Vascular Flashcards
What is the first line and gold standard for investigating an AAA?
FIrst Line - Abdo US as a screening tool and for follow-up
Gold standard - CT Angiogram for pre-operative planning
What is the management for AAA?
4.5-5.4cm = 3 monthly monitoring via Abdo US
>5.5cm = Referral to Vascular service within two weeks
Open repair or Endovascular Aneurysm Repair (EVAR)
What is the interpretation of the APBI?
Less than 0.5 suggests severe arterial disease.
Compression treatment is contraindicated.
Refer the person urgently for specialist vascular assessment.
Greater than 0.5 to less than 0.8 suggests the presence of arterial disease or mixed arterial/venous disease.
Compression should generally be avoided. However, reduced compression can be used under specialist advice and with strict supervision.
Refer the person for specialist vascular assessment.
Between 0.8 and 1.3 suggests no evidence of significant arterial disease.
Compression may be safely applied in most people.
Greater than 1.3 may suggest the presence of arterial calcification, such as in some people with diabetes, rheumatoid arthritis, systemic vasculitis, atherosclerotic disease, and advanced chronic renal failure.
For values above 1.5, the vessels are likely to be incompressible, and the result cannot be relied on to guide clinical decisions.
What is the treatment for Acute Limb Ischaemia?
For thrombotic causes, management strategies include:
Angiography for incomplete ischaemia. This helps map the occlusion site and plan for intervention. Potential endovascular procedures include angioplasty, thrombectomy, or intra-arterial thrombolysis.
Urgent bypass surgery for complete ischaemia.
For embolic causes:
Urgent surgical embolectomy and if that fails on the table thrombolysis
What is the management of aneurysms?
Observation and Risk Factor Modification: Small, asymptomatic aneurysms may be managed conservatively with close monitoring and aggressive risk factor management. This includes lifestyle changes such as smoking cessation, control of hypertension, maintaining a healthy weight, regular exercise, and a low-sodium diet.
Medical Therapy: Medications such as antihypertensives and statins may be used to reduce the risk of aneurysm expansion and rupture. Anticoagulant or antiplatelet drugs might be prescribed to reduce the risk of thrombosis in specific circumstances.
Surgery: Larger or symptomatic aneurysms, or those that are rapidly increasing in size, are generally managed surgically. The specific surgical approach depends on the location and characteristics of the aneurysm but could include endovascular repair (such as stent placement) or open surgical repair.
Postoperative Care and Surveillance: Following surgical repair, patients require regular surveillance to monitor for complications or the development of new aneurysms. This typically involves imaging studies at regular intervals, with the timing and modality dependent on the specifics of the initial aneurysm and the type of surgical repair.
What are characteristic for arterial ulcers?
Risk Factors of PAD ( Smoking, HTN, DMT2, CAD , hypercholesterolemia )
Symptoms of PAD
Hair loss and shiny appearance of the skin
Location over a bony prominence
Deep and well-delineated appearance
Develop over long period of time
Painful
What is the management of venous ulcers?
Compression ( Bandage or Stocking)
Topical or systemic antibiotics (if there is evidence of infection)
Who is AAA screening for?
Men over 65
What is superficial thrombophlebitis?
Superficial thrombophlebitis is a condition in which a blood clot forms in a vein near the surface of the skin, causing inflammation and tenderness.
What is the criteria for Carotid Endarterectomy for Carotid artery stenosis?
Carotid artery stenosis of 70-99%, with symptoms of an ischemic event such as a stroke or TIA in the corresponding vascular territory.
In the context of TIA or stroke >50% occlusion is indication for the surgery
What is Amaurosis Fugax?
Temporary blockage of blood flow to the retinal arteries ( TIA )
Typically caused by carotid artery stenosis
What is the gold standard for diagnosing Varicose Veins?
Duplex ultrasound
What skin change is seen in Chronic Venous Insuffienency?
Lipodermatosclerosis
Haemosiderin Staning
What are the investigations for suspected Peripheral Arterial Disease?
ABPI
Duplex US
What is Chronic Limb ischaemia and what’s the difference between that and Critical Limb Ischaemia?
Triad of ischaemic pain at rest for more than 2 weeks (burning pain that is worse at night when the leg is elevated, and relieved by hanging the leg off the bed), arterial ulcers and gangrene.
Critical limb ischaemia is a worsening of chronic limb ischaemia to the point where the limb may receive permanent damage and has all the same risk factors as chronic limb ischaemia
