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Surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

How do venous leg ulcers come about?

A
  • most due to venous hypertension secondary to chronic venous insufficiency
  • other: calf pump dysfunction or neuromuscular disorders
  • ulcers form due to capillary fibrin cuff or leucocyte sequestration
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2
Q

Features of venous insufficiency:

A
  • oedema
  • brown pigmentation
  • lipodermatosclerosis
  • eczema
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3
Q

What is venous insufficiency related to?

A
  • deep: previous DVT

- superficial: varicose veins

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4
Q

Investigation and management of lower leg ulcers:

A
  • doppler ultrasound looks for presence of reflux and duplex ultrasound looks at anatomy/flow of vein
  • 4 layer compression banding after exclusion of arterial disease or surgery
  • if failure to heal after 12 weeks or >10cm2 skin grafting
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5
Q

What is Marjoiln’s ulcer?

A
  • squamous cell carcinoma
  • occurring at sites of chronic inflammation e.g. burns, osteomyelitis after 10-20 years
  • mainly lower limb
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6
Q

What are arterial ulcers?

A
  • toes and heel
  • painful
  • areas of gangrene
  • cold with no palpable pulses
  • low ABPI measurements
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7
Q

What are neuropathic ulcers?

A
  • plantar surface of metatarsal head and plantar surface of hallux
  • plantar neuropathic ulcer most commonly leads to amputation in diabetics
  • due to pressure
  • cushioned shoes to reduce callous formation
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8
Q

What is pyoderma gangrenosum?

A
  • associated with IBD/RA
  • stoma sites
  • erythematous nodules or pustules which ulcerate
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9
Q

Three patterns of presentation in patients with peripheral arterial disease:

A
  • intermittent claudication
  • critical limb ischaemia
  • acute limb-threatening ischaemia
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10
Q

Features of acute limb-threatening ischaemia:

A
  • pale
  • pulseless
  • painful
  • paralysed
  • paraesthetic
  • perishing with cold
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11
Q

3 features of critical limb ischaemia:

A
  • rest pain in foot for more than 2 weeks
  • ulceration
  • gangrene
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12
Q

ABPI suggestive of critical limb ischaemia:

A

<0.5

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13
Q

Interpretation of ABPI:

A

1 - normal
0.6-0.9 - claudication
0.3-0.6 - rest pain
<0.3 - impending

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14
Q

Features of intermittent claudication:

A
  • aching or burning in leg muscles following walking
  • able to walk predictable distance before symptoms
  • relieved within minutes of stopping
  • not present at rest
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15
Q

Assessment intermittent claudication:

A
  • femoral, popliteal, posterior tibialis and dorsalis pedis pulses
  • ABPI
  • duplex US
  • magnetic resonance angiography (MRA) before intervention
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16
Q

Management of peripheral arterial disease:

A
  • stop smoking
  • treat hypertension, diabetes, obesity
  • statin (atorvastatin 80mg)
  • clopidofrel
  • exercise training
  • severe: angioplasty, stenting, bypass surgery, amputation
17
Q

Drugs to use in peripheral arterial disease:

A
  • naftidrofuryl oxalate = vasodilator

- cilostazol: phosphodiesterase III inhibitor with both anti platelet and vasodilator effects

18
Q

What is superficial thrombophlebitis?

A
  • inflammation due to thrombosis of superficial vein
  • usually long saphenous vein
  • usually non-infective (bacterial can result in septic thrombophlebitis)
19
Q

What is risk of superficial thrombophlebitis related to?

A

length of vein affected - >5cm likely to have associated DVT

20
Q

Investigations superficial thrombophlebitis:

A
  • ultrasound scan to exclude concurrent DVT
  • antiembolism stockings
  • consider treatment with prophylactic LMWH for up to 30 days or fondaparinux for 45 days
  • if contra, 8-12 days oral NSAIDs
21
Q

What are varicose veins?

A
  • dilated, tortuous, superficial veins
  • secondary to incompetent venous valves
  • most commonly in legs due to reflux of great saphenous vein and small saphenous vein
22
Q

Risk factors varicose veins:

A
  • age
  • female
  • pregnancy: uterus causes compression of pelvic veins
  • obesity
23
Q

Symptoms varicose veins:

A
  • aching, throbbing, itching
  • varicose eczema (venous stasis)
  • haemosiderin deposition (hyperpigmentation)
  • lipodermatosclerosis (hard tight skin)
  • atrophie blanche (hypopigmentation)
  • bleeding
  • superficial thrombophlebitis
  • venous ulceration
  • DVT
24
Q

Management varicose veins:

A
  • leg elevation
  • weight loss
  • exercise
  • stockings
  • endothermal ablation
  • foam sclerotherapy
  • surgery (ligation or stripping)
25
Q

Reasons for referral of varicose veins to secondary care:

A
  • significant symptoms
  • previous bleeding from veins
  • skin changes secondary to chronic venous insufficiency
  • superficial thombophlebitis
  • active or healed venous leg ulcer
26
Q

Cervical rib:

A
  • supernumerary fibrous band arising from 7th vertebra
  • incidence of 1 in 500
  • thoracic outlet syndrome
  • surgical division of rib
  • bilateral in 70%
  • compression of subclavian artery may produce absent radial pulse on examination and positive Adsons test
  • treatment if evidence of neuromuscular compromise
27
Q

What is subclavian steal syndrome:

A
  • proximal stenotic lesion of subclavian artery
  • retrograde flow through vertebral or internal thoracic arteries
  • decreased cerebral blood flow and syncopal symptoms
  • duplex scan and/or angiogram will delineate lesion and allow treatment to be planned
28
Q

What is Takayasu’s arteritis?

A
  • large vessel granulomatous vasculitis
  • intimal narrowing
  • young asian females
  • mild systemic illness, pulses phase with symptoms of vascular insufficiency
  • treat with systemic steroids
29
Q

What is coarctation of the aorta?

A
  • aortic stenosis at site of ductus arteriosus insertion
  • most common in boys and Turner’s
  • symptoms of arterial insufficiency such as syncope and claudication
  • blood pressure mismatch may be seen
  • angioplasty or surgical resection
30
Q

Axillary/brachial emobolus:

A
  • 50% of upper limb emboli in brachial
  • 30% axillary
  • sudden onset: pain, pallor, paresis, pulselessness, paraesthesia
  • sources: left atrium with cardiac arrhythmia, mural thrombus
  • cardiac arrhythmias may result in impaired consciousness
31
Q

What are arterial occlusions:

A
  • resulting from atheroma common
  • trauma may result in vascular changes and long term occlusion but rare
  • claudication, ulceration, gangrene
  • may result in subclavian steal syndrome
  • progressive: development of collaterals, acute ischaemia may occur as result of acute thrombosis
32
Q

What is Adsons test?

A
  • for compression of subclavian artery
  • lateral flexion of neck away from symptomatic side and traction of symptomatic arm
  • obliteration of radial pulse

Surgery (10 decks)

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