Surgery - Vascular Surgery Flashcards
how can peripheral arterial disease (PAD) present?
NAME?
describe intermittent claudication. which areas are typically affected by this?
NAME?
describe the nature of the pain felt in intermittent claudication
- crampy| - achey
describe critical limb ischaemia (CLI)
- the end stage of PAD| - pain in limb at rest
features of CLI?
NAME?
describe the pain felt in CLI
NAME?
triad of leriche syndrome?
NAME?
what causes leriche syndrome?
occlusion of distal aorta / common iliac artery
describe buerger’s test
- with pt laying on their back, lift their leg to 45 degs- hold there for 1-2 mins- look for pallor- then sit the pt up and hang their legs over side of bed - look for colour changes
what is buerger’s angle?
the angle at which the leg becomes pale
in a healthy pt, what happens at the end of buerger’s test?
legs remain pink
in a pt with PAD, what happens at the end of buerger’s test?
- initially legs turn blue| - then go dark red (rubor)
describe an arterial ulcer
- small, deep “punched out” lesion- well-defined borders- typically on toes- no bleeding - painful
describe a venous ulcer
NAME?
where is the gaiter region?
mid-calf down to ankle
investigations for PAD?
NAME?
what is the normal range for ABPI?
0.9 - 1.3
what would an ABPI of < 0.3 indicate?
CLI
what could an ABPI of > 1.3 indicate? who is this more common in?
- arterial calcification| - diabetics
management of intermittent claudication?
NAME?
drugs offered in intermittent claudication?
- atorvastatin 80mg- clopidogrel 75mg OD (alt: aspirin)- naftidrofuryl oxalate
surgical options for intermittent claudication?
NAME?
management of acute limb ischaemia?
vascular emergency:- endovascular thrombolysis- thrombectomy- endarterectomy- bypass surgery- amputation
how could a venous thrombus cause a stroke?
NAME?
risk factors for VTE?
NAME?
what is a thrombophilia? give some examples
a condition that predisposes you to forming clots- antiphospholipid syndrome- factor V lieden- protein C / S deficiency
which pts are offered VTE prophylaxis? what are they offered?
NAME?
contraindications to LMWH?
- active bleeding| - pre-existing anticoagulation with warfarin / DOAC
key contraindication for anti-embolic compression stockings?
peripheral arterial disease (PAD)
presentation of a DVT?
NAME?
how is leg swelling measured in suspected DVT? what is significant?
- measure calf circumference 10cm below tibial tuberosity| - > 3cm is significant
which scoring system is used to calculate the risk of the pt having a DVT / PE?
wells score
is D-dimer sensitive or specific for VTE? what does this mean?
NAME?
causes of a raised D-dimer?
NAME?
how is DVT diagnosed?
doppler USS
what should you do if doppler USS is negative but wells score and D-dimer both suggest DVT?
repeat the doppler in 6-8 days
how is pulmonary embolism (PE) diagnosed?
either CTPA or ventilation-perfusion (VQ) scan
when would a VQ scan be done instead of CTPA for a pt with a suspected PE?
- significant renal impairment| - contrast allergy
initial management for suspected / confirmed DVT / PE?
- DOAC (apixaban, rivaroxaban)| - start immediately, don’t delay for scans
what management can be considered for a iliofemoral DVT?
catheter-directed thrombolysis
drug options for long-term anticoagulation in VTE?
NAME?
first line anticoagulation in VTE in pregnancy?
LMWH (dalteparin)
how long should anticoagulation be continued for in VTE:i) with a reversible cause?ii) with an unclear cause?iii) active cancer?
i) 3 monthsii) beyond 3 monthsiii) 3-6 months, then review
which pts can be offered an inferior vena cava filter? what is this?
- pts with recurrent PEs| - acts like a sieve and catches all the clots
why is it important to investigate an unprovoked DVT?
it may indicate an underlying malignancy
how is an unprovoked DVT investigated?
NAME?
what is a varicose vein? how big are they?
- distended superficial vein- typically on legs- >3mm in diameter
what is a reticular vein? how big are they?
dilated blood vessels in the skin, measuring 1 - 3mm
how big are telangiectasia?
< 1mm in diameter (tiny!)
pathophysiology of varicose veins?
NAME?