vascular surgery Flashcards
what is carotid artery stenosis and how does it occur?
it is narrowing of the carotid arteries secondary to atherosclerosis
the plaque can break away and cause embolic strokes - high risk of CAD and MI
what are the risk factors and classification of carotid artery stenosis?
RFs: male, age, smoking, HTN, poor diet, reduced physical activity, hypercholesterolaemia
classification: reduction in diameter: <50% is mild, 50-69% is moderate and >70% is severe
how does carotid artery stenosis present?
asymptomatic until stroke or TIA, carotid artery bruit during systole
how is carotid artery stenosis investigated and managed?
ix: carotid USS, CT, MRI
mx: diet, exercise, smoking, comorbidities, anti platelets, lipid lowering meds, carotid endarterectomy, angioplasty and stenting
what are the complications of carotid endarterectomy?
facial, glossopharyngeal nerve, hypoglossal and recurrent laryngeal nerve injury
what is buergers disease?
it is thromboangiitis obliterans - inflammatory condition causing thrombus formation in small and medium vessels resulting in painful, blue discolouration of the finger tips and toes, worse at night, ulcers, gangrene, amputation and corkscrew collaterals
who does buergers disease affect? what is the treatment?
young males, smokers
mx - stop smoking, IV iloprost
what is chronic venous insufficiency?
it is when blood does not drain from the legs to the heart due to damage in the veins due to age, obesity, immobility, prolonged standing
the blood pools: venous HTN, usually in gaiter area - skin changes (haemosiderin staining, venous eczema, lipodermatosclerosis, atrophie blanche)
what are complications of chronic venous insufficiency?
cellulitis, poor healing after injury, skin ulcers, pain
how is chronic venous insufficiency managed?
monitor skin, avoid damage, emollients, topical steroids, potent if lipodermatosclerosis, loose weight, stay active, elevate legs, compression stockings, ABx, analgesia, wound care for ulceration
what is lymphoedema?
impaired lymphatic drainage - swollen with protein rich fluid - prone to infection - can be primary which is rare and genetic under 30y/o or secondary due to mastectomy and ALN removal
how is lymphoedema investigated?
stemmers test for tenting (none in lymphoedema), limb volume using circumferential measurements, water displacement and perometry, bioimpendance spectrometry, lymphoscintigraphy
how is lymphoedema managed?
massage, compression bandage, improve lymph drainage with exercises, loose weight, good skin care, lymphaticovenular anastamoses, ABx, CBT, antidepressants
what is lymphatic fildriasis?
infectious disease caused by parasitic worms - live in lymphatic system resulting in lymphoedema and skin thickening and fibrosis - elephanitis
found in asia and africa
what is the presentation of arterial leg ulcers?
distal - toes and dorsum of foot, PAD (6Ps), smaller, deeper, well defined, punched out, pale, less likely to bleed, painful at night / lying
