radicals and enzymes –> destroys the tissue
33
Q

what is linked to venous ulcers

A

Popliteal vein compression and obesity

34
Q

treatment of venous ulcers

A

multilayer compression dressings that control exudates and colonization
Antibiotics if cellulite present
graduated compression stocking (RULE OUT ARTERIAL )
Skin grafting
saphenofemoral ligation and varicose vein stripping

35
Q

neuropathic ulcers cute

A

by trauma unnoticed by patient

36
Q

features of neuropathic ulcer

A
  • PAINLESS
  • punched out appearance
  • located over pressure points / calluses
    surrounded by inflammatory process
37
Q

Diabetic ABI

A
  • false elevated b/c diabetic foot
38
Q

Diabetic ulcer RF

A
  1. previous RF
  2. Peripheral Neuropathy (Stocking distribution or Charcots)
  3. Ass. PAD
  4. Callusus
  5. living aline
  6. Other diabetic related complications
39
Q

before angiography what must you tell that patient with diabetes

A

STOP METFORMIN 48 hours before to prevent lactic acidosis

40
Q

how to treat an infected diabetic ulcers

A
  1. BS antibiotics
    • debridement of dead tissue
  3. amputation
  4. get x-ray to outrun osteomyltitis
41
Q

venous system of let is comprised of three groups

A
  1. superficial veins - long and short system and tributaries
  2. deep venous system - running b/w muscular compartment of the leg
  3. perforators in the calf and thigh - connects superficial and deep system
42
Q

definition of saphenous veins

A
  • tortuous dilatation segments of veins > 3mm in size ass/ w/ venous HTN caused by incompetent valves
43
Q

complication of varicose veins 7

A
  1. tortuous veins on exam
  2. statsis dermatitis // eczema
  3. phlebitis
  4. lipoermatosclerosis - fibrosi dermatitis of subcutaneous tissue
  5. skin pigmentation - due to heamosiderin deposition
  6. Ulceration
  7. Bleeding
44
Q

saphena varix

A

thrill located at the SFJ

45
Q

Perthes maneuver

A

test to dertmine potency of deep venous system

  • normally when tourniquet is one - you get patient to walk / toe stands - which empty veins
  • if deep vein obstruction exist - MORE CONGESTED
46
Q

Trendelenburg test

A

used to distinguish patient with superficial venous reflux

  • empty veins while supine
  • close off varicose vein - just below SFJ
  • ask patient to stand - slow filling - superficial vein problem
  • if rapid filling = reflux pathway is involved
47
Q

most accurate way to dx outpatient reflux of veins

A

Hand held doppler auscultation

48
Q

Gold standard test for varicose beings

A

COLOR DUPLEX

49
Q

surgical treatment for Varicose veins

A
  1. Local stab avulsion
  2. SF / SP ligation
  3. LSV stippling
  4. Endoscopic perforator ligation
  5. radio frequency ablation
  6. laser ablation
50
Q

Complication post Varicose veins

A
  1. Hematoma
  2. Bleeding
  3. Damage to rural and saphenous vein
  4. recurrence
  5. damage to surrounding artery
  6. Infection
51
Q

Homan’s sign

A

Calf pain on dorsiflexion of foot (unreliable and should NOT be performed

52
Q

when do you give an IVC filter

A 
inserted percutaneously via jugular / femoral vein to catch and prevent PE's 
Used in:
recurrent PE despite treatment 
C/I anticoagulant 
  - major surgery
53
Q

risk of IVC filter

A 
PAH BIA 
pneumothorax 
Air embolism 
Heamothorax 
Bleeding 
IVC obstruction 
Arrhythmia
54
Q

When do you use thrombolysis in DvT

A
  1. ACUTE limb schema
  2. Venous thrombi
  3. Acute surgical graph occlusion
  4. thromboses popliteal artery aneurysm
55
Q

how do you give thrombosis in a patient with DVT who qualifies and what is the complication

A 
give via a low dose intra-arterial infusion 
- allergy 
cather leak and occlusion 
nursing 
major bleed and stroke
56
Q

complication of venous gangrene

A
  1. PE

2. venous gangrene

RCSI SURGERY COPY (7 decks)

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