Vascular Surgery Flashcards
What is the definition of an abdominal aneurysm?
Dilatation of the aorta greater than 3cm
What are some risk factors for AAA?
Smoking, hypertension, hyperlipidaemia, family history, male gender, increasing age
How do patients present with an abdominal aortic aneurysm?
Often asymptomatic and found as incidental finding or through screening.
Can present with non-specific abdo/back pain, pulsation and expansile mass.
What screening are patient offered for AAA and from what age?
At 65 men are offered a screening ultrasound scan
What imaging can be used to diagnose AAA?
Ultrasound- usually initial imaging
CT angiogram can be used to guide elective surgery as gives more detailed picture
How big would an AAA be to fit into the different categories of small, medium and large aneurysms?
Small: 3-4.4cm
Medium: 4.5-5.4cm
Large: >5.5cm
How would you manage a patient with an AAA less than 5.5cm?
3-4.4cm ultrasound yearly
4.5-5.4cm ultrasound every 3 months
Reduce cardiovascular risk factors
How would you manage a large AAA (>5.5cm)?
Consider surgery- either open or endovascular repair
How might a ruptured abdominal aortic aneurysm present?
Symptoms: Severe abdo pain radiating to back or groin, collapse, LOC
Signs: tender, pulsation and expansile abdo mass, haemodynamic instability
What does permissive hypotension refer to in ruptured AAA management?
Aiming for lower than normal BP when fluid resuscitating to not increase blood loss
How will you manage suspected AAA rupture if the patient is unstable?
Transferred to theatre right away
High flow O2, IV access, urgent bloods with group and save 6units
How will you manage suspected AAA rupture in stable patient?
CT angiogram
High flow O2, IV access, urgent bloods with group and save 6units
What is an aortic dissection?
Tear in the intimal layer of aortic wall, causing blood to flow between tunica intima and media
Which of anterograde or retrograde aortic dissections can result in cardiac tamponade?
Retrograde dissections
Which 2 classifications systems are used for aortic dissections?
Stanford classification
DeBakey classification
What are some risk factors for aortic dissection?
Hypertension, atherosclerosis, connective disorders, bicuspid aortic valve
What is a characteristic presentation of a patient with aortic dissection?
Symptoms: Tearing chest pain radiating to the back
Signs: tachycardia, hypotension, new aortic regurgitation murmur
Which imaging is recommended for diagnosis of aortic dissection?
CT angiogram
If a 60 year old man with a background of hypertension presents with sudden onset tearing chest pain, what would be your top differential?
Aortic dissection
How does the location of an aortic dissection affect where the patient feels the pain?
Pain more likely in anterior chest when ascending aorta affected
Pain more likely to be felt in the back when descending aorta affected
What is peripheral arterial disease?
Narrowing of the peripheral arteries, reducing blood supply to the limb/peripheries
What is intermittent claudication?
A crampy/achy pain in the calf or thigh occurring during exertion and relieved by rest
What is the end stage of peripheral arterial disease?
Critical limb ischaemia
What are some feature of critical limb ischaemia? (6P’s)
Burning pain at rest (worse at night)
Pallor, pulseless, paralysis, perishing cold, parasthesia
What causes leriche syndrome?
Occlusion of distal aorta or proximal common iliac artery
What is the clinical triad in Leriche syndrome?
Thigh/buttock claudication
Absent femoral pulses
Male impotence
What is Buerger’s test?
Laying a patient supine, lift their leg- it will become pale if peripheral arterial disease present
Then get patient sitting up with legs hanging over end of the bed- if PAD is present the legs will go blue then a dark red colour
What are the non-surgical management options of intermittent claudication?
Lifestyle changes, exercise training
Medication: Statin, clopidogrel, 5-HT2 receptor antagonist (peripheral vasodilator)
What surgical options are used to manage critical limb ischaemia?
Angioplasty and stenting, endartectomy, bypass surgery
A young male smoker presents with painful blue discolouration of his fingertips. What would be your top vascular differential?
Buerger disease (thromboangiitis obliterans)
What is the main component of management of Buerger’s disease?
Smoking cessation
Why would you not try to actively re-warm an acutely ischaemic limb?
This would enhance tissue damage
What are some features of venous insufficiency?
Oedema, brown pigmentation, lipodermatosclerosis, eczema
Where do arterial ulcers commonly occur?
Toes and heel
What can cause ulcers to occur at stoma sites and is associated with IBD?
Pyoderma gangrenosum
What would be management of an AAA that has grown at a rate of more than >1cm/year?
2 week wait referral for surgery
Which out of arterial and neuropathic ulcers are more likely to be painless?
Neuropathic
