Vascular Flashcards
Define an aneurysm
Abnormal focal dilatation of a vessel >50% of normal
What is a true aneurysm?
Involves all 3 layers of arterial wall (tunica intima media externa)
What congenital condition predisposes cerebral aneurysms?
ADPCKD
A saccular aneurysm is also known as what
Berry aneurysm
What infections are associated with aneurysms?S
Syphilis, TB
False aneurysms are also known as what
Pseudoaneurysm
What condition is known as a mimic of AAA?
Renal colic
Abdominal aorta measuring more than how many cm = AAA?
3cm
Who is offered AAA aneurysm? What test is used in screening?
All men >65yr
US
What is the management of AAA picked up at screening depending on the size?
3.0-4.4cm: 2 yearly US
4.5-5.4cm: 3 monthly US
>5.5cm: consider repair
(also smoking cessation+ HTN Mx)
Grey Turners / Cullen’s sign may be seen in AAA rupture - T or F
True
What is the presentation of a ruptured AAA?
Sudden onset abdo/back pain
Expansile tender abdo mass
Collapse
What test is done for ruptured AAA diagnosed?
CT angiogram with contrast
event if eGFR 9 give contrast since need
What type of repair is 1st and 2nd line for AAA?
1st line open repair
2nd line EVAR
What has higher rates of failure/complications for AAA - open repair or EVAR?
EVAR
Venous system
- low or high pressure
- low or high volume
- low or high resistance
Low pressure
High volume
Low resistance
Is the saphenous vein a superficial or deep veins?
Superficial
In peripheral venous disease is there increased or decreased pressure in the vascular system?
Increased pressure due to pooling of blood
Is lipodermatosclerosis a feature of arterial or venous disease?
Venous
What does Trendelenburg’s test involve? What is a positive test a sign of?
Lie flat, elevate leg to drain vein, stand, occlude saphenofemoral junction, see if refills distally
Peripheral venous disease AKA venous insufficiency
What investigation is done for peripheral venous disease?
Duplex US
asses deep + superficial veins + level of competence
“Dilated tortuous elongated superficial vein” is the description of
Varicose vein
Thrombophlebitis is a complication of varicose veins - true or false
True
Where are venous ulcers classically found?
Gaiter area
Venous or arterial ulcer
- Large or small
- Shallow or deep
Venous large shallow
What causes skin pigmentation in peripheral venous disease?
Haemosiderin deposits from erythrocyte leakage/ breakdown
Is champagne flute shape legs a feature of arterial or venous disease?
Venous
What is the 1st line management of peripheral venous disease (no ulcers)?
Conservative weight management - inform risk of ulcers if progression
What is the 1st line management of venous ulcers?
Graduated compression stockings
(mimic normal venous system)
(also compression bandages)
What is a contraindication to graduated compression stockings? Is it a relative or absolute contraindication?
PAD
Absolute
What arteries travel through the transverse foramen of C6-C1?
L/R vertebral arteries
What is the 1st branch of the subclavian arteries?
L/R vertebral arteries
What is the management post TIA
Dual antiplatelet (usually aspirin + clopidogrel)
Statin
HTN Mx
Urgent carotid duplex
What are the criteria for urgent referral after carotid duplex post TIA? What procedure they referring for?
If 70-99% carotid artery stenosis
Urgent referral for carotid endarterectomy (within 2wk)
What test is diagnostic for carotid stenosis?
Duplex US
Why are 100% carotid stenosis not suitable for carotid endarectomy?
No stroke risk since can’t through a clot (embolism)
In 100% carotid artery stenosis, how is the brain still perfused?
Watershed arteries and vertebral arteries
The general risk factors for atherosclerosis are risk factors for carotid disease - what additional risk factor is there for carotid disease?
Head neck radiation
What are the big risks during carotid endarterectomy?
2% stroke
1% death
What are the 3 criteria for carotid endarterectomy?
Symptoms same side as stenosis +
Less than 14 days since TIA +
70-99% stenosis on duplex US
Carotid endarterectomy is only done for symptomatic carotid disease - true or false
True
since it is a high risk procedure, benefit is to only prevent further strokes
A patient had right sided amaurosis fugax 5 days ago + 80% right sided carotid artery stenosis on duplex ultrasound - are they suitable for carotid endarterectomy?
Yes - amaurosis fugax is a type of TIA - and ophthalmic arteries arise from internal carotid so it is carotid disease
A patient had a TIA with right sided cerebellar symptoms 5 days ago + 80% right sided carotid artery stenosis on duplex ultrasound - are they suitable for carotid endarterectomy?
No - cerebellar arteries don’t arise from the carotids so this is not symptomatic carotid disease
What a crescendo TIAs?
Recurrent
What nerve is the recurrent laryngeal nerve a branch of?
Vagus
What time frame is required to meet the definition of acute limb ischaemia?
Less than 2 weeks
normally hours
In acute limb ischaemia
- more often upper or lower limb?
- contralateral limb affected or unaffected?
- presence or abscense of preceding symptoms?
Lower
Contralateral limb unaffected
No preceding symptoms
What are the 6 Ps of acute limb ischaemia?
Pallor Perishingly cold Pain Pulseless Late Paraesthesia Paralysis
What time frame is acute limb ischaemic salvageable, sometimes salvageable and non-salvageable?
0-4hr salvageable
4-12hr sometimes salvageable
>12hr non-salvageable
In acute limb ischaemia, what is a more worrying sign - blanches on pressure or non-blanching?
Non-blanching - suggests more progressed
What is a more worrying sign in acute limb ischaemia - white foot or mottling?
Mottling
Foot initially white then mottled
What is the commonest cause of acute limb ischaemia: embolic / thrombotic / traumatic / dissection / external compression
Embolic
AF cardioembolic, aneurysm, endocarditis
What is the definitive management of acute limb ischaemia ?
Salvageable: embolectomy + fasciotomy (re-vascularisation)
Non-salvageable: surgical removal of dead tissue (to prevent sepsis)
What has a better outcome - acute or acute on chronic limb ischaemia?
Acute on chronic - since collaterals grown so better outcome
What are the red flags for compartment syndrome?
Pain out of proportion
Pain on passive stretching
What are the diagnostic criteria for compartment syndrome?
Compartment pressure >30 or <20 below diastolic
What is the management of compartment syndrome?
Fasciotomy
Are paraesthesia/paralysis a late or early sign in compartment syndrome?
Late
By definition, how long must symptoms be present for a diagnosis of critical limb ischaemia?
Longer than 2 weeks
In critical limb ischaemia, is pain present at rest or on exercise?
At rest (also claudication after walking short distance)
What is ABPI in critical limb ischaemia?
<0.5 or normal/high
high = calcification
What is a sunset foot a sign of? What does this mean?
Sign of critical limb ischaemia - foot is red due to hyperaemia - though on elevation of the leg foot goes white
A ‘punched out’ ulcer is arterial or venous?
Arterial
Is critical limb ischaemia more associated with arterial or venous ulcers?
Arterial
What is Buerger’s test? What is it testing for?
PAD
Are critical limb ischaemia symptoms worse at night or in the daytime?
At night
