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Satia's MRCS copied decks > Vascular > Flashcards

Vascular Flashcards

1
Q

Pain in the buttock when walking

A

common / Internal iliac stenosis

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2
Q

Pain in the thigh when walking

A

common / external iliac artery stenosis

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3
Q

Pain in the calve when walking

A

Superficial femoral artery stenosis

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4
Q

Typical narrowing of superficial femoral artery

A

Narrowed at adductor canal

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5
Q

BMT for vascular disease

A

Smoking cessation *****

Control of HTN

Statin

Single anti-platelet

Graduated exercise program

Weight-loss

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6
Q

IC due to aortoiliac disease

A

Balloon angioplasty + kissing iliac stents
-good 5 year patency

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7
Q

Three requirments for by-pass:

A

There must be high-flow, high-pressure blood entering
the graft (inflow)

The conduit must be suitable

The blood must have somewhere to go when it leaves
the graft (outflow or run-off).

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8
Q

Indications for carotid end-arterectomy

A

• There is a high degree of internal carotid artery stenosis (usually taken as a greater than 60–70% diameter reduction)

• The patient is expected to survive at least 2 years

• The intervention can be undertaken with a stroke and/ or death rate of less than 3–5%

• The intervention can be performed soon after the index event

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9
Q

Primary stenting for atherosclerotic renal
artery disease may be considered

A

Refractory hypertension not responsive to medical therapy

To preserve renal function

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10
Q

Subcritical ischaemia

A

Rest / night pain

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11
Q

Critical ischaemia

A

Tissue loss

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12
Q

Non-critical ischaemia

A

Intermittent claudication

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13
Q

aortic bifurcation (saddle) embolus

A

Paraplegia due to cauda equina ischaemia

White marble mottling to waist

Absent femoral pulses

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14
Q

Infectious causes of aneurysms

A

Arteries are generally resistant to infection, but
two organisms:

-Treponema pallidum (syphilis)
-Salmonella

Have a particular ability to produce primary mycotic aneurysms

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15
Q

How are varicose veins managed?

A

MUST undergo a duplex scan before treatment

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16
Q

What are the symptoms of an axillary / brachial embolus?

A

50% of upper limb emboli will lodge in the brachial artery
30% of upper limb emboli will lodge in the axillary artery
Sudden onset of symptoms; pain, pallor, paresis, pulselessness, paraesthesia
Sources are left atrium with cardiac arrhythmia (mainly AF), mural thrombus
Cardiac arrhythmias may result in impaired consciousness in addition to the embolus

17
Q

How is Raynaud’s disease treated?

A

Calcium antagonists

18
Q

What are the signs and symptoms of an upper limb venous thrombosis?

A

Gradual onset of upper limb swelling and discomfort.
Sensation and motor function are normal
Condition may complicate pre-existing malignancy (especially breast cancer) or arise as a result of repetitive use of the limb in a task such as painting a ceiling
The condition is diagnosed with duplex ultrasound and treatment is with anticoagulation

19
Q

What are the signs and symptoms of a cervical rib?

A

Congenital cases may present around the third decade, some cases are reported to occur following trauma
Bilateral in up to 70%
Compression of the subclavian artery may produce absent radial pulse on clinical examination and in particular may result in a positive Adsons test (lateral flexion of the neck away from symptomatic side and traction of the symptomatic arm- leads to obliteration of radial pulse)
Treatment is most commonly undertaken when there is evidence of neurovascular compromise. A transaxillary approach is the traditional operative method for excision

20
Q

What are the symptoms of subclavian steal syndrome?

A

Due to proximal stenotic lesion of the subclavian artery
Results in retrograte flow through vertebral or internal thoracic arteries
The result is that decrease in cerebral blood flow may occur and produce syncopal symptoms
A duplex scan and/ or angiogram will delineate the lesion and allow treatment to be planned

21
Q

How is Takayasu’s arteritis treated?

A

Systemic steroids

22
Q

What are the indications for surgical revascularisation of the lower limb?

