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Finals - Surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

Abdominal Aortic Aneurysm - Definition

A

Dilatation of abdominal aorta >3cm

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2
Q

Abdominal Aortic Aneurysm - Demographics

A

Men > Women

More common >65yrs

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3
Q

Abdominal Aortic Aneurysm - Risk factors

A
  • Smoking
  • Hypertension + Hyperlipidaemia
  • Family History
  • Male gender
  • Increasing age

DIABETES IS A NEGATIVE RISK FACTOR

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4
Q

Abdominal Aortic Aneurysm - Clinical features

A
  • Can be asymptomatic

- Can present with: abdo/back/loin pain+ distal embolism

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5
Q

Abdominal Aortic Aneurysm - Investigations

A
  • Abdo USS: Diagnostic test

- CT with contrast: for measuring diameter

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6
Q

Abdominal Aortic Aneurysm - Screening

A
  • Abdo Ultrasound for Men aged 65
  • Detected AAA will have regular surveillance
  • Usually under surveillance for 3-5 years before intervention
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7
Q

Abdominal Aortic Aneurysm - Management

A

Non-surgical

  • Monitoring (3-4.4cm yrly, 4.4-5.4cm 3 monthly)
  • Address CVD risk factors (incl. statin + aspirin therapy)

Surgical

  • Considered if: >5cm, symptomatic or growing +1cm/yr
  • Unfit patients left until 6cm
  • Open or Endovascular (EVAR)
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8
Q

Ruptured AAA - Risk factors

A

Risk grows exponentially with aneurysm diameter

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9
Q

Ruptured AAA - Types

A

Posterior rupture - 80%
- bleed into retroperitoneal space

Anterior rupture - 20%

  • bleed into peritoneal cavity
  • worse prognosis
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10
Q

Ruptured AAA - Clinical Presentation

A
  • Abdo/back pain
  • Syncope
  • Vomiting
  • Haemodynamically compromised
  • Mass in abdomen
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11
Q

Ruptured AAA - Management

A

ABCDE approach

  • High flow O2 + 2x large bore cannula access
  • Urgent bloods (incl clotting group + save)
  • At least 6 units of blood

Surgical repair

  • If unstable: immediately
  • If stable: imaging first to assess EVAR viability
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12
Q

What is permissive Hypotension

A

In ruptured AAA/aortic dissection systolic kept at 100 to prevent clots being dislodged

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13
Q

Thoracic Aortic Aneurysm - Pathophysiology

A

Degradation of tunica media (middle arterial layer)

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14
Q

Thoracic Aortic Aneurysm - Causes

A
  • Connective tissue disorder (common)
  • Bicuspid aortic valve (common)
  • Trauma/aortic dissection/arteritis/syphilis
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15
Q

Thoracic Aortic Aneurysm - Risk factors

A

Reversible: smoking, HTN, BMI,

Non-reversible: increasing age, male, FH

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16
Q

Thoracic Aortic Aneurysm - Clinical features

A

Pain (depending on which part of aorta)

  • ascending: anterior chest
  • aortic arch: neck
  • descending: between scapulae
Back pain (spinal compression)
Hoarse voice (recurrent laryngeal compression)
SVC compression
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17
Q

Thoracic Aortic Aneurysm - Investigations

A
  • CT with contrast: definitve

- Transoesophageal USS: look for underlying pathology

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18
Q

Thoracic Aortic Aneurysm - Management

A

Depends on area

  • Ascending or arch (>5.5): excise region + replace
  • Descending (>6): Open or EVAR
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19
Q

Aortic Dissection - Definition

A

Tear in intimal (inner) layer of aortic wall

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20
Q

Aortic Dissection - Direction of propagation

A

Tear can propagate

  • Anterograde dissection: propagate towards iliacs
  • Retrograde dissection: propagate towards aortic valve
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21
Q

Aortic Dissection - Classification (Stanford)

A

Type A - involves ascending aorta

Type B - does not involve ascending aorta

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22
Q

Aortic Dissection - Risk factors

A

Reversible: HTN, atherosclerosis

Non-reversible: male, biscuspid aortic valve, connective tissue disorder

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23
Q

Aortic Dissection - Clinical features

A

Tearing chest pain - radiating to back

Examination - tachycardic, hypotensive, new murmur

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24
Q

Aortic Dissection - Investigations

A

CT angiogram - first line
Bloods
Crossmatch: 4 units
ECG

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25
Q

Aortic Dissection - Management

A

ABCDE approach - High flow O2, IV access

Type A (worse prognosis)

