vascular SAQs Flashcards
critical limb ischemia definition
rest pain present for over 2 weeks with or without ulceration or gangrene, worse at night, improved by hanging off bed
1st and 2nd line Ix for for PAD?
- ABPI
- Duplex USS
- MR angiography before any investigations
Mx of PAD?
- pharmocological: statin + clopidogrel + exercise training
- Critical limb ischemia:
- endovascular revascularization (percutaneous transluminl angioplasty + stent placement)
- surgical revascularisation
- amputation
indications for surgery in AAA?
- > 5.5cm
- increased by >1cm in a year
- symptomatic
- rupture
AAA screening
- all males over 65 yrars offered USS
- > 3cm = 12m screening
- > 4.4cm = 3m screening
- > 5.5cm = 2w wait for elective aneurysm repair
other than aorta where else can aneurysms be found
- intracranial = berry aneurysms
- popitheal
- femoral
- iliac
virchows triad
- endothelial injury: trauma, surgery, atheresclerosis
- stasis of blood flow: AF, LV dysfunction, immobility, varicose veins
- hypercoagulability: malignancy, pregnancy, sepsis, thrombophilia
pt with medial mallous ulcer, presents with rolled up edges + large amt of granulomatous tissue =
A Marjolin ulcer is a cutaneous malignancy that arises in the setting of previously injured skin, longstanding scars, and chronic wounds.
criticial limb ischemia definition
Critical limb ischaemia is defined as rest pain which is present for over 2 weeks with or without ulceration or gangrene.
worse at night, better when hanging off bed
Ix for CLI?
handheld arterial doppler, MR angiography
4 Tx for CLI
- stenting
- angiplasty
- bypass grafting
- amputation
AAA: who receives once-yearly follow ups?
aneurysm 3-4.4cm
Virchow’s triad + examples of each
Endothelial injury: trauma, surgery, atherosclerosis, venepuncture, cardiac valve disease.
Stasis of blood flow: AF, left ventricular dysfunction, immobility, varicose veins.
Hypercoagulability: malignancy, pregnancy, oestrogen therapy, sepsis, thrombophilia.
Ix for venous leg ulcer?
Doppler ultrasound
Tx options for acute limb ischemia
Thrombolysis. ● Embolectomy. ● Angioplasty. ● Arterial bypass grafting.
Describe the three subgroups of limb viability for the acute ischaemic limb
Viable: Doppler pulses present, limb not immediately threatened, sensation intact.
Threatened: loss of sensory and motor function, urgent treatment required.
Irreversible: fixed mottling with muscle paralysis, requires amputation.
2 types of classification used in aortic dissection?
Stanford, DeBakey
IMMEDIATE steps for a stab wound?
● Direct pressure on the wound. ● Elevate limb. ● Urgent vascular review. ● Tourniquet.
signs that may lead you to suspect a vascular injury
● Bruit. ● Active haemorrhage. ● Pulsatile haemorrhage. ● Haematoma formation.
6Ps
What is permissive hypotension and how may this be beneficial for this patient?
Permissive hypotension is a strategy used in the resuscitation of bleeding trauma patients. This advocates the cautious use of fluid to maintain a blood pressure lower than normal but that can sustain sufficient organ perfusion. It is believed to prevent a large increase in blood pressure to disrupt clot formation, avoid further tearing to the aorta and limit blood loss.
classification of varicose veins?
Classified as primary which is the degeneration of the valve annulus and leaflets
secondary which is due to valve destruction or venous outflow destruction.
common sites for varicose veins to occur?
Long saphenous-femoral vein junction. ● Short saphenous-popliteal vein junction. ● Perforating veins.
Tx options for varicose veins
watchful waiting
compression bandaging
sclerotherapy
laser ablation
ligation and stripping
