Vascular Flashcards
<p>Angioplasty criteria for critical limb ischaemia</p>
<p>If good run offs</p>
<p>And small lesion</p>
<p>Surgicurycriteria for critical limb ischaemia</p>
<p>If angioplasty fails/not possible</p>
<p>What is PTFE</p>
<p>poly-tetra-flour-ethylene</p>
<p>PTFE made of prosthetic material, lasts 5 years</p>
<p></p>
<p>When to use PTFE vs vein</p>
<p>Femoral to above knee popliteal: PTFE same as vein</p>
<p>Femoral to distal: vein better</p>
<p>ABPI 1.2</p>
<p>Vessel calcification</p>
<p>DM</p>
<p>ABPI 0.8 -1</p>
<p>Mild stenosis</p>
<p>RFs mx</p>
<p>ABPI 0.5-0.8</p>
<p>Mod stenosis</p>
<p>RFs Mx</p>
<p>Consider dupplex</p>
<p>Avoid compression bandage if mixed ulcer</p>
<p>ABPI 0.3-0.5</p>
<p>Significant stenosis</p>
<p>Compression bandage CI</p>
<p>Acute limb ischaemia <6hrs sx</p>
<p>white leg</p>
<p>Acute limb ischaemia 6-12hrs sx</p>
<p>mottled with blanching on pressure</p>
<p>Acute limb ischaemia >12 hours sx</p>
<p>Fixed mottling</p>
<p>Thrombolysis vs surgery for acute limb ischaeamia</p>
<p>Thrombolysis: acute on chronic</p>
<p>Embelectomy: absence of chronic leisions</p>
<p>Fasciectomy indication after embolectomy for acute limb ischaemia</p>
<p>Consider if >6hours</p>
<p>Only below knee (as above knee very rare)</p>
<p>Vascular graftsurgery anticoagulation</p>
<p>3,000 units of heparin infusion 3,5 mins before clamping</p>
<p>Problem with using PTFE in distal grafts</p>
<p>Neo-intimal hyperplasia of the distal graft, leading to its occlusion</p>
<p>How to avoid neo-intimal hyperplasia</p>
<p>Miller cuff</p>
<p>If there is no good vein for distal grafting, do a PTFE graft with an added vein graft at the end</p>
<p>AAA op indications</p>
<p>Symptomatic</p>
<p>>5.5 cm</p>
<p>Rupture</p>
<p>Target BP for type B aortic dissection</p>
<p><120 SBP</p>
<p>Surveillance for AAA</p>
<p>3-4.4cm 2yrly</p>
<p>4.5-5.4 3mthly</p>
<p></p>
<p>Which has a higher patency rate post grafting, above or below knee anastomosis</p>
<p>Above knee</p>
<p>False aneurysm</p>
<p>AKA pseudoaneurysm</p>
<p>Collection of blood between muscularis and adventitia layers of the artery</p>
<p>Dissecting aneurysm</p>
<p>Tear in the intima of the aorta, allowing blood to collect in the intima-media space, propagating the tear along the wall of the vessels</p>
<p>Screening for AAA</p>
<p>One off USS men above 65</p>
<p>Phlegmasia alba dolens</p>
<p>Post thrombotic sx</p>
<p>Painful white leg post DVT (superficial venous system unable to cope with the volume)</p>
<p>Phlegmasia crulea dolens</p>
<p>Untreated phlegma alba dolens leads to phlegmasia cerulea dolens</p>
<p>Painful blue leg</p>
<p>(complete lack of venous drainage)</p>
<p>Affects arterial supply and will lead to gangrene if untreated</p>
<p>Endoleak types post EVAR</p>
<p>T1: inadequate apposition of stent graft, incomplete seal</p>
<p>T2: most common, aneurysm fills with small vessel branches</p>
<p>T3: small defect in the graft</p>
<p>T4: porous graft</p>
<p>T5: unclear causea</p>
<p>Buergers test process</p>
<p>Supine leg raise to 45 degrees for 1-2 mins</p>
<p>(if pallor at <20 indicates severe ischaemia)</p>
<p>Then sit up and time for legs to go pink</p>
<p>Buergers test results</p>
<p>Normally 10-15s for legs to return to normal</p>
<p>If an elevation of <20 causes pallor indicates severe ischaemia</p>
<p>In peripheral arterial disease, feet become blue then red</p>
<p>What bacteria associated with AAA</p>
<p>salmonella</p>
<p>Mycotic aneurysm</p>
<p>Dilation of vessel wall as a result of damage by infections such as staph aureus, salmonella, and strep.</p>
<p>AAA repair complications</p>
<p>Ischaemic colitis</p>
<p>Incisional hernia</p>
<p>Paraplegia</p>
<p>Trash foot</p>
<p>How is paraplegia caused by AAA repair</p>
<p>Damage to the artery of adamkiewicz (anterior radiculomedullary artery) supplying blood from T8 to conus medullaris</p>
<p>Trash foot</p>
<p>acute lower limb ischaemia following aortic surgery</p>
<p>Cholesterol emboli dislodging from atherosclerotic plaque</p>
<p>Mx of stable chronic aortic dissection</p>
<p>aggressive antihypertensives</p>
<p>Fontaine vs Rutherford ischaemic leg classification</p>
<p>Fontaine:</p>
<p>IIa, claudication more on walking >200m</p>
<p>IIb claudication walking <200m</p>
<p></p>
<p>Rutherford:</p>
<p>1. Intermittent claudication</p>
<p>2. claudication more on walking >200m</p>
<p>3. claudication walking <200m</p>
<p>Fontaine leg ischaemia classification</p>
<p>I. Mild claudication</p>
<p>IIa.claudication more on walking >200m</p>
<p>IIb. claudication walking <200m</p>
<p>III. Rest pain</p>
<p>IV. Ulcer/gangrene</p>
<p>Rutherford leg ischaemia classification</p>
<p>1. Mildclaudication</p>
<p>2. Moderate claudication</p>
<p>3. Severe claudication</p>
<p>4. Rest pain</p>
<p>5. Minor tissue loss</p>
<p>6. Major tissue loss</p>
<p>CIs to thrombolysis for acute limb ischaemia</p>
<p>CVA in the last 2 months</p>
<p>Surgery in the last 2 wks</p>
<p>Mx of aortic dissection in pregnancy</p>
<p>Depends on the fetal age</p>
<p><28wks aortic repair</p>
<p>28-32 depends on fetal condition</p>
<p>>32 wks c section followed by repair</p>
<p>Most common site of rupture for AAA</p>
<p>80% posterior into the retroperitoneal</p>
<p>20% anterior into intraperitoneal space</p>
