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Phase 2- Periop > Vascular Conditions > Flashcards

Vascular Conditions Flashcards

1
Q

What are varicose veins?

A

Dilated segments of veins associated with valve incompetence. The blood flow from the deep venous system flows to the superficial venous system resulting in venous hypertension and dilatation of the superficial venous system

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2
Q

Give 4 causes of varicose veins

A 
Idiopathic (98%)
DVT 
Pregnancy 
Uterine fibroids
Ovarian masses
Arteriovenous malformations
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3
Q

Give 3 risk factors for varicose veins

A

Prolonged standing
Obesity
Pregnancy
Family history

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4
Q

How do varicose veins present?

A 
Often cosmetic complaint
Pain 
Itching 
Swelling 
Skin changes (varicose eczema) 
Ulceration 
Thrombophlebitis
Bleeding
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5
Q

What classification system is used in varicose veins?

A

CEAP classification

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6
Q

What is meant by C0 on the CEAP

chronic venous disorders classification score?

A

No visible or palpable signs of venous disease

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7
Q

What is meant by C1 on the CEAP chronic venous disorders classification score?

A

Telangiectasia or reticular veins

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8
Q

What is meant by C2 on the CEAP chronic venous disorders classification score?

A

Varicose veins

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9
Q

What is meant by C3 on the CEAP chronic venous disorders classification score?

A

Oedema

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10
Q

What is meant by C4a on the CEAP chronic venous disorders classification score?

A

Pigmentation or eczema

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11
Q

What is meant by C4b on the CEAP chronic venous disorders classification score?

A

Lipodermatosclerosis or atrophie blanche

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12
Q

What is meant by C5 on the CEAP chronic venous disorders classification score?

A

Healed ulcer

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13
Q

What is meant by C6 on the CEAP chronic venous disorders classification score?

A

Active venous ulcer

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14
Q

How is a varicose vein diagnosed?

A

Duplex ultrasound to assess valve competence and DVT risk

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15
Q

How are varicose veins managed conservatively?

A 
Avoid prolonged standing
Weight loss
Exercise
Compression stockings 
Bandage ulcers to compress leg
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16
Q

How are varicose veins managed surgically?

A

Vein ligation, stripping and avulsion
Foam sclerotherapy
Thermal ablation

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17
Q

Give 3 indications for surgery in varicose veins

A

Symptomatic primary or recurrent varicose veins
Lower limb skin changes
Superficial vein thrombosis
Venous leg ulcer

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18
Q

Give 3 post-op complications of varicose vein surgery

A 
Haemorrhage 
Thrombophlebitis
DVT 
Recurrence
Nerve damage
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19
Q

What is acute limb ischaemia?

A

Acute limb ischaemia is the sudden decrease in limb perfusion which threatens the viability of the limb. It results from partial or complete occlusion of arterial blood supply to the limb

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20
Q

Give the 3 main causes of acute limb ischaemia

A

Thrombosis
Embolism
Trauma

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21
Q

What are the symptoms of acute limb ischaemia?

A 
Pain 
Pallor
Paraesthesia
Pulselessness
Perishingly cold 
Paralysis
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22
Q

How is acute limb ischaemia classified?

A 
I = viable 
IIa = marginally threatened 
IIb = immediately threatened 
III = irreversible (major tissue loss, permanent nerve damage)
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23
Q

How is acute limb ischaemia initially managed?

A

High flow oxygen
IV access
Heparin infusion

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24
Q

How is acute limb ischaemia managed surgically?

A 
Embolectomy 
Local intra-articular thrombolysis
Bypass surgery 
Angioplasty 
Amputation of limb
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25
Q

Give 3 complications of acute limb ischaemia

A

Compartment syndrome
Hyperkalaemia
Acidosis
Rhabdomyolysis

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26
Q

What is an ulcer?

A

Break in the skin or mucous membrane

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27
Q

What is the most common type of ulcer?

A

Venous ulcer (80%)

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28
Q

What is the pathophysiology of a venous ulcer?

A

Retrograde flow of blood in the venous system causes venous dilation. Blood pools distally and oxygen delivery to the skin is impaired. Ulcers form over the path of the long and short saphenous veins.

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29
Q

What do venous ulcers look like?

A

Shallow
Irregular borders
Granulating base

Other signs of venous insufficiency present –> varicose veins, oedema, lipodermatosclerosis, atrophie blanche, telangiectasia

30
Q

Give 3 risk factors for venous ulcer formation

A 
DVT 
Varicose veins 
Trauma 
Pregnancy 
Obesity
31
Q

How are venous ulcers managed?

A

Conservative –> leg elevation, increased exercise, emollients, antibiotics, 4-layer compression bandaging

Medical –> antibiotics, radiofrequency ablation

Surgical –> varicose vein surgery

32
Q

What is the pathophysiology of an arterial ulcer?

A

Reduction in arterial blood flow leading to reduced perfusion of the tissues and poor wound healing.

33
Q

What do arterial ulcers look like?

A

Small, deep lesions
Necrotic base
Found at pressure areas and sites of trauma

34
Q

Give 3 risk factors for arterial ulcers

A 
Smoking 
Type II diabetes 
Hypertension 
Hyperlipidaemia 
Old age 
Family history 
Obesity
35
Q

What symptoms are associated with an arterial ulcer?

A 
Intermittent claudication 
Critical limb ischaemia 
Pain 
Cold limbs 
Necrotic toes 
Hair loss
36
Q

How is an arterial ulcer managed?

A

Conservative –> stop smoking, weight loss, increase exercise
Medical –> statins, aspirin, optimise blood pressure and blood glucose
Surgical –> angioplasty, bypass grafting, skin reconstruction

37
Q

What is the pathophysiology of a neuropathic ulcer?

