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Vascular Flashcards

1
Q

What are the 2 types of aneurysm, give an example of each

A

saccular - berry aneurysms

fusiform - AAA

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2
Q

What are the risk factors for a AAA?

A 
HTN
male 
smoker
FH
connective tissue disorders
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3
Q

How would an unruptured AAA present?

A

abdo, back, loin pain

lower limb ischaemia

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4
Q

What is a AAA?

A

the abdominal aorta is >3cm

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5
Q

Following AAA screening results, how are patients managed for varying sizes seen?

A 
<3 = nothing
<4.4 = yearly duplex USS
<5.4 = 3 monthly duplex USS
>5.5 = refer to surgeons within 2 weeks for EVAR
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6
Q

What imaging is done prior to surgery for a AAA?

A

CT contrast

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7
Q

How does a ruptured AAA present?

A

Abdominal pain radiating to back or groin
Pulsatile, expansile abdominal mass
Shock

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8
Q

What is the management of a ruptured AAA?

A

crossmatch 6 units
Keep BP <100 systolic
Open repair

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9
Q

What is a complication of EVAR for AAA?

A

Endoleak - the stent may not prevent blood leaking in to the aneurysm

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10
Q

Compare the presentation of thoracic aortic aneurysms depending on their exact location. Which is most common?

A

root (most common) - chest pain
arch - hoarse voice, neck pain
descending - intrascapular pain
thoracoabdominal - back pain

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11
Q

Aside from pain, how else might TAAs present?

A

distended neck veins (SVC)
SOB (trachea)
Heart failure (valve involvement)

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12
Q

What would the CXR of a TAA show?

A

Widened mediastinum
Enlarged aortic knob
Tracheal deviation

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13
Q

What is the screening programme for AAAs?

A

once only abdominal USS for men aged 65

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14
Q

How would a popliteal aneurysm present?

A

pain behind the knee
claudication and acute limb ischaemia
fibular nerve compression

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15
Q

What is an important risk factor for femoral artery aneurysms? How do they present?

A

IVDU
Groin swelling
claudication and acute limb ischaemia

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16
Q

What are the risk factors for splenic artery aneurysms?

A

portal hypertension
pancreatitis
multiple pregnancy

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17
Q

What is the imaging modality of choice for visceral artery aneurysms vs peripheral artery aneurysms?

A

visceral: CT angio
peripheral: duplex USS

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18
Q

What is an aortic dissection?

A

tear in the intima allowing blood to flow between the intima and media

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19
Q

What are the complications of a retrograde aortic valve dissection

A

aortic valve prolapse

tamponade

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20
Q

What are the risk factors for aortic dissection

A

HTN
atherosclerosis
connective tissue disorders
bicuspid aortic valve

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21
Q

Describe the categories of aortic dissection (Stanford classification)

A

A: root or arch
B: anything distal to the left subclavian artery

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22
Q

How does an aortic dissection present? Symptoms and examination findings

A

Tearing retrosternal pain radiating to the back
Tachycardic
Blood pressure discrepancies between the arms
End organ perfusion reduced: LOC, oligouria

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23
Q

Aortic dissections can extend to other arteries, how might this present?

A

paraplegia (spinal arteries)
limb ischaemia (distal aorta)
angina (coronary arteries)

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24
Q

If there were to be ECG changes (not very common) in an aortic dissection, what would they be?

