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Year 6 > Vascular > Flashcards

Vascular Flashcards

1
Q

Abdominal aortic aneurysm features

A
  • Pulsatile abdominal mass
  • Abdominal or back pain = suggests rapid expansion or impending rupture
  • Signs of rupture = severe pain, hypotension, shock
  • Compression symptoms if very large = early satiety, N&V
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2
Q

Abdominal aortic aneurysm investigations

A
  • USS = investigation of choice for screening/monitoring
  • CT angiography = used preoperatively for surgical planning
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3
Q

When are Abdominal aortic aneurysms first screened for, and how often are they monitored?

A

A single abdo US is offered to all men at age 65, follow up screening depends on the size of the aneurysm:

  • 3 - 4.4cm = yearly repeat US
  • 4.5 - 5.4 = repeat US every 3 months
  • > 5.5 = surgical intervention
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4
Q

Abdominal aortic aneurysm management

A

Surgery = open repair or endovascular aneurysm repair (EVAR)

This is offered to all pt w/ AAA’s > 5.5 cm, or those with rapidly expansion

Rapid expansion = growing > 5mm in 6 month, or > 10mm over a year

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5
Q

Define Acute limb ischaemia

A

Severe, symptomatic hypoperfusion of a limb that has been occurring for less that 2 weeks

In reality, surgical intervention is ideally w/in 4-6 hours of presentation

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6
Q

What are the causes of Acute limb ischaemia?

A
  • Thrombosis = atherosclerotic plaque rupture
  • Embolism = AF
  • Vasospasm = Raynaud’s
  • External vascular compromise = trauma, compartment syndrome
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7
Q

Acute limb ischaemia features

A

6 P’s:

  • Pulseless
  • Painful
  • Pale
  • Paralysis
  • Perishingly cold
  • Paraesthesia
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8
Q

How is Acute limb ischaemia stratified?

A

Using the Rutherford criteria:

  • Stage I = viable limb, arterial signal can be picked up on Doppler
  • Stage IIa = mild sensory deficit, no motor deficit
  • Stage IIb = severe sensory deficit (more than just toes), mild motor deficit, rest pain - needs immediate treatment whilst limb is still salvageable
  • Stage III = severe sensory and motor deficit (non-viable limb)
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9
Q

Acute limb ischaemia management

A

Thrombotic causes:
- Angiography (stages I-IIa)
- Urgent bypass surgery (stage IIb)

Embolic causes:
- Immediate embolectomy
- If that fails, on-table thrombolysis

If limb is non-viable (stage III) = amputation - keep them nil by mouth and give IV heparin

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10
Q

Define Aneurysm

A

A localised dilation or expansion of a segment of a blood vessel to more than 50% of its usual diameter

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11
Q

Arterial ulcer features

A
  • Occur distally (heel or toe tips)
  • Small and deep
  • Punched out margins
  • Don’t bleed or ooze
  • Painful, elevated by hanging foot off the bed
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12
Q

Venous ulcer features

A
  • Occur in the gaiter area
  • Large and shallow
  • Sloping edges
  • Bleed and ooze
  • Painful when leg elevated
  • Associated w/ chronic venous changes
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13
Q

What are the features if chronic venous insufficiency

A
  • Haemosiderin deposition = dark patches on the skin
  • Lipodermatosclerosis = hardening of the skin
  • Atrophie blanche = painful papules which ulcerate and then leave white scars
  • Ulcers
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14
Q

Define Buerger’s disease

A

A non-atherosclerotic vasculitis characterised by the occlusion of small and medium-sized arteries

Strongly linked to smoking

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15
Q

Buerger’s disease features

A
  • Typically presents as acute limb ischaemia w/out a background of peripheral claudication
  • Raynaud’s
  • Ulcers on fingers and toes often associated w/ gangrene
  • Superficial thrombophlebitis
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16
Q

Buerger’s disease investigations

A
  • Arterial Doppler = diminished pulses distal to the occlusion
  • Arterial Duplex = Martorell’s sign (corkscrew-shaped collateral vessels)
  • CT angiography
17
Q

Buerger’s disease management

A
  • Smoking cessation
  • Vasoactive medication to improve blood flow (nifedipine, iloprost, prostaglandin E1)
  • Management of critical limb ischaemia
18
Q

Carotid artery stenosis management

A

Conservative (don’t meet surgical criteria):
- Clopidogrel 75mg
- Statins
- BP control
- Smoking cessation

Surgical:
- For pts w/ stenosis of 70 - 99% and symptoms of a stroke or TIA in the corresponding vascular territory
- Surgery = carotid endarterectomy

