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Surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

How is the ABPI calculated?

A

Ankle SBP / Brachial SBP

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2
Q

What are the ranges of ABPI when considering peripheral vascular disease?

A

> 0.9 = normal
0.6 - 0.9 = mild PVD
0.3 - 0.6 = moderate - severe PVD
< 0.3 = end stage PVD - critical limb ischaemia

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3
Q

What are the 6 Ps of critical limb ischaemia?

A

Pain
Pallor
Pulseless
Paralysis
Paraesthesia
Perishingly cold

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4
Q

What is the normal diameter of the Abdominal aorta?

A

1.5 cm in females
1.7cm in males

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5
Q

When is an abdominal aorta considered aneurysmal?

A

A diameter over 3cm

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6
Q

What is the screening process for AAA?

A

Men aged 65 are invited for a one off abdominal ultrasound of the abdominal aorta

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7
Q

What is considered a small AAA and what further action is required?

A

A diameter of 3-4.4cm

Repeat US every 12 months

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8
Q

What is considered a medium AAA and what further action is required?

A

A diameter of 4.5-5.4cm

Repeat US every 3 months

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9
Q

What is considered a large AAA and what further action is required?

A

> 5.5.cm

Urgent referal to vascular surgery

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10
Q

What is considered a low rupture risk in terms of AAA and what is the management plan?

A

Asymptomatic AAA and less than 5.5 cm

Repeat abdominal US in line with guidance and optimise CV risk factors (e.g. quit smoking)

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11
Q

What is considered high rupture risk in terms of AAA and what is the management plan?

A

Symptomatic AAA, over 5.5cm, or rapidly enlarging (1cm/year)

Required urgent referal to vascular surgery for EVAR or open repair

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12
Q

How might a ruptured AAA present?

A

Severe, central abdominal pain that radiates to the back
A pulsatile and expansible abdominal mass
Shock or collapse

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13
Q

What is the management for a haemodynamically unstable AAA rupture?

A

Straight to theatre

If patient is frail with multiple co-morbidities then consider a palliative approach

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14
Q

What is the management of a AAA rupture in a haemodynamically stable patient?

A

CT angiogram and possible EVAR

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15
Q

In PVD and all patients with established cardiovascular disease, what medications should they be started on?

A

A statin - atorvostatin 80mg
Clopidogrel 75mg (or aspirin if contraindicated)

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16
Q

What is the surgical management for severe PVD?

A
  1. Endovascular revascularisation - percutaneous transluminal angioplasty +/- stent
    Short segment stenosis (<10cm), aortic illiac disease, high-risk patients
  2. Surgical revascularisation - bypass or endarterectomy
    - Long segment lesions (>10cm), multifocal lesions, lession of the common femoral a., purely infrapopliteal disease
17
Q

What drugs are licensed for PAD?

A

Naftirofuryl Oxalate - vasodilater reserved for patients with a poor quality of life

18
Q

What is the initial investigation for suspected acute limb ischemia?

A

Handheld doppler

19
Q

Generally, what causes limb ischaemia?

A

Thrombus (due to a ruptured atherosclerotic plaque)
Embolus (secondary to AF)

20
Q

What symptoms might patients with varicose veins experience?

A

Aching and throbbing
Itching

21
Q

What investigation should be done for varicose veins?

A

Venous duplex ultrasound - will demonstrate any retrograde venous flow

22
Q

What are the conservative treatments for varicose veins?

A

Elevate legs
Weight loss
Regular excercise
Graduated compression stockings

23
Q

What CXR sign might be seen in Aortic dissection?

A

Widening of the aorta

24
Q

What is subclavian steal syndrome?

A

Occurs due to proximal stenotic lesion of the subclavian artery which results in retrograde flow through the vertebral or internal thoracic arteries

25
Q

What symptoms might a patient with subclavian steal syndrome have?

A

Syncopal episodes as a result of decreased cerebral blood flow

26
Q

What is Takayasu’s arteritis?

A

A large vessel granulomatous vasculitis that results in intimal narrowing

27
Q

What is the typical presentation of Takayasu’s arteritis?

A

A young Asian female with features of mild systemic illness followed by a pulseless phase with symptoms of vascular insufficiency

28
Q

How is Takayasu’s arteritis treated?

A

Systemic steriods

29
Q

What is superficial thrombophlebitis?

A

Inflammation associated with thrombosis of one of the superficial veins, usually the long saphenous vein

30
Q

What is the management of superficial thrombophlebitis?

A

Compression stockings
Prophylactic dose of LMWH for 30 days or fondaparinux for 45 days
NSAIDs for 8-12 days if LMWH is contraindicated

31
Q

What might an ABPI of greater than 1.3 suggest?

A

Arterial calcification which can be a result of DM or end-stage renal failure

Surgery (8 decks)

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