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Vascular Flashcards

1
Q

At which level does the aorta bifurcate to the iliac arteries?

A

L5

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2
Q

What is the most important risk factor for aortic dissection? What are other risk factors?

A

Main RF = Hypertension

Others=
Marfan's syndrome
Ehlers-Danlos
Turner's syndrome
Coarctation of the aorta
Truama
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3
Q

How does aortic dissection present?

A

Severe tearing chest pain which radiates to the bacjok

Weak/absent pulses

Aortic regurgitation - Early diastolic murmur with rumbling character

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4
Q

What are the two types of aortic dissection and how are they managed?

A

Type A = Ascending Aorta = Surgery - Midline sternotomy, remove section of aorta and replace with synthetic graft

Type B = Descending Aorta = Beta-blockers –> IV Labetalol

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5
Q

How is aortic dissection diagnosed?

A

CT Angiogram chest/abdo/pelvis

If they are unstable then TOE

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6
Q

What is seen on imaging in aortic dissection?

A

A false lumen

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7
Q

What is seen on CXR in aortic dissection?

A

Widened mediastinum

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8
Q

What is an abdominal aortic aneurysm?

A

Dilation of the abdominal aorta of more than 3cm

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9
Q

Who is offered a scan for AAA?

A

All men at 65

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10
Q

What is the first line scan for AAA?

A

Abdominal ultrasound

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11
Q

What is the diagnostic imaging for an AAA?

A

CT Angiogram

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12
Q

What is the most common cause of an AAA?

A

Arterial disease - HTN, diabetes, smoking

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13
Q

How does an AAA present?

A

Usually asymptomatic until rupture

May be a pulsatile mass in the abdomen

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14
Q

How do you manage an AAA which is between 3 and 4.4cm?

A

Monitor annually

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15
Q

How do you manage an AAA which is between 4.5cm to 5.5cm?

A

Monitor every 3 months

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16
Q

How do you manage an AAA over 5.5cm?

A

Repair

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17
Q

Which AAAs should be repaired?

A

Over 5.5cm

Symptomatic

Growing more than 1cm per year

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18
Q

When should a patient with an AAA stop driving? When does the DVLA need to be informed?

A

Inform DVLA at 6cm

Stop driving at 6.5cm

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19
Q

How does a ruptured AAA present?

A

Severe abdominal pain - may radiate to back

Hypotension

Tachycardia

May be collapse/loss of consciousness

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20
Q

How is a ruptured AAA managed?

A

Immediate vascular review

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21
Q

What is the stepwise progression of peripheral arterial disease?

A
  1. Intermittent claudication
  2. Critical limb ischaemia
  3. Acute limb-threatening ischaemia
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22
Q

What are features of intermittent claudication?

A

Aching/burning pain in leg following walking
Relieved within minutes of stopping
Not present at rest

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23
Q

How does critical limb ischaemia present?

A

1 or more of…
Rest pain in foot
Arterial ulceration
Gangrene

Patients often hang leg off bed to ease pain

24
Q

How does acute limb-threatening ischaemia present?

