Vascular Flashcards
Where are abdominal aortic aneurysms most commonly located?
Between the renal and inferior and mesenteric arteries
The Infrarenal aorta
What is the investigation for AAA?
Abdominal ultrasound is the initial investigation of choice for both screening and follow up
What is the imaging modality of choice for preoperative evaluation in AAA?
CT Angiography
When should patients be offered repair for AAA?
AAA>5.5cm in size or rapid expansion
What is the follow up for AAA 3-4.4cm in diameter?
Yearly repeat ultrasound
What is the follow up for AAA 4.5-5.4cm in diameter?
Repeat ultrasound every 3 months is offered
What is the follow up for AAA more than 5.5cm in diameter?
Surgical intervention is recommended
What is acute limb ischaemia?
It is a severe, symptomatic hypoperfusion of a limb that has been occuring for less than 2 weeks.
Although the definition states two weeks it is considered a surgical emergency and demands urgent intervention, ideally within 4-6 hours
What can acute limb ischaemia be caused by?
- Thrombosis (40%) - This often results from the rupture of atherosclerotic plaques.
- Embolism (40%) - These are most commonly observed in patients with atrial fibrillation.
- Vasospasm - Such as observed in Raynaud’s phenomenon.
External vascular compromise:
- Trauma
- Compartment syndrome
What are the symptoms of Acute Limb Ischaemia?
- Pulseless
- Painful
- Pale
- Paralysis
- Paraesthesia
- Perishingly cold
What is the management of ALI where thrombosis is the cause?
- Angiography for incomplete ischaemia
- Urgent bypass surgery for complete ischaemia
What is the management of ALI where embolism is the cause?
Immediate Embolectomy
What is Buerger’s disease?
A non-atherosclerotic vasculitis characterized by the occlusion of small and medium-sized arteries
What factors may contribute to Buerger’s disease diagnosis?
- Young male smokers of Mediterranean and Middle Eastern origin
What are the clinical features of Buerger’s disease?
- Typically presents as an acutely ischaemic limb without a background of peripheral claudication
- Raynauds
- Ulcers or non-healing wounds on the fingers and toes, often associated with gangrene
- Superficial migratory thrombophlebitis
What is the management of Buerger’s disease?
- Stop Smoking
- Vasoactive medications
*Nifedipine: A CCB promotes vasodilation
*Iloprost: Synthetic prostacyclin analog that also promotes vasodilation and inhibits platelet aggregation
*Prostaglandin E1
What is the first-line treatment for superficial thrombophlebitis?
NSAIDS
Naproxen
What are varicose veins?
They are tortuous dilated superficial veins
What are the direct complications of varicose veins?
Bleeding
Thrombophlebitis
What are indirect complications of varicose veins?
They occurs as a result of venous hypertension
- Oedema
- Venous Ulceration
- Pigmentation changes
- Lipodermatosclerosis
- Varicose Eczema
What is the pathophysiology of primary varicose veins?
Weak vein walls –> Dilated veins –> Valve cusps cant meet –> Valve incompetence
What is the pathophysiology of secondary varicose veins?
Pelvic or abdominal masses –> Venous return obstructed
