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Y4 Surgery > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

what is an aneurysm?

A

focal dilatation of a blood vessel to more than 1.5x its normal diameter

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2
Q

what sex is most commonly affected by AAA?

A

males

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3
Q

what co-exists in around 25% of patients with a AAA?

A

femoral or popliteal aneurysms

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4
Q

what is the main cause of an AAA?

A

degenerative changes

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5
Q

Describe the 369 rule for bowel obstruction on AXR

A

Describes the cm of dilation that suggests diagnosis on a scan

Small bowel >3cm
Large bowel >6cm
Caecum >9cm

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6
Q

What investigation is done in the case of a suspected AAA rupture, and when would this not ne done?

A

CT angiography

Not done if the patient is haemo-dynamically unstable = straight to theatre

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7
Q

What are the two surgical options for managing a ruptured AA?

A

Open surgical repair
EVAR

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8
Q

What is the target systolic BP in patients with a ruptured AAA?

A

70-80mmHg

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9
Q

What is an aneurysm?

A

Abnormal dilatation of a blood vessel by more than 50% of its normal diameter

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10
Q

At what diameter is a AAA diagnosed?

A

> 3cm (normal is 2cm)

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11
Q

What effect does diabetes have on the risk of AAA?

A

Reduces

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12
Q

Name three risk factors for AAA?

A

Smoking
Male sex
Hyperlipidaemia

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13
Q

How do the vast majority of AAA’s present?

A

Asymptomatic, found at screening (75%)

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14
Q

What triad of symptoms can be seen in symptomatic, inflammatory AAA?

A

Low back pain
Weight loss
Raised ESR

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15
Q

What is the mortality rate for AAA rupture?

A

90%

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16
Q

What is the classic triad of symptoms of a ruptured AAA?

A

Abdominal or back pain
Hypovolaemia
Pulsatile abdominal mass

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17
Q

What test is done for AAA screening?

A

Abdominal USS

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18
Q

What size of AAA should be rescreened and when?

A

25-39mm
At 5-10 years

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19
Q

What is the gold standard investigation when planning management for AAA?

A

CTA

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20
Q

What medications should a patient with a AAA be put on to minimise risk factors?

A

Anti-platelet
Statin
Anti-hypertensives

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21
Q

What medication may have an effect on AAA growth rate?

A

Metformin

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22
Q

When should a AAA that is 30-44mm be measured?

A

Anually

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23
Q

When should a AAA that is 45-54mm be measured?

A

3 monthly

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24
Q

When is repair of a AAA indicated?

A

Diameter >55mm
Symptomatic = urgent repair
Rapid expansion (>10mm/year)

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25
Q

What are the two options for surgical repair fo a AAA?

A

OSR
EVAR

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26
Q

What is an endoleak?

A

A surgical complication
The persistence of blood flow outside the lumen of an endo-vascular stent graft

27
Q

What are the rules about driving with a AAA for car drivers?

A

Inform DVLA when >60mm
Suspended when >65mm

28
Q

What are the rules about driving with a AAA for HGV drivers?

A

Inform when >55mm, suspended until repaired

29
Q

What are acute aortic syndromes?

A

A group of conditions that affect the thoracic aorta

30
Q

Name the three acute aortic syndromes?

A

Aortic dissection
Intra-mural haematoma (IMH)
Penetrating aortic ulcer (PAU)

31
Q

What is an aortic dissection?

A

A tear in the intima of the aorta, allowing blood to form a false lumen between the intima and the adventitia

32
Q

What are the two classification systems for aortic dissection?

A

Stanford system
DeBakey system

33
Q

Describe the Stanford system for classifying aortic dissection

A

A = proximal to the left subclavian
B = distal to the left subclavian

34
Q

Which type of aortic dissection, according toe the Stanford system, is an acute emergency?

A

A

35
Q

Describe the DeBakey system for classifying aortic dissection

A

1 = ascending to descending aorta
2 = ascending only

36
Q

Describe the DeBakey system for classifying aortic dissection

A

1 = ascending to descending aorta
2 = ascending only
3a = beyond the origin of the LSA, above the diaphragm
3b = beyond the origin of the LSA, below the diaphragm

37
Q

What is the best test for an aortic dissection?

A

CT angiogram

38
Q

How is a type A aortic dissection managed?

A

Emergency surgery - usually involves aortic root replacement with bypass

39
Q

How is an uncomplicated type B aortic dissection managed?

A

IV beta blockade

40
Q

How is a complicated type B aortic dissection managed?

A

TEVAR

41
Q

How is a chronic type B aortic dissection managed?

A

Annual surveillance
Beta blocker and CCB

42
Q

What is an intramural haematoma (IMH)?

A

Clotted blood in the intramural space in the absence of an obvious intimal tear

43
Q

What condition is IMH associated with?

A

Hypertension

44
Q

What are the possible complications of IMH?

A

Dissection
Rupture

45
Q

What is the least common acute aortic syndrome?

A

Penetrating aortic ulcer (PAU)

46
Q

What causes a PAU?

A

Focal ulceration of a plaque into the media

47
Q

Which has a better prognosis - PAU or dissection?

A

Dissection

48
Q

What is acute limb ischaemia?

A

A sudden reduction in perfusion to a limb, causing a potential threat to limb viability

49
Q

What classification system is used for acute limb ischaemia?

A

Rutherford classification

50
Q

What is the classical presentation of acute limb ischaemia (the 6 P’s)?

A

Pain
Pallor
Paraesthesia
Paralysis
Perishingly cold
Pulseless

51
Q

Why is calf tenderness in acute limb ischaemia concerning?

A

Suggests there is severe muscle ischaemia

52
Q

What bloods should be done for acute limb ischaemia?

A

FBC
U+Es
Coagulation

53
Q

What is the first line imaging for acute limb ischaemia?

A

CTA

54
Q

What medication should be given initially for acute limb ischaemia?

A

Unfrac1tionated heparin - 5000 unit bolus followed by an infusion

55
Q

What is the first line imaging for carotid disease?

A

Duplex scan

56
Q

What is the primary intervention in carotid disease?

A

Risk factor control

57
Q

What medications should be started in carotid artery disease?

A

Low dose aspirin (clopidogrel if intolerant)
Atorvastatin 40-80mg

57
Q

How does diabetic peripheral neuropathy present?

A

Progressive, symmetrical loss of sensation in the distal lower extremities
Can be painful

58
Q

What classification systems can be used for diabetic foot ulcers?

A

SINBAD
WIFI system

59
Q

Describe the foot of a patient with a neuropathic ulcer

A

Warm, well perfused
Bounding pulse
Distended veins
Callus present

60
Q

Where do neuropathic ulcers tend to form?

A

Sites of repetitive trauma

61
Q

What is the most important initial step in neuropathic ulcers?

A

Pressure offloading - best method is with a total contact cast

62
Q

What can precipitate an ischaemic ulcer?

A

A minor infection

63
Q

How is osteomyelitis in a diabetic foot managed?

A

Up to 6 weeks of antibiotics
Amputation if this fails

Y4 Surgery (6 decks)

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