Vascular Flashcards
Which part of the aorta is most likely to be affected in aortic dissection?
Ascending aorta + aortic arch - blood between tunica initma & tunica media → false lumen
Which genetic condition is most commonly associated with aortic dissection?
Marfans syndrome
Other RF
HTN (stress, ↑ volume, coarctation), weak vessel call - connective tissue disease, smoking, Fhx, cardiac Hx, drug abuse, trauma
AD in R subclavian
↓ pulse in R arm and ↓ BP
AD in Descending aorta
Limb ischaemic, mesenteric ischaemia, renal artery involvement
AD in carotids
stroke like presentation
Classification of AD
Stanford
A - Ascending aorta + arch
B - everything else
Mgmt
HDU/ICU
Aggressive BP control (aim 100-120SBP - IV antihyper)
ECG - incase MI (thrombolysis)
CT-angiogram
Stamford A - surgery
Stamford B - medically, TEVAR (Thoracic Endovascular Aortic Repair)
Complications
Death Rupture Cardiac Tamponade - low bp MI severe hypertension compress branching arteries - renal or subclavian
INV of AD
Widened mediastinum on CRX
TOE - transoesophageal ECHO
Angiograms
What is a true aneurysm?
Involves all three levels of arterial wall
Pseudoaneurysm - where mostly commonly found, what is it important to differentiate between
Blood outer 2 laters - often after trauma IVD, femoral artery, differentiate between abscess
What is the width of normal aorta, width of aneurysm
2cm, 3cm
RF
Male, age, smoking, HTN, ↑lipids. COPD, connective tissue disorders
Mgmt
Regular USS monitoring
Triad for rupture
Hypotension, pain in flank/back, pulsatile mass
Inv
USS vs CTA
Mgmt
X match, transfer to theatre, ICU input
What are the indications for repair
Male >5.5cm
Female > 5cm
Symptomatic
Growth >1cm/year
Who is offered screening?
Men > 65 years
How often screening for the following AAA’s:
a) 3-4.5 cm
b) 4.5 cm
Yearly
Every 3 months
Mortality of ruptured AAA after repair and overall
50%, 80%
What types of repairs for elective, common complication
EVAR - Endovascular aneurysm repair
Open repair
Risk - AKI and renal impairment due to proximity to renal arteries.
When give anaesthetic for the repair in rupture AAA?
With patient prepped and ready on the table, don’t want drop in BB and muscle relaxant.
pain out of proportion with injury, paraesthesuia , swelling
Compartment syndrome
causes
fractures, trauma, plaster cast
management
release pressure, fasiotomy
Chronic compartment syndrome
after exercise, extreme tightness
Claudication Hx - essential qs
When it comes on, after how long of walking, does it wake then up at night
P’s of critical limb
Pallor, pulseness, perishingly cold, pain, paraesthesia
Investigation
ABPI
MRA
Mgmt
Lifestyle
Antiplatelets - stop acute occlusion
Angioplasty
Bypass
Describe arterial ulcers
punched out loss hair, over bony prominence
Acute limb iscaemic causes
Thromboembolic disease, more rarely dissection, trauma
Mgmt
Heparin infusion
CTA, MRA (best) or USS Doppler (quick)
Embolectomy
