Vascular Flashcards
Define an arterial aneurysm?
true vs false?
Abnormal diation of vessle >150%
True - abnormal dilation of vessle
Flase - collection of blood around vessle that has connection
When surgery for an AAA
> 5.5cm
What is number needed to screen
number needed to screen to prevent 1 cause of death / morbidity
2 specific comps of AAA repaire
distal thombus -> ischemia
spinal / mesenteric ischemia
[bleeding / infection / DVT / renal failure]
Why might you do a EVAR [endovascular aneurysm repair] over open?
2 Cons of EVAR?
Comorbidities - more risky
position of renal arteries/vasculature
Morphological aspects of AAA making more amenable to EVAR
Long term follow up needed
Not suitable for all aneurysms
High Reintervention rate
Best Ix if stable pt with ?RAAA
Other Ix?
Abdo CT with contrast
Cross match/Group and save FBC U+E Amylase ECG
mottling of foot post AAA surgical repair called? what is it?
trash foot
Atheromatous debris lodges in distal vessels -> ischemia
Name 2 cells in the aneurysm wall
2 layers of a vessle?
fibroblast
macrophage
lymphocytes
Intima
tunica media
tunica externa
serosa
2 most common causes of acute limb ischemia
Acute thrombosis
Emboli
2 Mx of acute limb ischemia pre surgery ?
2 definitive Mx?
Heparin, analgesia, O2, fluids
Thrombolysis, angioplasty, embolectomy, bypass
How does heparin work?
2 comps?
Inactivates thombin + factor Xa
bleeding
heparin induced thrombocytopenia
need frequent monitoring of APTT
long term -> osteoperosis
Medical Mx for intermittent claudication
HTN control
Statins
Diabetic control
antiplatlet
Pain at rest in intermittenet claudication called?
critical ischemia
2 radiological Ix in TIA
Echo
CT head
Carotid duplex scanning
Carotid endarctectomy - 2 specific comps
Damage to - hypoglossal / vagus nerve, internal jugular, cervical lymph nodes
Stroke, MI, wound haematoma, Death
2 pros of endarectomy local over GA
Can look for neuro Sx in real time
Avoid risks of GA
What is an ulcer?
3 causes ?
Abnormal break in epithelial surface
Venous disease, arterial disease, neuropathy, trauma, malignancy, infection, lymphadenopathy
3 Differences between ischemic and neuropathic ulcer
Neuro - sensory loss, warm foot, neuro deformity (claw foot, charcot joint), unrecognised trauma
Ichemic - cold, absent pulses, secondary infection/cellulitis
Which diabetic drug do you need to stop before angiogram with contrast?
metformin - interacts -> lactic acidosis
Difference between primary and secondary intention with wound healing>
primary - wound edges heals from epidermis and dermis
secondary - wound open and allowed to granulate from bottom up
-> larger scar and longer to heal
virchows triad
impaired blood flow
vessle wall damage
hypercoaguable
Bar PE comp of DVT?
Venous insufficiency
Reccurent PE despite being on anticoagulation mx?
inferior vena cava filter
Varicose vein pathology
valves become incompetenet ->dilate and become tortuous
2 Varicose vein RFs
obesity, preg, FHx, DVT, tumour
Where is the saphenovenous junction
5cm medial and below femoral pulse
3 Skin changes you would look for in varicose veins
Eczema
ulceration
oedema
haemosiderin staining
Conservative Mx of varicose
avoid long standing
stockings,
weight loss
walking
nerve which runs on saphenous vein and what supplies
saphenous -> anterior calf
3 things that make femoral triangle ? whats in it?
inguinal ligament
medial border of adductor longus
medial border of sartorius
femoral artery / vein / nerve
lymphatic supply
