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
what is the presentation of venous ulcers?
gaiter area, chronic venous changes, minor injury to leg, superficial, larger, irregular sloping border, more likely to bleed, less pain, worse on lying, better with elevation
how are leg ulcers investigated and managed?
ix: ABPI, bloods, charcoal swabs, skin biopsy
arterial mx: refer - surgical revascularisation
venous mx: r/o arterial, vascular surgery, tissue viability, derm, pain and diabetes input, clean, debridement, dressing and compression, pentoxyfylline, ABx, analgesia
what is peripheral arterial disease?
it is made of intermittent claudication, critical and acute limb ischaemia
what is IC?
it is aching or burning in the legs following exertion and relieved within minutes of stopping
investigated with pulses and ABPI
what is acute limb ischaemia?
it is due to thrombus or embolus cutting off blood supply - pale, perishingly cold, pulseless, pain, paraesthesia, paralysis
ix: USS and ABPI
what is the management of peripheral arterial disease?
acute: A-E, IV opioids, IV unfractionated heparin, vascular r/v - intraarterial thrombolysis, surgical embolectomy, angioplasty, bypass surgery, amputation
PAD: quit smoking, control BP, DM, obesity, statins, exercise, clopidogrel, endovascular/surgical revascularisation using percutaneous transluminal angioplasty and stenting or surgical bypass or endarterectomy
how is ABPI classified?
1: normal
0.6-0.9: claudication
0.3-0.6: rest pain
<0.3: severe