  • immediate surgical management
  • remove + replace ascending aorta

Type B
- Uncomplicated: medical (IV beta blockers)

Long-term

  • Life-long anti-hypertensives
  • Surveillance imaging
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26
Q

Chronic Limb Ischaemia - Definition

A

Symptomatic reduced blood supply to limbs

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27
Q

Chronic Limb Ischaemia - Cause

A

Typically atherosclerosis

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28
Q

Chronic Limb Ischaemia - Risk factors

A

Modifiable - smoking, DM, HTN, hyperlipidaemia

Non-modifiable - age, FH, obesity, inactivity

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29
Q

Chronic Limb Ischaemia - Fontaine classification

A

Stage I - asymptomatic
Stage II - intermittent claudication
Stage III - ischaemic rest pain
Stage IV - ulceration, gangrene or both

30
Q

Chronic Limb Ischaemia - Special test

A

Buerger’s test

31
Q

Chronic Limb Ischaemia - Investigations

A

ABPI: Gold standard

  • Normal >0.9
  • Moderate 0.5-0.8
  • Severe <0.5

CVD risk assessment

Thrombophilia screen (for <50s)

32
Q

Chronic Limb Ischaemia - Management

A

Conservative - smoking cessation, exercise, weight loss
Medical - statins, anti-platelet, diabetic control
Surgical - angioplasty or bypass surgery

33
Q

Chronic Limb Ischaemia - When to operate

A
  • Very short claudication distance
  • Rest pain
  • Poor QoL
34
Q

Critical Limb Ischaemia - Definition

A

Advanced chronic limb ischaemia

Three ways to define

  1. Rest pain for 2+ weeks
  2. Ischaemic lesions (or gangrene)
  3. ABPI <0.5
35
Q

Critical Limb Ischaemia - Investigations

A

Doppler ultrasound: gold standard
- assess severity + locate occlusion

Can do CT/MR angiogram

36
Q

Critical Limb Ischaemia - Management

A

Urgent surgical referral

Potentially amputation

37
Q

Acute Limb Ischaemia - Definition

A

Sudden decrease in limb perfusion threatening viability of the limb

38
Q

Acute Limb Ischaemia - Cause

A
  1. Embolisation (most common)
  2. Thrombosis in situ
  3. Trauma (least common
    - e.g. compartment syndrome
39
Q

Acute Limb Ischaemia - Clinical Presentation

A

The 6 P’s

  1. Pale
  2. Pulseless
  3. Painful
  4. Paralysis
  5. Paraesthesia
  6. Perishingly cold
40
Q

Acute Limb Ischaemia - Rutherford score

A

Assessment of severity of ischaemia + viability of limb

41
Q

Acute Limb Ischaemia - Investigations

A
  • Routine bloods
  • ECG
  • Doppler (both limbs)
  • CT angiogram
42
Q

Acute Limb Ischaemia - Management

A

Initial management - high flow O2 + heparin

Non-surgical - prolonged heparin (for low rutherford score)

Surgical - embolectomy (embolus) or angioplasty (thrombus)

Treat underlying cause
Rehab

43
Q

Acute Mesenteric Ischaemia - Definition

A

Sudden decrease in blood supply to bowel

44
Q

Acute mesenteric Ischaemia - Causes

A
  1. Embolism (50%)
  2. Thrombus (25%)
  3. Non-occlusive (20%) - i.e. shock
  4. Venous occlusion (<10%)
45
Q

Acute mesenteric ischaemia - Risk factors

A
  • Smoking
  • HTN
  • Hyperlipidaemia
46
Q

Acute mesenteric ischaemia - Clinical Features

A
  • Abdo pain out of proportion to findings
  • Nausea + vomiting
  • Signs of peritonism (late stage)
47
Q

Acute mesenteric ischaemia - Investigations

A

CT scan with contrast: diagnostic test

- shows oedmatous bowel –> loss of bowel wall definition

48
Q

Acute mesenteric ischaemia - Management

A

Initial

  • ABCDE approach
  • ITU input
  • Broad-spectrum abx
  • Emergency surgery: revascularisation or resection
49
Q