A

Peripheral neuropathy causes a loss of sensation in the feet which then leads to unnoticed injuries and repeated stress causing painless ulcers at the pressure points.

38
Q

Give 2 risk factors of developing a neuropathic ulcer?

A

Concurrent vascular disease
Diabetes
B12 deficiency

39
Q

What do neuropathic ulcers look like/present as?

A 
Variable in size and depth 
Punched out appearance 
Warm feet 
Good pulses 
Tingling in feet
40
Q

How is a neuropathic ulcer managed?

A 
Diabetic foot team 
Control diabetes 
Reduce CV risk 
Antibiotics 
Amputation in severe cases
41
Q

What is Charcot’s foot?

A

Commonly seen alongside neuropathic ulcers. Neuroarthropathy where a loss of joint sensation results in unnoticed trauma. The foot becomes deformed and the deformity predisposed to ulcers. Presents with pain, swelling, distortion and loss of function.

42
Q

What is a DVT?

A

Blood in the deep veins of the legs or pelvis clots and forms a mass.

43
Q

Give 5 risk factors for a DVT

A 
Immobility 
Surgery 
Obesity 
Heart failure 
Trauma 
Infection 
Sepsis
Pregnancy 
Diabetes 
Smoking
Malignancy 
Thrombocytopenia
44
Q

What criteria is used to predict DVT risk?

A

Wells criteria

45
Q

What factors are included in the Well’s score?

A

All score 1 point:
Active cancer
Paralysis or immobilisation of lower limb
Bedridden for >3 days or major surgery <12 weeks
Localised tenderness along route of the deep veins
Swelling of the entire leg
Calf swelling at least 3cm larger than other leg
Pitting oedema in affected leg
Collateral superficial veins
Previously documented DVT

-2 points:
Alternative diagnosis at least as likely as DVT

46
Q

Give 4 signs of a DVT

A

Swollen calf
Red, hot, tender leg
Prominent superficial veins
Oedematous feet

47
Q

Give 4 signs of a PE

A 
Pleuritic chest pain 
Tachycardia 
Tachypnoea
Cough 
Haematemesis 
Venous eczema
48
Q

Give 4 ways to prevent a DVT

A 
Exercise
TED stockings 
Pneumatic compression boots
Heparin 
Warfarin 
Remove COCP
49
Q

How is a DVT diagnosed?

A

D-dimer
Ultrasound
CT

50
Q

How is a DVT treated?

A

Anticoagulation for 12 weeks (heparin)
Compression stockings
Thrombolysis

51
Q

What is an abdominal aortic aneurysm?

A

Dilatation of the aortic aneurysm greater than 3cm

52
Q

Give 4 risk factors for an AAA

A 
Trauma 
Infection 
Connective tissue disease
Inflammatory disease
Smoking 
Hypertension 
Hyperlipidaemia 
Family history 
Male 
Elderly
53
Q

How can an AAA present?

A

Most are asymptomatic

Abdominal pain, back or loin pain, limb ischaemia, syncope

54
Q

Who is screened for AAA?

A

Men over the age of 65

55
Q

Give 3 complications of AAA

A

Aortoduodenal fistula
Embolism
Retroperitoneal leak
AAA rupture

56
Q

How is an AAA managed?

A

<5.5cm –> monitor via USS, smoking cessation, control blood pressure, statins, aspirin, weight loss
>5.5cm –> open repair (midline laparotomy), endovascular repair (use a graft and stent)
>6cm –> stop driving

57
Q

What is the main surgical complication of endovascular treatment of an AAA?

A

Endovascular leaking: incomplete seal around the aneurysm results in blood leaking around the graft. Aneurysm can continue to grow and can rupture.

58
Q

How would a patient present with a ruptured AAA?

A

Back pain, syncope, vomiting, hypotension, pulsatile abdominal mass

59
Q

How is a ruptured AAA treated?

A

High flow oxygen, IV access, group and save, blood transfusion
If stable –> CT scan
If unstable –> straight to surgery for endovascular repair

60
Q

What is ABPI?

A

Non-invasive method of assessing the extent of chronic arterial disease in the lower limbs. Ratio of the blood pressure in the brachial artery and the pressure in the dorsalis pedis and posterior tibial arteries.

61
Q

In ABPI what does a value >1.2 mean?

A

Abnormally hard vessel

62
Q

In ABPI what does a value <0.9 mean?

A

Arterial disease

63
Q

What is gangrene?

A

Serious condition where loss of blood supply causes visible necrosis.

64
Q

Give 3 risk factors for gangrene

A

Diabetes
Atherosclerosis
Peripheral artery disease
Raynauds

65
Q

Give 5 symptoms of gangrene

A 
Redness 
Swelling 
Loss of sensation 
Pain 
Blisters
Cold and pale skin 
Fever 
Loss of appetite
Tachycardia
Dizziness
Shivering
66
Q

What is dry gangrene?

A

Blood flow to the extremity is blocked

67
Q

What is wet gangrene?

A

Combination of injury and bacterial infection

68
Q

What is gas gangrene?

A

Infection develops deep inside the body and bacteria release gas

69
Q

How is gangrene treated?

A 
Debridement surgery 
Amputation 
Treat infection (antibiotics)
Bypass surgery 
Angioplasty
70
Q

What is claudication?

A

Pain or discomfort on walking which is relieved at rest. It is caused by narrowed arterial supply to the legs due to atherosclerosis which leads to peripheral artery disease.

71
Q

Give 4 risk factors for leg claudication

A 
Smoking 
Diabetes 
>70 yrs old
Male
Hypertension 
Hypercholesterolaemia 
Afro-caribbean descent
Heart disease

Phase 2- Periop (5 decks)

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