vascular (AAA, limb, PVD) Flashcards
constant pain vs intermittent pain,what is the different causes
constant is inflammatory
intermittent is more muscular or blocking.
what does it tell you if there is back pain also
that the pain is retroperitoneal
definiton of arterial aneurism
increeace in vessel diameter of 50% or more then the non-dilated adjacent vessel.
demographics + risk factorsof arterial aneurism
men 6:1 F
increacing with age
7th most common cause of male death in uk
risk factors
over 75, family history, smoking, sex, HTN, ethnicity (90% dec in asian men), high cholesterol, genetic disorders, connective tissue disorders, infective.
types of aneurism
atheroscolerotic
genetic aneurism
iatrogenic (more pseudo)
mycotic- infective cause- from other intraabdomial sepsis.
imaging in AAA
ultrasound- screening program (duplex scan)
Ct scans
MRI is CT contraindicated.
consequences of rupture AAA
75% die before hospital
40% in hospital mortality for those reaching theatre.
emergency management aaa
ABC-
need to monitor urine output as part of C.
check BM as past of Disability.
need to discuss with anethastist, ICU, theatre managers.
open vs EVAR
open more durable but needs more ability to handle the operation.
an do a bifurcated graft if aneurism extends into the iliac vessels.
EVAR is good for less fit patients. provides a few years of reasonable quality of life.
complications- blocking lumber / spinal arteries, or the IMA.
acute ischaemic limb overview including risk factors + some differential diagnosis
sudden decrease in perfusion to an affected limb. arterial occlusion can lead to poor function outcomes within hours.
smoking, DM, no exercise, HTN, hyperlipidaemia, age, valvular heart disease.
DD
DVT, neuro causes, infection, trauma.
causes + signs and symptoms of acute ischaemic limb
Embolism (usually cardiac) - this is usually sudden
thrombosis, dissection, trauma, PVD
S+S
6-p’s
pulseless
parasthesia
pain
pallor
paralysis
perishing cold
if fixed mottling of skin is present- then damage is irreversable.
what is the Rutherford score for grading and what does it indicate.
investigation and management of acute ischaemic limb
bloods- lactate to ax for amount of ischaemia
thrombophilia screen if younger than 50
imaging: ECG
doppler of upper/ lower limbs to work out ABPI
CT angio is gold standard. - if salvageable go cof a CT arteriogram to get more info.
Rx:
this is an emergency so act fastly
initial- high flow o2, IV access + therapeutic dose heparin
Conservative- prolonged heparin
surgical- if cons fails or if higher Rutherford scale
embolic- embolectomy (fogarty catheter) or local intraarterial thrombolysis, or bypass surg
if thrombotic disease- thrombolysis, thrombectomy, angio, bypass, endartectomy
level 3 - amputation/ palliation.
high levels of care required post intervention. due to ischaemia reperfusion syndrome.
long term Mx: antiplatelet agent (aspirin, clopidogrel, DOAC) + lifestyle advice.
what is reperfusion injury
sudden increase in capillary permeability- can lead to compartment syndrome (inflammation everywhere)
release of substanced form damaged muscle cells
hyper K
H+ ions
myoglobin –> AKI
oxygen radicals from ischaemic tissue.
it is why you amputate in grade 3–> reperfusion would kill them.
discuss PVD
caused by atherosclerosis
centres of inflammation, damage and ischaemia
4 stages
1- asymptomatic
2a- mild claudication
2b- moderate to sever claudication
3- ischaemia and pain at rest
4- ulceration or gangrene
narrowing of vessels results in ischaemia- initially on exertion but after progression can become more severe.
