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Peri-op > Vascular > Flashcards

Vascular Flashcards

1
Q

Acute limb ischaemia: define

A

sudden decrease in limb perfusion that causes a potential threat to viability

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2
Q

Acute limb ischaemia: causes

A

atherosclerosis (60%)
- dehydration, low BP, cancer, polycythaemia
emboli (40%)
rare: trauma, aortic dissection, iatrogenic injury, peripheral aneurysm (popliteal)

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3
Q

ABPI limits for critical limb ischaemia, peripheral arterial disease and artierial stifferning

A

Critical limb ischaemia <0.5
peripheral arterial disease < 0.9 (intermittent claudication)
artierial stifferning >1.3

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4
Q

Acute limb ischaemia signs

A 
Pain 
Pallor
Pulselessness
Parasthesia
Paralysis 
Parshingly cold
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5
Q

Ischaemia colour changes and explanaitons

A

Marble white- arterial spasm
Blue blanching moltting limb -deoxygenated blood fills vessels as they begin to relax -> salvagable
Purple non-blanching- blood coagulation -> blistering and liquafaction

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6
Q

Acute ischaemia manageemnt

A 
check for renal and cerebral disease 
definitive treatment 
- thrombolysis/embolectomy 
- bypass surgery 
- ambutation
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7
Q

Critical limb ischaemia define

A

ABPI <0.5
rest pain>2 wks not relieved by simple anaelgesia or
doppler ankle pressure <50 mmHg

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8
Q

Chronic arterial disease disease

A

spectrum
atherosclerosis
-> intermittent claudication
-> ischaemic limb ischaemia

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9
Q

Intermittent claudication define

A

chronic arterial disease caused by atherosclerosis
muscle pain only associated with exeercise
comes on after a constant ‘claudication’ distance
subsides within 5 mins of rest

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10
Q

Intermittent claudication in the calf: likely artery affected

A

superficial femoral a

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11
Q

Intermittent claudication in the thigh/buttock: likely artery affected?

A

arterio-illiac a.

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12
Q

Intermittent claudication ABPI

A

might be normal at rest

0.5-0.9 -> diagnostic

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13
Q

Intermittent claudication: why can it remain stable for years?

A

Collateral circulation development

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14
Q

Intermittent claudication: management

A

smoking cessation
supervised exercise therapy
antiplatelets
angioplasty/stenting/bypass (symptoms 6m+ despite best medical therapy)

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15
Q

Vascular emergencies: hard signs

A

external arterial bleeding
rapidly expanding haematoma
palpable thrill, audible bruit
obvious acute limb ischaemia, not easily corrected

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16
Q

Vascular emergencies: soft signs

A 
history of bleeding at the scene
would near a major artery
small non-pulsatile haematoma 
diminished unilateral pulse
neurogenic deficit
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17
Q

Types of claudication

A

arterial (intermittent)
venous (DVT)
neurogenic

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18
Q

Features of intermittend claudication

A 
pain in muscle groups
unilateral
exercise related
thin dry skin, sunset foot
diminished foot pulses
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19
Q

Features of venous claudication

A 
'bursting' pain 
whole leg
unilateral 
elevation relieves pain 
vericose veins and venous skin changes
hot leg 
swollen painful calf 
pulses present
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20
Q

Features of neurogenic claudication

A 
whole leg
bilateral 
pain immediately upon standing 
spine flexion relieves pain 
no skin changes 
tingling and sensation changes
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21
Q

Diabetic foot features

A 
ulceration, 
infection, 
sensory neuropathy,
failure to heal trivial injuries 
ulceration (end point)
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22
Q

Types of diabetic foot types

A

ischaemic

neuropathic

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23
Q

Diabetic foot prophylactic

A

regular inspections,
nail care,
choriopodist debridement

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24
Q

Diabetic foot ischaemic ulceration management

A 
local/systemic infection
-> flucloxacillin/ doxycycline 14 d 
-> tazocin/ meropenenm 14+ d if severe 
debridement +/- digit amputation 
X-ray- ?osteomyelitis 
revascularisation (angioplasty or femoro-distal bypass)
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25
Q

