Vascular Surgery Flashcards
What is peripheral vascular disease (PVD)?
obstruction of the large arteries that supply blood to the peripheries
What are some causes of PVD?
atherosclerosis (thickening of the artery wall due to accumulation of calcium and fatty materials)
thromboembolism (blood clot occluding the artery)
aneurysm (bulge in artery wall)
inflammatory processes
Why is smoking a risk factor for PVD?
causes changes in and damage to the endothelial lining of blood vessels
Why is diabetes a risk factor for PVD?
due to peripheral neuropathy
What are some risk factors for PVD (other than smoking and diabetes)?
dyslipidemia (high cholesterol)
hypertension
obesity
stroke/CV disease
family history of vascular disease
What is claudication?
pain with walking due to decreased circulation (cramping, aching, fatigue, numbness)
What are two long standing symptoms patients with PVD might have?
claudication & resting pain
What is the classification scale for PVD?
0: asymptomatic
1: mild claudication
2: moderate claudication
3: severe claudication
4: resting pain
5: minor tissue loss, ischemic ulceration not exceeding ulcer of the digits of the foot
6: major tissue loss, severe ischemic ulcers or frank gangrene
How is PVD diagnosed?
using an ankle-brachial pressure index (ABPI/ABI)
normal range is 1 to 4
PVD
Name some conservative managements for PVD
smoking cessation
diabetic management
management of cholesterol
exercise
What is the main outcome measure used to monitor PVD?
progressing treadmill test
recording the claudication pain time onset and maximum walking time
What does endovascular surgery entail?
minimally invasive surgery designed to access regions of the body via major blood vessels
involves the inserting a catheter through the skin into a large blood vessel
i.e. angioplasty
What is an angioplasty?
a type of endovascular surgery where a collapsed balloon is inserted into a vessel and expanded at narrow points
a stent may also be inserted to ensure the vessel remains open after the balloon is removed
Post angioplasty, how long should a patient remain in bed?
4 hours and avoid strenuous activity for a week
What are inflow operations?
surgeries to restore blood flow to the top of the leg
also called super-inguinal open surgery
What are outflow operations?
surgeries to restore blood flow below the knee
also called infra-inguinal open surgery
Name 4 inflow operations
aorto-bifermoral bypass graft
axillo-bifemoral bypass graft
iliofemoral bypass (unilateral or g=femoral-femoral crossover)
femoral endarterectomy and profundaplasty
What is a aorto-bifemoral bypass?
used for obstruction of the aorta below the level of the kidneys
incision in the abdomen and bilateral groin, an artificial graft is used to reinforce the aorta
indications: severe claudication non-healing ulcers on the extremities aortic aneurysms acute abdominal aortic occlusion critical limb ischaemia
What is a axillo-bifemoral bypass?
a surgery where the axillary artery is connected to the femoral arteries using an artificial graft
this is less stress on the heart but more prone to complications
What is an ilio-femoral bypass (note can be done unilaterally or with a femoral-femoral crossover)?
a surgery for cases of isolated iliac or proximal common femoral artery occlusion
femoral-femoral crossover involves a graft from a normal femoral artery in the groin on one leg and takes blood to the femoral artery in the other leg
What is a femoral endarterectomy? Why is this procedure less risky than others?
a surgery to remove the atherosclerotic plaque in the lining of an artery
there is no prosthetic material being introduced
What is a carotid endarterectomy?
a surgery to remove atherosclerotic plaque from the carotid artery (where stroke is likely to occur if the plaque breaks free and moves to the brain)
Name 3 outflow operations.
femoro-popliteal bypass
femoro-tibial bypass
femoro-crural bypass
What is a femoro-popliteal bypass?
a natural graft is placed from the femoral artery to the popliteal artery to bypass an area of blockage
What is a femoro-tibial bypass?
a graft is placed from the femoral artery to the anterior tibial artery
What is an abdominal aortic aneurysm?
a localised ballooning of the abdominal aorta
rupture can be life-threatening
In relation to vascular surgery, what should be considered in a preoperative assessment (if possible)?
gain rapport with the patient previous level of mobility home set up comorbidities that may impact recovery provide education
In relation to vascular surgery, what should be considered in a post-operative assessment?
circulation
chest review
mobility
In relation to vascular surgery, what post-operative treatments should be applied?
circulatory exercises chest therapy mobility starting with a rollator home exercise program education and advice re lifestyle changes to support risk factor reduction
What are the 6 P’s associated with acute arterial occlusion?
pain pallor pulselessness paraesthesia (pins & needles) paralysis poikilothermy (varying temperature)
What causes an acute arterial occlusion and what are the options for intervention?
failed bypass graft
thrombosis of native vessels due to progressive atherosclerosis (plaque build-up)
embolism of the heart (blockage from a clot)
injury
options: revascularisation or amputation
Would it take more energy to use a prosthesis with a trans-femoral or trans-tibial amputation?
trans-femoral
