Vascular Flashcards
AAA
If >5.5cm or symptomatic
duplex uss–> CTA for planning
young/fit/complex - open
old - EVAR
unstable rupture - always emergency open
PAD
Conservative - Smoking cessation, Exercise therapy
Medical - BP Control, Statin therapy, Clopidogrel
Surgical - Endarterectomy, Bypass surgery (vein /
PTFE graft), Angioplasty (PTA) +/-
stenting
Amputation if gangrenous
Acute limb ischaemia
Medical - Local thrombolysis (streptokinase, tPA), LMWH
Surgical – Angioplasty** +/- stent, Embolectomy (fogarty)** +/- faciotomy, Amputation
Follow up - Warfarin long-term, Tx Embolic source, *Reperfusion injury
Diabetic foot
Prevention / Conservative / No Infection - Optimise diabetic control, Patient education – self-care, self-examination, Refer to podiatry to optimize footwear, reduce pressure areas.
Dry gangrene – allow auto-amputation + healing by 2º intention.
Infected Diabetic Foot - Debridement & Revascularisation (Angioplasty / bypass)
Wet gangrene - Amputation
(Below knee – preserve mobility in young / active patient.
Above knee – absent femoral pulse; some mobility.
Through knee – already immobile patient.)
Empirical antibiotics
Stroke/Carotid stenosis
Conservative - Smoking cessation, Glycaemic control, Exercise therapy
Best Medical Therapy - Antiplatelet (aspirin / clopidogrel), Statin therapy, BP control
Surgical (urgent within 2 weeks!) - Carotid endarterectomy with patch repair.
Carotid stenting – only applicable in re-do carotid stenosis.(Higher risk of stroke compared to endarterectomy!)
DVT
Medical / Surgical Tx - Anti-coagulation (LMWH, Warfarin), Catheter-directed thrombolysis, Mechanical thrombectomy
DVT Prophylaxis - Reduce risk factors (mobilization), Compression stockings, Pneumatic compression
Varicose veins
Conservative - Compression stockings (contraindicated if concurrent PVD – check ABPI), Regular exercise, Elevating affected area
Endovenous Surgery - Radiofrequency ablation, Endovenous laser ablation (EVLT), Foam sclerotherapy
Open Surgery - Ligation and stripping, Phlebectomy