A

ST changes in the inferior leads

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25
How is an aortic dissection diagnosed?
CT angiogram | Transoesophageal echo
26
What are the risk factors for a DVT?
Immobility Cancer Prothrombotic drugs eg COCP, HRT
27
How does a DVT present?
Swollen, red, painful calf
28
What is on the WELLs score for DVT?
``` Bedridden >3 days or major surgery <12 weeks ago Paralysed or plaster immobilisation of lower limb Active cancer (within 6 months) Calf swelling >3cm Whole leg swelling Tenderness along the deep venous system Pitting oedema of one leg Collateral superficial veins Previous DVT ```
29
You calculate your Wells score to be 2 or more... what next?
Proximal leg vein USS within 4 hours OR interim anticoagulation + D-dimer then USS within 24 hours -ve both: unlikely a DVT +ve USS: treat -ve USS but +ve D-dimer: stop interim anticoagulants and repeat USS in a week
30
You calculate your Wells score to be 1...what next?
D-dimer within 4 hours OR interim anticoagulation + D-dimer in 24 hours D-dimer -ve: unlikely a DVT don't scan D-dimer +ve then go on to do a USS +ve USS: treat -ve USS stop interim anticoagulants and repeat USS in a week
31
Once a diagnosis of DVT is suspected, what treatment should be given?
DOAC (e.g. apixaban)
32
In which patients are DOACs for DVT treatment not recommended? What should be used instead?
eGFR <15 Antiphospholipid syndrome LMWH and then warfarin
33
How long should anticoagulation continue in DVTs?
provoked: 3 months unprovoked: 6 months cancer: 3-6 months depending on risks and benefits
34
When is a carotid endarterectomy indicated? What is done in the procedure?
Stenosis >50% | The atheroma is removed and so is the damaged intima
35
How is Raynauds managed?
Calcium antagonists
36
What is the pathophysiology of subclavian steal syndrome?
atherosclerosis of the subclavian artery means that when it is used O2 demands outweigh perfusion ability. There is retrograde flow from the vertebral artery to compensate.
37
How does subclavian steal syndrome present?
Arm claudication | Neurological symptoms: syncope, blurred vision, vertigo
38
How is subclavian steal syndrome managed?
Antiplatelet + statin + surgery
39
What is the pathophysiology of varicose veins?
Valvular incompetence (often saphenofemoral junction) leads to blood backing up in the superficial veins which then increase in pressure and dilate
40
How do varicose veins present?
Itching and aching
41
What are the associated skin changes/complications of varicose veins?
``` venous eczema haemosiderin deposits venous ulcers hypopigmentation lipodermatosclerosis ```
42
What is the conservative management of varicose veins?
weight loss avoid standing but exercise leg elevation 4 layer compression bandaging
43
What are the surgical options for varicose veins?
stripping injection scleropathy radiofrequency ablation
44
What symptoms define critical limb ischaemia? What ABPI defines critical limb ischaemia?
rest pain in the foot for >2 weeks gangrene ulcers <0.5
45
What symptoms define acute limb threatening ischaemia?
P's | pallor, pulseless, parasthesia, paralysis, pain, perishingly cold
46
What would indicate limb ischaemia is irreversible? What needs to be done at this point?
fixed mottled skin or hardened muscles | amputation
47
What blood test results would you see in reperfusion syndrome?
Raised myoglobin, K and H
48
What are some differentials for limb pain?
cold and pale = acute limb ischaemia until proven otherwise hot and swollen = DVT? Cellulitis? ``` other: trauma = compartment syndrome malignancy arthritis neurological: spinal herniation, central causes e.g. MS ```
49
What are the risk factors for a venous ulcer?
Varicose veins DVT history Obesity Pregnancy
50
What are the risk factors for an arterial ulcer
HTN Diabetes Obesity Smoking
51
What are the risk factors for a neuropathic ulcer?
Any peripheral neuropathy e.g. Diabetes, B12
52
Compare the appearance of a venous, arterial and neuropathic ulcer
``` V = shallow, irregular border, granulating base A = regular border N = punched out, on hard callus, on pressure area e.g. heal ```
53
What other skin changes/examination findings may be present in the limb to point you towards either a venous or arterial ulcer?
V = venous eczema, varicose veins, haemosiderin deposition, hypopigmentation, lipodermatosclerosis A = cold, hairless, absent pulses
54
State the interpretation of ABPI results
``` >1.2 = calcified stiff arteries 1 - 1.2 = normal 0.9 - 1 = acceptable 0.6 - 0.9 = PAD <0.5 = critical limb ischaemia (urgent referral) ```
55
Aside from ABPI what other investigations would you want to do on someone with a leg ulcer?
venous duplex USS CT angiogram glucose and B12 swab the ulcer
56
What must you ensure before starting compression bandaging for venous ulcers?
That ABPI >0.8 (or else you will just worse flow)
57
What is the management of venous, arterial and neuropathic ulcers?
V: multicomponent compression bandaging and emollients A: CVS drugs and angioplasty N: diabetic control and foot care
58
What is intermittent claudication?
There is a predictable distance before the onset of pain
59
What is Buergers test? How would you interpret the result?
Raise the legs until they are pale and then lower them and note the angle that colour returns <20 degrees is severe peripheral artery disease
60
What is deep venous insufficiency and what causes it?
essentially varicose veins but of the deep venous system - post DVT - trauma - venous outflow obstruction
61
How does deep venous insufficiency present?
aching and itching venous claudication: bursting pain and tightness on walking O/E: pitting oedema and venous skin changes e.g. eczema, haemosiderin, lipodermatosclerosis
62
What is a pseudoaneurysm and what causes them?
Blood between the media and adventitia - IVDU - iatrogenic: cardiac catheterisation, ABG
63
How and where may a pseudoaneurysm present?
Femoral is most common location | Limb ischaemia and infection
64
How is a pseudoaneurysm managed?
US guided thrombin injection | Stent or bypass

Finals (16 decks)

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