Surgery: Vasc Flashcards
Atherosclerosis RFs
Elderly Male FHx HTN Diabetes Hyperlipidaemia Smoker
How does PAD px? (3)
Claudication: pain and cramping in the calf after a certain distance
Critical Limb Ischaemia: rest pain, night pain, tissue loss
Acute Limb Ischaemia: sudden onset <2wks, 6P’s
What is Leriche syndrome? (3)
Internal iliac vasc def: buttock claudication, impotence, reduced pulses
Ddx of claudication ie pain when you walk (2)
Spinal stenosis + post thrombotic syndrome
What is the perfusion pressure in critical limb ischaemia?
<40mmHg
Which of the 6P’s of ALI comes on early and starts to worry you?
Paraesthesia
How does the ABPI relate to PAD px?
- 7-0.9: claudication
- 4-0.7: critical limb ischaemia
<0.4: acute limb ischaemia
Why can reperfusing the leg be life threatening?
Cardiac arrest, VF, VT
What is the arterial blood supply to the lower leg?
Popliteal -> Anterior Tibial + Tibioperoneal Trunk -> Posterior Tibial + Peroneal
What are important components of your clerking when a pt presents w leg pain?
Timing, RFs, DHx, prev scars
Where do you amputate up to?
The level where there’s most blood supply ie dead foot below knee and dead ankle above knee
What is the surface anatomy landmark for the femoral artery?
The mid-inguinal point ie half way b/w ASIS + pubic symphysis
What is Buerger’s angle + test?
The angle at which the raised leg becomes pale where <20° is severe
If you get reactive hyperaemia seen as a sunset foot when the pt sits following the leg raise the test is pos
What are the two shapes of true aneurysms?
Fusiform + Saccular
Who is screened for AAA?
Single USS for males >65yrs
Ddx of left sided loin to groin back pain (2)
AAA + Renal Colic
When do you operate on an AAA?
2wk referral to vasc surgery for EVAR/open repair if: sx, >5.5cm, expansion rate >1cm per annum
What is the mortality rate for an emergency AAA repair?
Half will make it into hospital and half will make it out
What is the f/u for open vs EVAR?
Open - once at 5yrs vs EVAR - yearly
Aortic Dissection: Type A vs B
A: before left subclavian
B: beyond left subclavian
Mx of Aortic Dissection
Med: invasive bp monitoring + IV beta blockers and analgesia
Surg: gold standard for type A under cardiothoracics and if rupture, uncontrolled pain or malperfusion of aortic branches or lower extremities then also required for type B under vascular surgeons
What is the consequence of aiming for a SBP <120 when mx dissection?
Oliguric
Def of Oliguria
UO <0.5ml/kg/hr
What is the risk of a long segment of phlebitis or if it’s close to groin?
DVT