Vascular Flashcards
Where are most AAA found?
Below the renal arteries
What are some causes of AAA?
Atherosclerosis Syphillis E.coli Salmonella Marfans Ehlers-Danlos Trauma
What are the RF for AAA?
Modifiable:
Smoking
Hypertension
Hypercholesterolaemia
Non-modifiabke:
Age
Male
Family history
Who is screened for AAA? What modality is used?
Males 65-74
USS
CT abdo is used if a patient is admitted
What is the presentation of AAA
Severe epigastric pain radiating to the back
Hypotension
Tachycardia
Junk legs
Possibly cullen’s sign or Grey-Turner’s sugn
What is the Mx of AAA?
Conservative:
Stop smoking
Exercise
Improve diet
Medical:
Statins, Aspirin, BP management
Surgical:
Open aortic surgery - young, longer recovery time
Endovascular repair - less peri-operative mortality but increased chance for more procedures
List some DDx for AAA
Renal colic
Diverticulitis
Testicular pain
How do you classify an Aortic Dissection?
Stanford type A: Tear in the ascending aorta or aortic arch proximal to the left subclavian artery origin
Stanford type B: Tear in the descending aorta distal to the left subclavian artery origin
Debakey type 1: Ascending AND Descending
Debakey type 2: Ascending aorta only
Debakey type 3: Descending aorta only
List the RF for Aortic Dissection
Modifiable:
Hypertension
Atherosclerosis
Cocaine
Non-modifiable:
CTD - SLE, Marfans, Ehlers-Danlos
Coarctation of the aorta (narrowing)
Iatrogenic - angiography/angioplasty
Presentation of Aortic Dissection
Sudden onset, central TEARING chest pain radiates to back and arms
Associated with: CAROTID: Blackouts, hemiparesis CORONARY: MI, Angina RENAL: AKI, Renal hypoperfusion COELIAC TRUNK: Abdominal pain
Tachycardic BP > 20 mmHg discrepancy between arms Radio-radial delay Wide pulse pressure Murmur on back below scapulae (As blood leaves the flap it's become just like a valve)
What are the signs of aortic insufficiency
Collapsing pulse
End diastolic murmur
Patient presents possible Aortic dissection, what Ix?
ECG
CXR - widened mediastinum, aortic notch visible
Cardiac enzymes
CT ANGIOGRAPHY - Diagnostic (intimal flap)
can use a transoesophageal echo in a pinch
U&Es
LFTs
Lactate - sign of malperfusion
FBC - Anaemia
X-match 10 units of blood
What is intermittent claudication?
Cramping in the calves, thigh, buttocks precipitated by exercise and relieved by rest
RF for PAD?
Smoking
Hypertension
Hypercholesterlaemia
Diabetes
What are the signs of PAD?
Reduced peripheral pulses Punched out ulcers Hair loss Cyanosis Brittle toenails Buerger's angle <20
What is Leriche Syndrome?
Blockage of the abdominal aorta as it bifurcates into the common iliac arteries
Bilateral claudication
Erectile dysfunction
Reduced femoral pulses
What age group for PAD?
Middle age disease
What is the triad of critical limb ischemia?
Rest pain
Arterial ulcers
Gangrene
What is the prognosis of PAD?
For those with intermittent claudication - 80% of getting better 5% intervention 1% amputation 15% dead within 15 years
For those with critical limb iscahemia -
90% need major intervention
25% require amputation
50% dead within 5 years
What are the Ix for claudication?
ABPI
Doppler ultrasound
MR angiography
What are the 6Ps that indicate acute limb ischaemia?
Painful Pale Pulseless Paraesthesia Perishingly cold Paralysed
What are the causes of acute limb ischaemia?
Embolic - Cardiac thrombus, cardiac arrhytmias
Thrombotic - Forms on previous atherosclerosis
Forms in hypercoagulable blood - P has malignancy or thrombophilia disorder
Prosthetic graft
What are the classifications of ALI?
VIABLE - No neurological signs, doppler audible at ankle
THREATENED - Sensory loss, tense calf, no audible doppler
DEAD - Complete neurological deficit, fixed mottling
What are the RF for DVT?
Age Pregnancy Trauma Cancer Surgery Oestrogen
Antithrombin deficiency
Protein C/S deficiency
Antiphospholipid syndrome