Varicose Veins - Definition

A

Tortuous, dilated segment of a superfical vein

50
Q

Varicose Veins - Cause

A
  1. Idiopathic (98%)

2. Secondary (2%)

51
Q

Varicose Veins - risk factors

A
  1. Prolonged standing
  2. Obesity
  3. Pregnancy
  4. Family History
52
Q

Varicose Veins - Clinical Features

A

Typically present for cosmetic issues

Potential Symptoms: pain, itching, aching, swelling
- Worse at night

53
Q

Varicose Veins - Investigations

A

Duplex ultrasound - Gold Standard

54
Q

Varicose Veins - Management

A 
Non-invasive: compression stockings (mainstay)
Invasive:
- Foam sclerotherapy
- Thermal ablation
- Vein ligation, stripping + avulsion
55
Q

Deep Venous Insufficiency - Definition

A

Chronic disease caused by failure of the venous system

56
Q

Deep Venous Insufficiency - Causes

A

Primary: underlying vein defect (connective tissue)

Secondary: due to damage

  • Post-thrombotic/Post-phebelitic
  • Trauma
  • Outflow obstruction
57
Q

Deep Venous Insufficiency - Clinical Features

A

Chronic swollen limb/limbs
- can become aching/puritic/painful

Venous claudication
- bursting pain + tightness on walking

58
Q

Deep Venous Insufficiency - Investigations

A

Doppler USS - primary investigation

ABPI - assess viability of compression stockings

59
Q

Deep Venous Insufficiency - Management

A

Conservative: compression stockings + analgesia
Surgical: valvuloplasty (less successful)

60
Q

What are the managements for different ulcers

A

Arterial
- C: lifestyle changes, M: statins, S: angioplasty/bypass

Venous
- C: compression bandaging, M: abx, S: treat varicose veins

Neuropathic

  • C: improve diabetic control + foot hygeine
  • S: amputation if severe/gangrenous
61
Q

Varicose Veins - Classification

A

CEAP classification

  • Clinical features
  • aEtiology
  • Anatomical location
  • Pathological aspects
62
Q

Ulcers - Investigations

A
  • ABPI: for venous this is to assess compression viability
  • Swabs: for infection
  • Neurological exam: esp. neuropathic + arterial
  • Full PVE: for neuropathic
63
Q

Hyperhidrosis - Definition

A

Sweating in excess of that required for thermoregulation

64
Q

Hyperhidrosis - Causes

A

Primary: No underlying Cause

Secondary:

  • Pregnancy
  • Anxiety
  • Infections (esp TB)
  • Malignancies (esp lymphoma)
  • Endocrine (hyperthyroidism, phaeochromocytoma)
  • Medication
65
Q

Hyperhidrosis - Clinical Features

A

Primary

  • Usually focal (hands, feet etc)
  • Bilateral
  • Typical onset before 25yrs
  • > 6 months

Secondary

  • Widespread
  • Worse at night
  • Look for features of underlying cause (e.g. weight loss)
66
Q

Hyperhidrosis - Investigations

A

Clinical diagnosis

Blood tests - for underlying cause

67
Q

Hyperhidrosis - Management

A

Conservative
- Lifestyle advice: loose clothing, pads, avoid spice

Medical

  • Aluminium chloride: at night, can cause painful erythema
  • Anticholinergic agents

Surgical

  • Iontophoresis: electrical current
  • Botox injections: 2-6monthly
  • Sympathetectomy
68
Q

Chronic Mesenteric Ischaemia - Pathophysiology + risk factors

A

Same as chronic limb ischaemia

  • Athersclerosis causing gradual build up + worsening symptoms
  • CVD risk factors
69
Q

Chronic Mesenteric Ischaemia - Clinical features

A
  • Post-prandial pain (~10-40 mins after)

- Weight loss

70
Q

Chronic Mesenteric Ischaemia - Investigations

A
  • CT angiogram - gold standard

- CVD risk profile

71
Q

Chronic Mesenteric Ischaemia - Management

A
  • Conservative: modify risk factors
  • Medical: Statins + antiplatelet therapy
  • Surgical: angioplasty or bypass

Finals - Surgery (5 decks)

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