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Surgery block > Vascular disease workshop > Flashcards

Vascular disease workshop Flashcards

1
Q

Peripheral Vascular Disease

A
  • Blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm.
  • This can happen in your arteries or veins. PVD typically causes pain and fatigue, often in your legs, and especially during exercise.
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2
Q

What are some venous diseases?

A
  • Incompetent (varicose) veins
  • Occluded veins
  • Bleeding, ulceration, pain, swelling
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3
Q

Atherothrombosis affects on vascular beds

A
  • Ischaemic stroke
  • Transient ischaemic attack
  • Myocardial infarction
  • Angina:
    • Stable
    • Unstable
  • Peripheral arterial disease:
    • Intermittent claudication
    • Rest pain
    • Gangrene
    • Necrosis
  • Renovascular disease
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4
Q

Acute vs chronic lower limb ischaemia

A
  • Acute → no previous history
  • Acute on chronic → suddenly worse
  • Chronic → longstanding problem
    • Claudication
    • Critical ischaemia
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5
Q

Explain acute ischaemia

A
  • Classically embolic
  • Thrombotic (pre-existing disease)
  • Trauma
  • Dissection of vessel

Treatment

  • Needs urgent assessment and referral to a vascular centre
  • Revascularise within 6 hours of symptoms
  • ….otherwise amputation or death and litigation!!
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6
Q

History of ischaemia (peripheral)

A

“6 Ps”

  • Pain
  • Pulseless
  • Pallor
  • Paraesthesia
  • Poikilothermia (Perishing cold)
  • Paralysis
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7
Q

Treatment of acute ischaemia

A
  • Embolus -embolectomy
  • Thrombus -Thrombolysis, angioplasty, bypass surgery
  • Dissection -Surgical correction
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8
Q

Explain chronic limb ischaemia

A
  • Intermittent Claudication
  • Chronic critical ischaemia
  • Rest pain
  • Tissue necrosis
  • >2 weeks duration
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9
Q

Explain atherosclerosis

A
  • Fatty streaks from macrophages
  • fibrous plaque
  • Atherosclerotic plaque
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10
Q

Rarer causes of atherosclerosis

A
  • Buerger’s disease (and other arteritides)
  • Popliteal aneurysm
  • Popliteal entrapment
  • Cystic adventitial disease
  • Trauma
  • Aortic dissection
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11
Q

Risk factors of atherosclerosis

A
  • Smoking
  • Diabetes
  • Hypertension
  • Hypercholesterolaemia
  • Age
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12
Q

What is intermittent claudication

A
  • Pain produced by the abnormal accumulation of metabolic products within the muscle.
  • Resting blood flow to the affected limb is NORMAL
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13
Q

History and examination Intermittent claudication

A
  • History
    • Onset of pain
    • Location
    • Character
    • Duration
    • Claudication distance (gradient)
    • Rest pain
  • Examination
    • Inspection (pale, pink, black, nicotine stains)
    • Palpation (cold, warm)
    • Pulses
    • Blood pressure both arms
    • ABPI
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14
Q

Explain ABPI measurement

A
  • Requires compliant vessels
  • Not useful in calcified arteries
  • May be unreliable in obesity
  • Difficult in ulcerated legs
  • Upper limb ischaemia may confuse result
  • Normal range 0.9-1.2
  • Lower level suggests ischaemia
  • Higher level if vessel incompressible
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15
Q

Management of intermittent claudication

A
  • Correct risk factors
  • Modify ‘at risk’ behaviour
  • Encourage patients to ‘keep walking and stop smoking’
  • Structured exercise programmes
  • Angioplasty
  • Bypass surgery

More info…

  • Intermittent Claudication does not kill. Myocardial ischaemia DOES!!
  • Only 1-2% of claudicants will lose the limb
  • Intervention does NOT improve limb salvage in claudicants
  • Claudication does NOT always require treatment!
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16
Q

Critical limb ischaemia signs and symptoms

A
  • The Limb is at risk:
  • Tissue necrosis/Gangrene
  • Rest Pain
  • Reduced ankle pressure / toe pressure
17
Q

Explain rest pain in critical limb ischaemia

A
  • Affects DISTAL extremity
  • Made worse by elevation
  • Classically patient hangs foot out of bed or sleeps in a chair
  • Occurs over days/weeks
18
Q

What is this?

A
  • Venous ulcer (neuropathic ulcer)
    • Most likely diabetic no sensation
  • Flat foot
19
Q

What is this?

A
  • Wet gangrene
    • Smells
  • Amputate → as increase risk of infection
20
Q

What is this?

A
  • Dry gangrene
  • Do not amputate, let fall off
    • If leave it then less tissue will be removed
21
Q

Risk factors of chronic limb ischaemia

A
  • Diabetes
  • High cholesterol
  • Smoking
  • Overweight
  • High BP
  • FH of atherosclerosis
22
Q

Management of chronic limb ischaemia

A
  • Analgesia / Medical Therapy
  • Angioplasty
    • balloon-tipped catheter to open a blocked blood vessel and improve blood flow
  • Reconstructive surgery
23
Q

What is an aneurysm?

A
  • An abnormal dilatation of an artery or a vein
  • A vessel is classified as aneurysmal if its diameter exceeds its expected diameter by more than 50%
24
Q

Common sites of aneurysms

A
  • Infrarenal aorta
  • Popliteal artery
  • Iliac artery
  • Femoral artery
  • Splenic
  • Hepatic
  • Circle of Willis
25
Q

Aetiology of aneurysm

A
  • There is increased elastase and collagenase activity in the walls of aneurysms.
  • There is a loss of elastic lamellae with a compensatory increase in the collagenous content of the adventitia.
  • Similar histological changes have been seen in the non-aneurysmal proximal aorta
  • Association with connective tissue disorders:
    • Marfan’s syndrome
26
Q

Presentation of aneurysms

A
  • Asymptomatic until they leak
  • Pulsation can be notes
  • Pain, malaise, wt. loss (Inflammatory)
  • Back pain *Sinister*
  • Hypotension, collapse
27
Q

Differential diagnosis of aneurysms

A
  • Myocardial ischaemia
  • Perforated ulcer
  • Acute cholecystitis
  • Acute pancreatitis
  • Ureteric colic
  • Acute diverticulitis
28
Q

History of aneurysm

A
  • Variable
  • Usually expand <10% per annum (2-5mm p.a.)
  • BUT some show periods of rapid expansion
  • Roughly 2-3% people over age of 65 with it men
29
Q

Investigation of aneurysm

A
  • Aneurysm morphology
    • Ultrasound
    • CT
    • MRI
    • Catheter angiography
30
Q

Treatment of aneurysm

A
  • Open repair
  • Midline or transverse incision
  • Laparotomy
  • Cross-clamping aorta
  • ~5% elective mortality (mainly cardiac)
  • Endovascular repair
31
Q

What is this?

A

Endoleak → can happen after a graft goes in thus, aneurysm grows around it

32
Q

What is this?

A

Limb occlusion

33
Q

Other types of aneurysms

A
  • Iliac - behave much as aortic
  • Femoral – usually easily palpable
  • Popliteal – Present with thrombosis or limb occlusion
  • Mesenteric, splenic. Rare
  • Calcified splenic AAA incidental on CT

Surgery block (13 decks)

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