Burger’s disease

A

chronic disease of non-atherosclerotic iflammation and thrombosis
thromboagitis abliterans
small and medium peripheral arteries and vessels
smoking related
-> ulcers and gangrene

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26
Q

Burger’s disease: management

A 
smoking cessation 
increase activity (unless there's critical ischaemia)
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27
Q

Raynaud’s phenomenon: define

A

Digital pallor due to vasospasm of the digital arteries

  • > cyanosis (deoxygenated blood)
  • > rubor (reactive hyperthermia)
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28
Q

Primary Raynaud’s phenomenon: define and management

A

Young women
Cold temperatures
No ulceration or infarction
-> reassurance +/-rifedipine (CCB)

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29
Q

Secondary Raynaud’s phenomenon: define and managements

A

Digital pallor due to vasospasm of digital arteries
In older people, causes
- connective tissue disease
- vibration induced injury
- artherosclerosis
Fixed obstruction -> ulceration and necrosis

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30
Q

Aneurysm define

A

Abnormal focal dilatation (>50% of normal diameter)

Of an endothelial-lined vascular structure

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31
Q

Common spractice yes of aneurysm

A

Infrarenal aorta
Popliteal
Femoral
Subclavian

32
Q

Aneurysm aetiology

A 
Atherosclerotic (non specific) 
Mycotic (infective)
-syphilis 
-salmonella 
-septic emboli
33
Q

True aneurysm define

A

All 3 layers of the arterial wall

  • fusiform- symmetrical
  • succular-asymmetrical
34
Q

False aneurysm define and progression

A

Wall of an artery is damaged and blood enters space between two layers

  • > haematoma (pulsation) surrounded by compacted thrombosis and connective tissue then either
  • > thrombosis spontaneously if small or
  • > continues to expand if>2cm (esp if on anticoag)
35
Q

AAA define

A

Dilatation of the abdominal aorta
1.5 x normal diameter or >3cm in total

(Normal AA diameter = 2cm)

36
Q

AAA symptoms

A

Usually asymptomatic

Abdo, back, loin, illiac fossa or groin pain

37
Q

AAA rupture into…

A

Retroperitoneum or peritoneal cavity

38
Q

AAA commonest location

A

Infra renal

39
Q

AAA diagnosis

A

USS

40
Q

AAA screening

A

65 y.o males

41
Q

AAA management

A

<5.5 cm -> conservative (regular surveillance, lifestyle changes, mess: statins, aspirin, BP control)
5.5cm+ -> EVAR (endovascular aneurysm repair) or open repair

42
Q

Stroke define

A

An episode of facial neurological dysfunction of >24h of presumed vascular aetiology

43
Q

TIA define

A

An episode of focal neurological dysfunction of <24 hours of presumed vascular aetiology

44
Q

Amaruosis fugax define

A

Transient and usually incomplete loss of vision of n on eye
Occlusion of a branch of the retinal artery by cholesterol emboli
-> “curtain or veil” coming across the eye
Lasts a few minutes and disappears
Never synchronously bilateral

45
Q

Ischaemic Cerebrovascular episodes: commonest cause

A

Atheroembolism from the carotid bifurcation (50%)

46
Q

Cause of amaurosis fugax

A

Arthero emboli of the opthalmic a

47
Q

Carotid artery disease assessment

A

Colour flow Doppler duplex ultrasound

MRI and CT- helpful in treatment planning

48
Q

Carotid endarectomy indication

A

60-70% diameter reduction of the interval carotid artery

49
Q

Severe carotid artery disease management

A

Carotid endarterectomy

Stenting

50
Q

Principles of carotid endarterectomy

A

Shunt to maintain blood flow to the head
Occluding plaque is removed
Artery repaired by primary closure or patch graft

51
Q

Carotid endarterectomy complications

A

Death
Major or minor stroke
Wound haematoma
Hypoglossal nerve damage

52
Q

Ruptured AAA clinical features

A

Sudden collapse
Abdo pain
Low BP
Pulsation abdo mass

53
Q

Ruptured AAA: implications

A

Leak into the retroperitoneal space
-> tamponade
General vasoconstriction and prothrombotic state