19
Q

Define Peripheral arterial disease

A

Substantial narrowing of the arteries distal to the aortic arch

20
Q

Peripheral arterial disease features

A
  • Intermittent claudication’s
  • Pale, cold leg
  • Hair loss
  • Ulcers
  • Poor wound healing
  • Weak/absent peripheral pulses
21
Q

Peripheral arterial disease investigations

A

CV assessment = FBC, BP, BM, lipids, ECG

ABPI is diagnostic:
- 0.9 - 1.2 = normal
- 0.8 - 0.9 = mild disease
- 0.5 - 0.8 = moderate disease
- <0.5 = severe disease

Imaging:
- Duplex
- MR arteriogram = in pts who are candidates for revascularisation
- CT arteriogram = in the rest of pts

22
Q

Define Critical limb ischaemia

A

Severe peripheral arterial disease with:

  • Rest pain
  • Tissue loss (ulcers)
  • Ankle artery pressure < 50mmHg
23
Q

Peripheral arterial disease management

A

Conservative:
- Modify RF
- Smoking cessation
- Refer to supervised exercise program

Medical:
- Clopidogrel 75mg daily
- Atorvastatin 80mg
- Optimise glycaemic control
- Manage HTN
- Analgesia = naftidrofuryl oxalate (vasodilator) can be prescribed if supervised exercise is ineffective, and pt doesn’t want surgery

Surgical:
- Endovascular revascularisation
- Surgical bypass (for larger, extensive stenosis)
- Pts w/ intermittent claudication not resolved by RF modification or exercise should be referred
- Anyone w/ critical limb ischaemia should be urgently referred

24
Q

Define Superficial thrombophlebitis

A

The formation of a blood clot in the superficial venous vasculature, often associated w/ inflammation of the vessel walls

25
Q

Superficial thrombophlebitis features

A
  • Localising pain along the course of the vein
  • Itching
  • Erythema
  • Tenderness and warmth over affected vein
  • Palpable, firm, cord-like vein
26
Q

What causes Superficial thrombophlebitis?

A
  • Varicose veins
  • Hormonal contraception
  • Pregnancy
  • Obesity
  • Smoking
  • Malignancies
27
Q

Superficial thrombophlebitis investigations

A
  • Doppler
  • D-dimer
28
Q

Superficial thrombophlebitis management

A

Compression stockings + NSAIDs

29
Q

Varicoceles features

A
  • Aching or heavy feeling in the scrotum
  • Visibly enlarged or twisting veins in the scrotum
  • Testicular atrophy
  • Unable to get above the swelling
  • Impaired fertility
30
Q

Varicoceles investigations

A
  • Examination = esp during Valsalva
  • Doppler = will show enlarged veins and retrograde blood flow
31
Q

Varicoceles management

A
  • Watchful waiting = for asymptomatic w/ no fertility issues
  • Embolization = blocking the blood flow to the enlarged veins
  • Surgery
32
Q

Define Varicose veins

A

Dilated and tortuous superficial veins

Develop due to the incompetence of the valves between the deep and superficial venous system, resulting in retrograde flow and pooling of the blood in the superior system

33
Q

Varicose veins management

A

Treatment is not required unless symptoms like bleeding, pain, ulceration, thrombophlebitis occur

Conservative:
- Reduction in long periods of standing
- Elevation of LL
- Compression stockings
- WL
- Regular walking to promote venous return

Invasive:
- Radiofrequency ablations = destruction of the vein endothelium using a high-temp catheter
- Endovenous laser ablations
- Injection sclerotherapy = occludes the veins
- Surgery = avulsion therapy or stripping

34
Q

Define Gangrene

A

Tissue destruction and necrosis

Can be:
- Wet = due to infections
- Dry = due to ischaemia

35
Q

What are the causes of Wet Gangrene?

A
  • Necrotising fasciitis
  • Gas gangrene = clostridium
  • Gangrenous cellulitis
36
Q

Gangrene features

A

Wet:
- Poorly demarcated areas of necrosis
- Fever and sepsis

Dry:
- Well demarcated areas of necrosis
- Auto-amputation

37
Q

Gangrene investigations

A

Wet:
- FBC, CRP, blood cultures, lactic acid
- XR, US, CT to assess extent of damage
- Tissue biopsy to confirm causative organism

Dry:
- Rule out wet gangrene
- Doppler US or angiography to locate blockage

38
Q

Gangrene management

A

Wet:
- Surgical debridement or amputation
- Broad-spectrum IV abx

Dry:
- Surgical debridement or amputation

Year 6 (12 decks)

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