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CVS > Peripheral Vascular Disease II > Flashcards

Peripheral Vascular Disease II Flashcards

1
Q

What is an anuerysm?

A

Dilatation of a vessel by more than 50% of its usual

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2
Q

What is a true/false aneurysm?

A

True- vessel walls (3 layers maintained

False- vessel wall breached. surrounding structures keep it in check

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3
Q

What are the types of aneurysm?

A

Saccular- Sac formed off the wall of artery
Fusiform- spindle shaped
Mycotic- secondary to an infectious process. infection weakens the wall
All types prone to rupture

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4
Q

What is the pathogenesis of an aortic aneurysm?

A

Due to degeneration of the tunica media

  • Unbalance between elastin/collagen in the aortic wall
  • Causes weakening of the wall and dilatation
  • Increases aortic wall stress
  • Progressive dilatation

Age, males, smoking and hypertension are risk factors

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5
Q

What is the main effect of an aneurysm?

A

Ruptures

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6
Q

What is the common presentation of an AAA?

A
  • Asymptomatic (75% of the time)

- Symptomatic: Pain (may mimic renal colic), Trashing- thrombus in the distal circulation, Rupture

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7
Q

How does a ruptured aneurysm present?

A
  • Sudden Epigastric and central chest pain
  • May radiate to the back
  • Mimic renal colic
  • collapse
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8
Q

What happens on examination?

A
  • May look fine
  • Hype/hypotensive
  • Pulsatile, expansile mass +/- tender
  • Transmitted pulse
  • Peripheral pulse
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9
Q

What is the outcome of an AAA rupture?

A
  • 75% Don’t make it
  • those who do:
    1. Mostly retro-pertioneal contained rupture
    free intra-peritoneal rupture= rapidly fatal
    50% operative mortality
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10
Q

What does duplex ultrasound offer in AAA?

A

non invasive.

Allows one to see aneurysm and measure its AP diameter

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11
Q

What is a CT used for in AAA?

A

aneurysm shape, size, iliac involvement

ONLY scan that can show a rupture.

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12
Q

What does endovascular aneurysm repair (EVAR) do?

A

Places a stent into the aneurysm to push the plaque distally, allowing better blood flow

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13
Q

Two big modifiable risk factors of AAA?

A
  1. Smoking 2. Hypertension
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14
Q

What are the three main types of acute limb threat?

A
  1. Acute limb ischaemia
  2. Acute on chronic limb ischaemia
  3. Diabetic foot sepsis
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15
Q

What happens in acute limb ischaemia? why?

A

Sudden onset of pain due to loss of blood supply in the leg, caused by an occlusion of an artery

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16
Q

What can be some causes for a sudden occlusion?

A
  • Embolism
  • Atheroembolism
  • Arterial dissection
  • trauma
  • extrinsic compression
17
Q

What are the clinical features of acute limb ischaemia?

A
  • Pain: severe, sudden, resistant to analgesia
  • Pale: limb white empty veins.
  • Pulseless
  • perishingly cold
  • parasthesia
  • paralysis

muscle/ calf tenderness with “woody compartements” or non blanching mottline= irreversible ischaemia

18
Q

What are the signs of ALI in these 3 stages:

  • salvageable
  • partly reversible
  • irreversible
A
  1. Salvagable- white foot, painful
  2. Partly reversible- mottled, blanches on pressure
  3. Irreversible- fixed mottling, non blanching, paralysis, tender/red compartments
19
Q

What investigations would you do for Acute LI?

A
  • FBC, coagulant +/- troponin
  • ECG: MI, disrhhythmias
  • CXR- any malignancy
20
Q

What main dug type is used in acute li?

A

anticoagulants

21
Q

How would you manage salvageable vs non salvageable Acute LI?

A

Salvageable- embolectomy, thrombolysis

non “ - palliative, amputation

22
Q

What are the three focal points of diabetic foot sepsis (DFS)

A
  • Diabetic neuropathy
  • peripheral vascular disease
  • infection

DFS is vascular surgical emergency

23
Q

Effects of DFS?

A

Can cause foot necrosis, ulceration, gangrene

may lead to amputation

24
Q

What is the source of infection in DFS?

A
  1. Simple puncture wound
  2. From a neuro-ischaemic ulcer
  3. from a nail plate/ inter-digital space
25
Q

Why does infection in the foot lead to sepsis and ischaemia?

A

Intrinsic muscles in the foot have small spaces
Infection takes over theses spaces–> pus build up
Increased pressure in the spaces–> restricts capillary blood flow–> ischaemia

26
Q

What are the clinical findings in DFS?

A
  1. Systemic:
    - Pyrexic
    - tachycardia
    - tachypnoea
    - confused
    - kussmauls breathing (deep, laboured)
  2. Local:
    - Swollen digits + forefoot
    - Tenderness
    - Ulcer, pus extending
    - Erythema
    - patches of necrosis
27
Q

How should DFS be treated?

A

Vascular surgical emergency

  1. Appropriate antibiotic based on infection (gram +/-)
  2. surgical debridement of infected tissue
28
Q

What can be some after-measures for DFS?

A
  • Adequate education
  • foot assessment
  • pressure offloading footwear.

CVS (21 decks)

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