Vascular Flashcards
What is Paget-Schroetter Syndrome?
A type of thoracic outlet syndrome caused by venous compression between first rib, clavicle and medial border of anterior scalene muscle resulting in upper limb DVTs.
Can be associated with body building (subclavius hypertrophy, axillary vein microtrauma)
What are the symptoms of thoracic outlet syndrome most commonly due to?
Neurogenic - 80-90% of cases with ulnar nerve root distribution symptoms. There is often no anatomical abnormality identified
What is Adson’s sign?
Loss of radial pulse in abducted arm by rotating head to ipsilateral side with extended neck after deep inspiration - a sign of TOS, although not specific
What are the borders and contents of the thoracic outlet?
Borders
1. Superior - Clavicle
2. Inferior - 1st rib
3. Lateral - middle scalene/cervical rib (if present)
Contents
1. Subclavian vein (medial)
2. Anterior scalene
3. Subclavian artery + brachial plexus (lateral)
What is Charcot’s Foot?
Neuropathic arthropathy with degeneration of weight bearing joint (often tarsometatarsal or metatarsophalangeal joints).
Presents as a hot swollen foot (joint) with palpable pulses in patient with peripheral neuropathy
Which 5 nerves can be injured during carotid endarterectomy, and how do these manifest?
- VII (Facial), marginal mandibular branch - ipsilateral drooping
- IX (glossopharyngeal) difficulty swallowing
- XII (hypoglossal) ispilateral tongue deviation (taste normal)
- Superior laryngeal - voice quality and high pitch phonation
- X (Vagus) - hoarseness or impaired cough
What are the characteristic arterial findings in Buerger’s disease?
Corkscrew arteries in both involved and unaffected limbs
Occurs in mostly Men between 20-40, smokers and usually distal extremities. Needs exclusion of proximal embolic and hypercoagulable states for diagnosis
What is the most common cause of prosthetic graft infection?
Staphylococcus species - (epidermidis or MRSA) - about 50%
Remainder pseudomonas, proteus, e.coli.
MRSA has a poor prognosis
What is the Samson classification of Prosthetic Graft infection (1-5)
- Confined to Dermis
- Involves SC tissue not contacting graft
- Involves body of graft but not anastomosis
- Involves exposed anastomosis without bacteraemia/haemorrhage
- Involves exposed anastomosis with bacteraemia/haemorrhage
What classification system can be used to grade arterial ischaemia?
Rutherfords
From which cells do Carotid body tumours arise?
Paraganglion cells.
Carotid body tumours arise at bifurcation splaying internal/external carotid arteries. They are more common in women and diagnosed in 40-50%
10% familial. Usually benign and mobile side-side
What is the inheritance of carotid body tumours?
Usually autosomal dominant.
May be associated with MENIIa or IIb or Von Hippel-Lindau syndrome
What is the genetic abnormality in Von Hippel Lindau syndrome?
Mutation of VHL tumour suppressor on Chromosome 3 (3p25-26)
What tumours are seen in Von Hippel Lindau syndrome?
Haemangioblastomas (cerebral in 60-80%, most common presentation), Phaeochromocytomas, RCC, Pancreatic serous cystadenoma
Retinal angiomatosis –> visual loss
How do Carotid body tumours present?
Slow growing spherical neck mass which may cause cranial nerve palsies (IX, X, XII).
Fixed in carotid sheath so can go side to side but not up and down
Endoscopic Thoracoscopic sympathectomy targets which nerve ganglions?
T2,T3 +/- T4 of paraspinal sympathetic chain
Hyperhidrosis when refractory to medical management with antiperspirants, anticholinergics and botox
80% satisfaction rates, 85-95% symptom improvement.
86% compensatory sweating (contralateral side)
<25% gustatory sweating
<5% cardiac sympathetic denervation
1-2% Horner’s Syndrome
Describe the 5 types of endoleak
In patients with an AAA, how many will also have popliteal aneurysms?
2-10%
Popliteal aneurysms are bilateral in 50% of cases
In patients with a popliteal aneurysm, how many will have a coexisting AAA?
40%
When should popliteal aneurysms be repaired?
In general if they are symptomatic (although they most often present with occlusion/embolisation i.e. acutely, rather than with claudication), or over 2cm. Definitely over 3cm
Usually bypass and exclude
When should carotid endarterectomy be performed?
70-99% symptomatic stenosis of ipsilateral carotid
Small benefit for 50-69% stenosis (NASCET)
What is Subclavian steal syndrome?
Retrograde flow of blood down vertebral artery to distal subclavian artery if proximal subclavian is stenosed/occluded.
Blood flows through common carotid to circle of Willis and back to vertebral
Most patients are asymptomatic, and can be treated with secondary prevention techniques.
Angioplasty is usually first line interventional, but can do transposition or bypass. Endarterectomy is not performed
Which coagulation factors are degraded by Protein C and Protein S
Factor V
Why does Factor V Leiden cause hypercoagulability
The mutated Factor V is not inactivated by protein C