Vascular Surgery Flashcards
Which of the following is not a risk factor for atherosclerosis?
A. Male
B. Familial Hypercholesterolaemia
C. Vegetarian diet
D. Smoking
C
What are the key features of critical limb ischaemia?
RFs present
6Ps: Pain; Pallor; Poikilothermia; Paralysis; Paraesthesia; Pulseness
Burning pain
Worse at night
Worse when leg raised
Buttock claudication, absent femoral pulses and male impotence are part of what syndrome?
What causes this?
Leriche Syndrome
Occlusion of distal aorta or proximal common iliac artery
What are the signs of arterial disease?
Skin pallor Cyanosis Dependent rubor (a deep red colour when the limb is lower than the rest of the body) Muscle wasting Hair loss Ulcers Poor wound healing Gangrene (breakdown of skin and a dark red/black change in colouration)
Reduced skin temperature
Reduce sensation
Prolonged capillary refill time (more than 2 seconds)
Changes during Buerger’s test
How can you quantify the severity in Buerger’s Test?
Quantify based on the angle at which the leg goes pale
Presence of blue to rubor
Outline the key differences between a venous and arterial ulcer?
Arterial: deeper, narrower, well-defined, punched out, peripherally, painful
Venous: shallower, larger, gaiter area, less painful, other signs of chronic venous insufficiency
An ABPI > 1.3 may indicate what?
Calcification
What is a normal ABPI?
Normal relative to patient’s condition
0.9-1.3
May be pseudo elevated in patients with calcific changes to the vessel
What is the management of intermittent claudication?
Supportive: RF modification; exercise training;
+
Medical: Atorvastatin + Clopidogrel ± Naftidrofuryl oxalate
±
Surgical: Endovascular angioplasty and stenting; Endarterectomy; Bypass
What classification system may be used in acute limb ischaemia?
Rutherford classification of acute limb ischaemia
Outline the criteria for Rutherford Classification of ALI.
1 = normal sensory; normal motor; Doppler fine
2a = slight sensory reduction; normal motor; Doppler fine
2b = sensory reduction; mild-moderate motor symptoms; Doppler Art reduced
3a = paraesthesia; gross motor symptoms; Art and Venous negative on Doppler
Give 5RFs for DVT
Immobility Recent surgery Long haul travel Pregnancy Hormone therapy with oestrogen (combined oral contraceptive pill and hormone replacement therapy) Malignancy Polycythaemia Systemic lupus erythematosus Thrombophilia
What may VTE prophylaxis entail?
Risk assess
TED Compression stockings
Anticoagulation: LMWH
How is a DVT diagnosed?
US-Leg
Should a patient present with a suspected DVT, what decision-making tool may be used?
Outline this.
Wells Score
Mnemonic: DAMN BC
DVT Sx + S
Another DDx unlikely
Mobility
kNOwn Hx
Blood in cough
Cancer
What is the first line management in a patient with Antiphospholipid syndrome?
LMWH
How do you manage a patient with a VTE?
Medical: DOAC
Long-term anticoagulation for at least 3 months
What surgical intervention may be used should a patient be experiencing recurrent PEs and/or unsuitable for anticoagulation?
IVC Filter
How do varicose veins develop?
Valvular incompetence results in retrograde flow.
This can be augmented by perforating veins allowing retrograde flow from deep to superficial veins
What is the difference between venous eczema, lipodermatosclerosis and chronic venous insufficiency.
They are a continuum.
Varicose veins results in pooling which leads to chronic venous insufficiency. The pooled blood contains Hb which breaks down to Haemosiderin which results in a brown discolouration of the skin.
The pooled blood results in skin irritation which causes venous eczema.
Fibrosis, stenosis and sclerosis results in lipodermatosclerosis
Which of the following is not a risk factor for Chronic Venous Insufficiency?
A. COCP
B. Prolonged standing
C. Family history
D. Being overweight
A
