Surgical Placement Flashcards
Abdominal Aortic aneurysm
what is the threshold?
when is surgery indicated?
> 5.5cm
if increasing at rate of >1.1cm over a year high risk
signs of AAA rupture of impending rupture?
abdo pain
hypotense
tenderness
mx of AAA?
elective endovasular repair
/
open repair
stent us placed into AA via femoral artery to prevent blood from collecting in the aneurysm
complication of EVAR?
endo -leak
Ulcers how to differentiate between arterial and venous?
arterial ulcer comes from peripheral arterial disease
insufficient blood flow
claudictaion
pale
pulseless
pain
paraesthesia
paralysis
perishlingly cold
arterial ulcer is
weoo defined border
pressure point
toe/heel/bony eminence
diabetic ulcer?
peripheral neuropathy
trauma
ischaemia
irregular
punched out border
where do neuropathic ulcers occur?
high pressure area
metatarsal heads as pt does not feel trauma
surrounded by callous tissue
neuropathic is due to loss of sensation as opposed to vascualr
venous ulcer?
vascular origin
chronic venous insufficiency
lower leg swelling (oedema)
hyperpigmentation
ulcer occurs around medial malleolus
irregular / warm inflamed skin
lipodermatosclerosis
inverted champagne bottle appearance
mx of venous ulcer?
4 layer compression band
skin graft
Marjolin’s ulcer
SCC
chronic inflammation
burns / osteomyelitis
Pyoderma gangrenosum
Associated with inflammatory bowel disease/RA
nodule / pustules which ulcerate
is a risk factor for embolic acute limb ischaemia
Atrial fibrillation
secondary prevention for CVD?
MI
angina
stroke
TIA
PAD
atorvastatin 80mg
clopidogrel 75mg
Varicose veins when should you refer to secondary care?
pain
swelling
bleeding
significant skin changes
ulcers
thrombophlebitis
varicose veins
dilated
tortuous
superficial veins
reflux from great saphenous vein
small saphenous bein
Rf for varicose veins?
increasing age
female gender
pregnancy
obesity
variety of skin changes may be seen:
varicose veins
varicose eczema (also known as venous stasis)
haemosiderin deposition → hyperpigmentation
lipodermatosclerosis → hard/tight skin
atrophie blanche → hypopigmentation
Long saphenous vein superficial thrombophlebitis how to investigate?
Patients with long saphenous vein superficial thrombophlebitis should have an ultrasound scan to exclude an underlying DVT
claudication of femoral vessels presents with?
calf pain
iliac claudication causes?
buttock pain
what is the strongest association with developing PVD
smoking
intermittent claudication assessment
femoral, popliteal, posterior tibialis and dorsalis pedis pulses
ankle brachial pressure index
duplex USS
Magnetic resonance angiography