A

6 P’s

Pale
Pulseless
Painful
Paralysis
Parasthaesia
Perishingly cold
25
How is peripheral arterial disease assessed?
Check pulses Handheld doppler ABPI
26
How does an arterial ulcer present?
``` Small, deep Well-defined border Punched out appearance Usually peripheral - e.g on toes Painful ```
27
How does a venous ulcer present?
``` Usually after injury to leg Large Irregular borders Often affects gaiter area Less painful than arterial ``` Other signs of venous disease - venous eczema, varicose veins, lipsclerodematosis
28
How is peripheral arterial disease managed?
STOP SMOKING Treat any co-morbidities Start patient on statin 80mg and clopidogrel 75mg Surgical options for severe PAD/acute limb ischaemia: Thrombus= Endovascular angioplasty + stenting, Bypass Embolus= Endarterectomy
29
What is Leriche syndrome?
Triad of.. Thigh/buttock claudication Absent femoral pulses Impotence
30
How do you interpret an ABPI?
``` 1.0-1.2= normal <0.9 = likely PAD <0.5 = severe PAD ```
31
How are venous ulcers managed?
Compression bandaging (ensure that arterial disease has been ruled out)
32
What is superficial thrombophlebitis and how is it managed?
Inflammation and thrombosis of one of the superficial veins - usually the long saphenous vein NSAIDs Compression stockings
33
What skin changes are seen in venous insufficiency?
Varicose veins Haemosiderin staining venous eczema Lipodermatosclerosis - hardening/tightening of skin
34
How are varicose veins managed?
If pregnant - will usually improve after delivery Compression stockings Surgical options - ablation, sclerotherapy, stripping
35
What is Buerger disease?
inflammatory condition - thrombus formation in the small and medium sized blood vessels Strongly associated w/ smoking
36
How does Buerger disease present?
Painful blue discolouration of fingertips/tips of toes
37
What is seen on angiogram in Buerger disease?
Corkscrew collaterals
38
How is Buerger disease managed?
Stop smoking
39
What 2 medications should all patients with PAD be prescribed?
Statin + clopidogrel
40
What can cause a falsely raised ABPI in a patient with PAD?
Diabetes - due to sclerosis of the vessels
41
How is ABPI calculated?
ABPI = Systolic BP of the ankle / Systolic BP of the arm
42
How to diagnose an aortic dissection in an unstable patient?
Transoesophageal echo
43
Which AAAs should be monitored annually?
3cm to 4.4cm
44
Which AAAs should be monitored every 3 months?
4.4cm to 5.4cm
45
Venous ulcer vs. arterial ulcer | Size, depth, border, location, appearance, pain
Size: Arterial smaller than venous Depth: Arterial deeper than venous Border: Arterial is well demarcated, venous is poorly defined Location: Arterial is usually peripheral (toes), venous is usually in the gaiter area Appearance: Arterial appear punched out, venous occurs with haemosiderin staining, venous eczema, liposclerodermatosis and varicose veins Pain: Arterial are painful, venous are less
46
What are skin signs of venous insufficiency?
``` Venous ulcer Haemosiderin staining Venous ulcer Liposclerodermatosis Varicose veins ```
47
What is ABPI and how is it interpreted?
Ankle pressure / Brachial pressure ``` <0.9 = arterial disease <0.5 = severe disease ```
48
What does the ABPI need to be for compression stockings/bandage?
At least 0.8
49
What is superficial thrombophlebitis and how is it managed?
Inflammation/thrombosis of one of the superficial veins- usually the long saphenous vein Management = NSAIDs + compression stockings
50
What is Takayasu's Arteritis and how does it present? How is it managed?
A type of large vessel vasculitis Presents with a mild systemic illness then a pulseless phase - symptoms of vascular insufficiency Managed with oral prednisolone Associated with raised ESR
51
What are the two types of acute limb-threatening ischaemia and how can you tell the difference between the two?
Can either be due to a thrombus or an embolus Thrombus - pre-existing claudication with sudden deterioration, no obvious source of emboli, reduced/absent pulses in other limb, evidence of widespread vascular disease (e.g. MI, stroke) Embolus - sudden onset, no history of claudication, obvious source of embolus (e.g. AF), no evidence of PAD in other limb
52
How is acute limb-threatening ischaemia managed?
Thrombus - endarterectomy or bypass Embolus - immediate embelectomy
53
Can you diagnose PAD using ABPI in diabetics?
No as it can be abnormally high
54
How urgently should someone with an AAA >5.5cm/rapidly enlarging/symptomatic see a vascular surgeon?
Within 2 weeks
55
Should someone with an AAA <5.5cm need to see a vascular surgeon?
Yes, within 12 weeks

Medicine Finals (32 decks)

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