54
Q

Ruptured AAA management

A

Senior surgical help + theatre prep
-antibiotic prophylaxis
-aorta clamping and EVAR/open repair
NO FLUIDS (permissive hypotension)

55
Q

Ruptured AAA complications

A 
Death (50%) 
MI 
Renal failure 
LL embolism 
GI ischaemic/infarct 
Abdominal compartment syndrome
56
Q

Varicose veins: define

A

Tortuous and dilated segment of veins

Associated with valvular incompetency

57
Q

Venous system: name superficial vessels

A

Long (great)and short (lesser)

Sap genius systems

58
Q

Venous system: deep

A

Vessels between the muscle compartments of the legs

Follow major arteries

59
Q

Venous system: perforations purpose

A

Connection of the super principal and deep systems

60
Q

Commonest location of incompetent valves leading to varicose veins

A

Sapheno- femoral junction

61
Q

Varicose veins causes

A

Congenital
Primary idiopathic
Pelvic masse (inc. pregnancy)
Pelvic venous abnormalities

62
Q

Varicose veins: tap test

A

Tap downwards over the veins from sapheno femoral junction

Incompetent valve-> impulse felt lower down

63
Q

Varicose vein trendelenberg test

A

Tests competence of sapheno-femoral and sapheno-popliteal junctions, mid thigh perforator
Pt laying down -> elevate the leg and apply tourniquet high in the thigh (later at different levels)
Pt stands up and vein filling is observed
- vein filling means there’s incompetency above the tourniquet

64
Q

Varicose veins: special tests

A

Tap test

Trendelenbergs test

65
Q

Vanricose veins diagnosis

A

Doppler duplex USS

66
Q

Varicose veins: name 3 types

A

Trunk
Reticular
Talangiectasia

67
Q

Trunk varicose veins define

A

Involve great and lesser saphenous veins or their main branches
Large (>4mm) subcutaneous and palpable
No skin discolouration
1/3 of population affected

68
Q

Reticular varicose veins define

A

Deep in the dermis
Small <4mm, impalpable
Discolouration of the overlying skin: deep blue
Present of 80% of the population

69
Q

Talangiectasia varicose veins

A 
Spider or thread veins 
Superficial in the dermis 
Usually <1mm 
Impalpable 
Discolouration of the overlying skin purple or bright red 
90% of adults
70
Q

Varicose veins management

A

Conservative
If ABPI >0.8: constriction garments, if < elastic support hose, weight loss, exercise, avoiding prolonged standing
Surgery: remove varicies, intercept connections (perforator) that are incompetent
Endovascular management: radio frequency ablation, LASER ablation, USS guided foam sclerotherapy

71
Q

Arterial ulceration features

A 
Ischaemic 
Feet and toes (pressure points) 
Usually don't bleed 
Yellow/brown/black 
Punched out boarder 
General poor circulation 
Progressive atherosclerosis/ embolus 
Very painful
72
Q

Venous ulceration features

A 
Caused by venous stasis 
Gaiter region 
Can bleed 
Red base, haemosidrin around 
Irregular shape 
Pt with varicose veins, swelling, clots 
Venous HTN due to inadequate calf muscle pumping 
Uncomfortable not painful
73
Q

Venous ulceration management

A

Gradual compression stockings

Arterial disease must be excluded

74
Q

Repercussion injury pathophysiology

A

Ischaemic tissue releases activated neutrophils, feee radicals, enzymes, H+, CO2, K+ and myoglobin
-> released into circulation

75
Q

Repercussion injury: consequences

A 
Acute Respiratory Distress Syndrome (ARDS) 
Myocardial stunting 
Endotaxaemia 
Acute tubular necrosis 
-> multiple organ failure
76
Q

Compartment syndrome pathophysiology

A

Ischaemia -> endothelial injury
Increased capillary permeability and swelling
Thought fasicular boundaries
-> increased interstitial pressure
-> muscle necrosis despite apparently adequate blood flow

77
Q

Compartment syndrome clinical features

A

Passive stretch test: Pain on passively stretching/extending toes
Fasciotomy +/- debridement of necrotic tissue

Peri-op (5 decks)

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