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>
Phlegmasia crulea dolens
Untreated phlegma alba dolens leads to phlegmasia cerulea dolens
Painful blue leg
(complete lack of venous drainage)
Affects arterial supply and will lead to gangrene if untreated
Endoleak types post EVAR
T1: inadequate apposition of stent graft, incomplete seal
T2: most common, aneurysm fills with small vessel branches
T3: small defect in the graft
T4: porous graft
T5: unclear causea
Buergers test process
Supine leg raise to 45 degrees for 1-2 mins
(if pallor at <20 indicates severe ischaemia)
Then sit up and time for legs to go pink
Buergers test results
Normally 10-15s for legs to return to normal
If an elevation of <20 causes pallor indicates severe ischaemia
In peripheral arterial disease, feet become blue then red
What bacteria associated with AAA
salmonella
Mycotic aneurysm
Dilation of vessel wall as a result of damage by infections such as staph aureus, salmonella, and strep.
AAA repair complications
Ischaemic colitis
Incisional hernia
Paraplegia
Trash foot
How is paraplegia caused by AAA repair
Damage to the artery of adamkiewicz (anterior radiculomedullary artery) supplying blood from T8 to conus medullaris
Trash foot
acute lower limb ischaemia following aortic surgery
Cholesterol emboli dislodging from atherosclerotic plaque
Mx of stable chronic aortic dissection
aggressive antihypertensives
Fontaine vs Rutherford ischaemic leg classification
Fontaine:
IIa, claudication more on walking >200m
IIb claudication walking <200m
Rutherford:
1. Intermittent claudication
2. claudication more on walking >200m
3. claudication walking <200m
Fontaine leg ischaemia classification
I. Mild claudication
IIa. claudication more on walking >200m
IIb. claudication walking <200m
III. Rest pain
IV. Ulcer/gangrene
Rutherford leg ischaemia classification
1. Mild claudication
2. Moderate claudication
3. Severe claudication
4. Rest pain
5. Minor tissue loss
6. Major tissue loss
CIs to thrombolysis for acute limb ischaemia
CVA in the last 2 months
Surgery in the last 2 wks
Mx of aortic dissection in pregnancy
Depends on the fetal age
<28wks aortic repair
28-32 depends on fetal condition
>32 wks c section followed by repair
Most common site of rupture for AAA
80% posterior into the retroperitoneal
20% anterior into intraperitoneal space
