Vascular Flashcards

1
Q

Mx of peripheral artery disease?

A

Atorvastatin + clopidogrel

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2
Q

What area of legs are effected more by intermittent claudication?

A

Distal extremity (calves) more common than proximal (thigh / buttock areas)

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3
Q

Px of chronic limb ischaemia?

A

Chronic rest pain
- Worse at night due to lower BP and no gravity

Non-healing ulcers

Rubor, pallor on elevation and reduced cap refill

Absent foot pulses

Circulation so severely impaired -> imminent risk of limb loss

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4
Q

6 P’s of acute limb ischaemia?

A

6 P’s
- Pain
- Pulseless
- Pallor
- Power loss (paralysis)
- Paraesthesia
- Perishing cold

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5
Q

ABPI ratios

A

ABPI ratio:
- <0.5 = severe
- 0.5 – 0.8 = mild arterial disease
- 0.8 – 1.3 = normal
- >1.3 = arterial calcification

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6
Q

What to examine for in peripheral artery disease?

A
  • Ulcers (legs and feet)
  • Differences in legs – temperature, muscle atrophy, skin changes
  • Pulses – femoral, popliteal and foot
  • Buerger’s test, capillary refill time
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7
Q

Ix of peripheral artery disease?

A
  1. Duplex ultrasound – speed and volume of blood flow
  2. MRI angiography – contrast added to highlight arterial circulation
  3. CT angiography
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8
Q

Mx of intermittent claudication?

A
  1. Exercise programme
    - Supervised or unsupervised
  2. Angioplasty or stenting
  3. Bypass surgery
  4. Naftidrofuryl oxalate
    - If patient doesn’t want referred to surgery
    - Discontinue if no benefit after 3 months
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9
Q

Mx of critical limb ischaemia?

A

Urgent referral to vascular MDT first

Analgesia (paracetamol + strong/weak opioids)

Options:
- Endovascular angioplasty and stenting
- Endarterectomy
- Bypass surgery
- Amputation

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10
Q

Mx options of acute limb ischaemia?

A

Endovascular
- Thrombolysis (catheter applies thrombolysis directly into clot)
- Thrombectomy (catheter removes thrombus with mechanical device)

Surgical
- Thrombo-embolectomy
- Endarterectomy
- Bypass surgery
- Amputation

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11
Q

What is minimum dilation for an AAA?

A

When dilatation of abdominal aorta diameter >3cm (1.5x normal size)

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12
Q

At what age is screening available for AAA?

A

All men >65

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13
Q

When to consider AAA repair?

A

o Symptomatic AAA
o >4cm and has grown by 1cm in one year
o >5.5cm

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14
Q

Ruptured AAA px?

A
  • Severe abdo pain which radiates to the back or groin
  • Haemodynamically unstable
  • Pulsatile and expansile mass
  • Collapse
  • Loss of consciousness
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15
Q

What is aortic dissection?

A

Aortic dissection is when there is a break in intima layer, and this allows blood to enter between the intima and media layers

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16
Q

Stanford classification of aortic dissection

A

Type A = affects ascending aorta (bad prognosis)

Type B = affects descending aorta (better prognosis)

17
Q

DeBakey classification of ascending aorta

A

Type 1 = begin in ascending aorta and extends to aortic arch / descending aorta
Type 2 = ascending aorta only
Type 3 = descending aorta distal to left subclavian

18
Q

Px of aortic dissection?

A

Sudden onset, severe, ripping / tearing chest pain
o Ascending aorta = anterior chest
o Aortic arch = neck
o Descending aorta = between scapulae
Differences in blood pressure between arms
Aortic regurgitation, coronary ischaemia,
cardiac tamponade
Diastolic murmur
Collapse

19
Q

Mx of aortic dissection?

A

Analgesia, O2 and IV access

BP and HR control to reduce aortic wall stress [B-blockers?]

Depends on type:
Type A: Surgery -> Replace aortic arch with graft (high mortality if untreated)
Type B:
-> Conservative – lower BP (IV Labetalol)
-> If rupture or complication -> Surgery – endovascular repair (TEVAR)

20
Q

Carotid artery stenosis diameter required for dx of severe stenosis?

A

Mild - <50%
Moderate 50-69%
Severe >70%

Moderate & severe -> assessment for carotid endarterectomy

21
Q

Ix for suspected stroke?

A

Non-enhanced CT

22
Q

Initial mx for suspected TIA or ischaemia stroke

23
Q

What is needed for a high rx diabetic foot?

A

Previous ulceration
Previous amputation
Renal replacement therapy
2 of:
- Neuropathy
- Callus / deformity
- Non-critical limb

24
Q

Antibiotics for diabetic foot sepsis?

A

Mild - oral flucloxacillin
Pen allergic -> Clarithromycin or doxycycline
Pen allergic + pregnant -> erithromycin

Moderate or severe:
* Flucloxacillin +/- gentamicin +/- metro
* Co-amoxiclav +/- gentamicin
* Co-trimoxazole +/- gentamicin +/- metro
* Ceftriaxone + metronidazole

25
Antibiotic for MRSA?
Vancomycin
26
What is charcot arthropathy?
This is progressive destruction of bones, soft tissues and joints in the ankle and feet due to peripheral neuropathy.
27
Ix for charcot arthropathy?
1. X-ray – degenerative changes, loss of joint space, fragmentation (mimics OA) 2. MRI – abscess or soft tissue swelling?
28
Mx for charcot arthropathy?
Removable offloading device (plaster cast) - No bisphosphonates
29
Px of varicose veins?
Tortuous dilated veins, skin discolouration, aching, itching - Late – varicose eczema, ulceration, thrombophlebitis, bleeding
30
Mx of varicose veins?
- Weight loss, avoid prolonged standing, increase exercise - Compression stockings - Venous ulceration -> four-layer bandaging - Pregnant -> compression hosiery for symptom relief of leg swelling
31
When to refer to vascular service with varicose veins?
- Symptomatic or skin changes or venous leg ulcer - Or superficial vein thrombosis – hard, painful veins
32
Surgical mx for varicose veins?
Mx if confirmed varicose veins + truncal reflux: 1. Endothermal ablation 2. Ultrasound guided foam sclerotherapy 3. Surgery
33
Ix for varicose veins?
Duplex ultrasound to assess valve incompetence - Extent of truncal reflux?
34
Deep venous insufficiency Ix
Doppler US - Foot pulses and ABPI – If bad, compression stocking could impair arterial flow
35
Deep venous insufficiency mx
Conservative (compression stockings + elevate legs + analgesia) - Surgical is an option but poor outcomes