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PACES > Vascular > Flashcards

Vascular Flashcards

1
Q

What 2 vascular procedures may result in a midline laparotomy scar?

A

Aortobifemoral bypass

Open AAA repair

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2
Q

Risk factors for AAA

A

Modifiable

  • Hypertension
  • Diabetes
  • Hypercholesterolaemia
  • Smoking

Non-modifiable

  • Age
  • Ethnicity
  • Sex
  • Connective tissue disorders
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3
Q

Screening for AAA

A

One off USS scan for all males at 65yo

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4
Q

Monitoring of incidental AAAs

A

If 3-4.5cm and asymptomatic: See vascular team within 12w, then USS every year

If 4.5-5.5cm and asymptomatic: USS every 3 months

If grows to more than 5.5cm, or grows >1cm in 1 year or is symptomatic but unruptured, needs elective surgical intervention

Old/frail = EVAR
Young/healthy = open AAA repair
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5
Q

Risk factors for varicose veins

A

Obesity
Pregnancy
Standing for long periods
Age

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6
Q

Skin changes associated with chronic venous insufficiency

A

Lipodermatosclerosis - extravasation of lipids leads to immune cell recruitment and fibrotic response
Venous eczema - venous stasis causes cutaneous inflammatory dermatitis
Atrophie blanche - angular white scar developing as a result of ulceration
Haemosiderin deposition

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7
Q

Indications for referral for varicose veins

A

Severe symptoms
Skin changes (haemosiderin, lipodermatosclerosis)
Venous ulceration
Superficial vein thrombophlebitis

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8
Q

Mx of varicose veins

A

Conservative

  • Avoid prolonged standing
  • Full length graduated compression (if no PAD)
  • Weight loss
  • Exercise

Surgical

  • Band ligation of saphenous vein
  • Injection sclerotherapy
  • Radiofrequency ablation
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9
Q

Management of superficial vein thrombophlebitis

A

Conservative + avoid DVT

  • NSAID analgesia
  • Compression stockings
  • Exercise

Refer for varicose vein Tx

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10
Q

Venous ulcer features

A

Located in gaiter area (superior to medial malleolus)
Painless
Sloped edge, margins not well defined (as chronically healing
Associated skin changes of venous insufficiency, and varicose veins

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11
Q

Arterial ulcer features

A

Punched out well defined lesions
Painful
Found distally in between toes or on soles of feet

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12
Q

Neuropathic ulcer features

A

Found on pressure points e.g. balls of feet
Occur as a result of repetitive unrecognised trauma
Gradually deepens with time, may develop associated gangrene

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13
Q

Bypass types, indications, procedure and complications

A 
Thoraco-femoral
Aorto-femoral
Aorto-bifemoral
Iliofemoral
Femoro-popliteal
Femoro-femoral

For larger vessels artificial (Dacron, PTFE) grafts may be used, for smaller vessels the long saphenous vein is generall used in an autologous graft

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14
Q

Presentation of intermittent claudication

A

Leg pain on exertion - distance normally reproducible, progressively shortens as disease worsens
Relieved by rest

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15
Q

Definition of critical limb ischaemia

A

Rest pain/tissue loss
Claudication lasting >2 weeks
Ankle pressure <40mmHg

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16
Q

Management of intermittent claudication

A

RF modification + CV prevention

Conservative

  • Weight loss
  • Exercise programmes
  • Stop smoking

Medical

  • Diabetes control
  • Hypertension control
  • High dose statin
  • 75mg clopidogrel lifelong

Surgery

  • Open/endovascular bypass surgery
  • Amputation (last resort)
17
Q

Ix for peripheral vascular disease

A
  • ABPI
  • Duplex US
  • Digital subtraction angiography
18
Q

ABPI figures

A 
0.9-1.2 = normal
>1.2 = vascular calcification
0.5-0.9 = Moderate ischaemia
0.3-0.5 = Severe ischaemia 
<0.3 = Critical limb ischaemia
19
Q

Indications for limb amputation

A
  • Dead (severe PAD, thromboangiitis obliterans)
    • Dangerous (sepsis, malignancy)
    • Damaged (trauma, burns, frostbite)
    • Damned nuisance (intractable pain, neurological damage)
20
Q

Causes of thoracic outlet syndrome

A
  • Hyperextension injuries
    • Repetitive stress
    • Extrinsic compression (e.g. poor posture)
    • Anatomical abnormalities e.g. cervical rib
21
Q

Symptoms of thoracic outlet syndrome

A 
- Venous
		○ DVT
		○ Limb swelling
	- Nervous
		○ Paraesthesia
		○ Motor weakness
		○ Muscle wasting
	- Arterial (common in patients with bony abnormalities)
                 - Claudication Sx
22
Q

Causes of SVCO

A

Malignant

  • Lung cancer
  • Lymphoma

Non-malignant

  • Aortic aneurysm
  • Benign mediastinal tumours
  • Thrombosis
23
Q

Arterial ulcer Mx

A

Conservative
- Exercise programmes

Medical

  • Pain relief
  • CV prevention (statin, antiplatelet, BP, DM)

Surgical

  • Angioplasty
  • Bypass grafting
24
Q

Venous ulcer Mx

A

Conservative

  • Full length graduated compression (clean and dress ulcer first)
  • Exercise
  • Weight reduction

Medical
Pentoxifylline

Treat varicose veins: Ligation/Sclerothearpy

25
Q

What are the standard diagnostic Ix that are used in vascular pathology

A

Bedside
ABPI

Imaging
Duplex US (2D USS + doppler)
Digital subtraction angiography
MR angiography
CT angiography
26
Q

Definitive Ix for acute limb ischaemia

A

CT angiography

27
Q

Mx of acute limb ischaemia

A

Immediate

Morphine
Oxygen
IV heparin
Prep for threatre (G+S, clotting)

Definitive
Embolectomy with fogarty (if embolic disease)
Thrombolysis (if thrombotic)

28
Q

Fontaine staging of PVD

A

1: Asymptomatic
2: Intermittent claudication (mild, moderate and severe)
3: Rest pain
4: Minor tissue loss (ischaemic ulcers on digits)
4b: Major tissue loss

29
Q

Types of amputation

A

Above knee
Below knee
Transmetatarsal
Hallux/toe

Decision depends on disease process, co-morbidity of patient etc.

30
Q

True aneurysm vs pseudoaneurysm

A

True aneurysm: Bulging of all layers of vessel wall

Pseudoaneurysm: Damage to the wall allows blood to extravasate and pool in surrounding tissue

31
Q

Most common AAA locations

A

90% infrarenal
Juxtarenal
Suprarenal

32
Q

Referral time for incidental AAA

A

> 5.5cm = within 2w

3 - 5.5cm = within 12w

33
Q

Varicose Veins Ix

A

ABPI (compression contraindicated in severe PVD)
Duplex US

Superficial veins: Visualise and measure size of incompetent segments
Deep veins: Rule out DVT

34
Q

Complications of DVT

A

PE

Chronic venous insufficiency: Post-thrombotic syndrome (valvular damage from DVT leads to long term incompetence)

Bleeding from anticoagulation/HIT

35
Q

Compression stockings vs full length graduated compression

A

Both can be used for the Tx of venous ulcers and varicose veins

Graduated compression gives better oedema control, and is more suitable for active ulceration

Graduated compression has to be applied by a trained professional; compression stockings are preferred in people who are able to self-care

PACES (13 decks)

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