A

Intermittent claudication
Critical ischaemia
Ulceration
Gangrene

23
Q

Describe the procedure of an arterial bypass surgery e.g. between superficial femoral artery and above knee popliteal

A

Artery dissected out, IV heparin 3,000 units given and then the vessels are cross clamped
Longitudinal arteriotomy
Graft cut to size and tunneled to arteriotomy sites
Anastomosis to femoral artery usually with 5/0 ‘double ended’ Prolene suture
Distal anastomosis usually using 6/0 ‘double ended’ Prolene

24
Q

Describe some facts about distal arterial disease treatment

A

Femoro-distal bypass surgery takes longer to perform, is more technically challenging and has higher failure rates.
In elderly diabetic patients with poor runoff a primary amputation may well be a safer and more effective option. There is no point in embarking on this type of surgery in patients who are wheelchair bound.
In femorodistal bypasses vein gives superior outcomes to PTFE

25
Q

What are some rules for bypass surgery

A

Vein mapping 1st to see whether there is suitable vein (the preferred conduit). Sub intimal hyperplasia occurs early when PTFE is used for the distal anastomosis and will lead to early graft occlusion and failure.
Essential operative procedure as for above knee fem-pop.
If there is insufficient vein for the entire conduit then vein can be attached to the end of the PTFE graft and then used for the distal anastomosis. This type of ‘vein boot’ is technically referred to as a Miller Cuff and is associated with better patency rates than PTFE alone.
Remember the more distal the arterial anastomosis the lower the success rate.

26
Q

When are amputations indicated?

A

Dead, deadly, dead useless

non viable tissue
Threat to life e.g. infection
viable, but prosthesis is preferable

27
Q

What are the main types of amputations?

A

Pelvic disarticulation (hindquarter)
Above knee amputation
Gritti Stokes (through knee amputation)
Below knee amputation (using either Skew or Burgess flaps)
Syme’s amputation (through ankle)
Amputations of mid foot and digits

28
Q

Pros and Cons of above knee amputations

A

Quick to perform
Heal reliably
Patients regain their general health quickly
For this benefit, a functional price has to be paid and many patients over the age of 70 will never walk on an above knee prosthesis.
Above knee amputations use equal anterior-posterior flaps

29
Q

Pros and Cons of below knee amputations

A

Technically more challenging to perform
Heal less reliably than their above knee counterparts.
However, many more patients are able to walk using a below knee prosthesis.
In below knee amputations the two main flaps are Skew flaps or the Burgess long posterior flap. Skew flaps result in a less bulky limb that is easier to attach a prosthesis to

30
Q

Indications for surgery in AAA

A

Symptomatic aneurysms (80% annual mortality if untreated)
Increasing size above 5.5cm if asymptomatic
Rupture (100% mortality without surgery)

31
Q

What type of aneurysm is suitable for EVAR?

A

Long neck
Straight iliac vessels
Healthy groin vessels

32
Q

What do each ABPI measurements indicate?

A

> 1.2 - abnormal calcification, often in diabetes

1 - Normal (be wary in DM)

0.9 - 0.6 = Claudication

0.6 - 0.3 = Rest pain

< 0.3 = impending

33
Q

What are some types of anatomical bypass surgery?

A

aorto-bifemoral
femoral-popliteal
femoral-distal

34
Q

What are some types of extra anatomical bypass surgery?

A

Axillo-femoral
fem-fem crossover

35
Q

What classification system is used for peripheral arterial disease?

A

Fontaine

36
Q

What are some signs and symptoms of peripheral venous disease?

A

Lipodermatosclerosis
Venous eczema
Haemosiderin deposits
Venous ulcer

37
Q

How is peripheral venous disease managed?

A

Conservative: Compression bandages but ABPI must be > 0.8

Natural:
Trahere (axillary vein and valve into deep venous system)
Kistner (venous valvuloplasty)
Palma (venous operation with contralateral great saphenous vein)

Artificial:
Above IL - Dacron
Below IL - PTFE

38
Q

How can varicose veins be treated?

A

Medical: sclerotherapy / radiofrequency ablation

Surgical: Trendelenburg ligation, Cockett ligation, Short saphenous vein ligation and SEPS

39
Q

How often are AAA monitored?

A

3-4.5 cm f/u scan in 1 year
4.5-5.5 f/u scan in 3 months
> 5.5cm - 2ww referral

Satia's MRCS copied decks (32 decks)

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