Vascular Surgery Flashcards
Aetiology of acute limb ischameia?
- Acute embolic ischameia: an embolus occluded a healthy arterial tree
- Acute traumatic ischaemia
- Acute thrombotic ischaemia: atherosclerosis and sluggish blood flow could cause thrombus formation
What is Claudication
Claudication is pain in the legs or arms that comes on with walking or using the arms. This is caused by too little blood flow to your legs or arms. Claudication is usually a symptom of peripheral artery disease, in which the arteries that supply blood to your limbs are narrowed, usually because of ATHEROSCLEROSIS
Risk factors of embolic ischaemia?
MI
Atrial fibrillation
Prosthetic valve replacement
What are the 6P’s of acute ischaemia?
Pain Paraesthesia Pale Pulseless Paralysis Piokilothermia (inability to regulate core body temperature )
What is the first line investigation in acute ischaemia and why?
DUPLEX. BEDSIDE. NON INVASIVE. NO CONTRAST NEEDED.
Pros and cons of MRA in acute ischaemia?
PROS: Less nephrotoxic and no radiation
COMS: more expensive and time consuming
Management of a patient with acute limb ischameia?
- IMMEDIATE IV Heparin (anticoagulant) to prevent clot propagation
- Analgesia
- Revascularization methods or improve existing perfusion
Management of a patient with acute limb ischameia?
- IMMEDIATE IV Heparin (anticoagulant) to prevent clot propagation
- Analgesia
- Revascularization methods or improve existing perfusion
Explain and reperfusion injury (one of the the two main complications of intervention after acute limb ischaemia)
Ischaemia-Reperfusion injury is defined as the paradoxical (self contradictory) exacerbation of cellular dysfunction and death, following restoration of blood flow to previously ischaemic tissues. Reestablishment of blood flow is essential to salvage ischaemic tissues. However reperfusion itself paradoxically causes further damage, threatening function and viability of the organ. IRI occurs in a wide range of organs including the heart, lung, kidney, gut, skeletal muscle and brain and may involve not only the ischaemic organ itself but may also induce systemic damage to distant organs, potentially leading to multi-system organ failure. Reperfusion injury is a multi-factorial process resulting in extensive tissue destruction.
Explain compartment syndrome (one of the the two main complications of intervention after acute limb ischaemia)
Muscle swelling due to reperfusion after ischaemia. The swollen muscles are compressed within the fixes fascial compartments, compressing the blood vessels which may lead to ischaemia itself. The pressure could also cause local nerve damage.
What is the treatment of compartment syndrome
The treatment is urgent fasciotomy to release the compression. The usual site for fasciotomy is the calf
Management of acute limb ischaemia?
If due to an Embolus: fogarty embolectomy
If due to thrombosis:
- thrombolysis of focal lesion
- bypass surgery if it is an extensive lesion
What is a bypass surgery
Coronary artery bypass surgery is also called bypass surgery or open heart surgery. It is done to allow blood to flow around blocked blood vessels in the heart. Coronary arteries are the blood vessels that supply the heart muscle with oxygen and nutrients. During bypass surgery, a piece of a blood vessel from the leg, arm or chest, called a graft, is removed and attached to the aorta and around the blocked blood vessel of the heart. The blocked blood vessel remains, but blood is carried around it in the new blood vessel. If there are several blocked vessels, you may have more than one bypass done.
Main cause of chronic ischaemia?
Above 45: Atherosclerotic changes.
Below 45:
-in DM patients: presenile atherosclerosis
-in non DM patients: buerger’s disease of raynaud’s disease
Main cause of chronic ischaemia?
Above 45: Atherosclerotic changes.
Below 45:
-in DM patients: presenile atherosclerosis
-in non DM patients: buerger’s disease, Raynaud’s disease, arteries
Clinical presentation of DVT?
UNILATERAL: Redness Hotness Tenderness Oedema Swelling Pain
Do DVT patients have pitting or non pitting oedema?
PITTING
What is the score used to predict likelihood of DVT?
Well’s score.
-2 to 0: unlikely
1 to 2: moderate probabity
3-8: high probability
What do we give -2 for on the well’s score?
Any other diagnosis just as likely as DVT