Vascular Surgery Flashcards
What CXR findings would you expect to see for an aortic dissection?
Widened mediastinum
What findings would you expect to see in a CT angiogram for aortic dissection?
False lumen
List the indications for a limb amputation
- Severe infection.
- Gangrene (from PAD).
- Serious trauma.
- Deformed limb with limited function.
- Complications from diabetes.
Describe the process of a limb amputation
- Removal of section of limb.
Then, EITHER:
- Shorten and smooth the bone in your remaining limb so that it’s covered by enough soft tissue and muscle.
- Stitch the remaining muscle to the bones to strengthen the remaining limb (myodesis).
List the possible complications of limb amputation
- Heart complications.
- DVT.
- Slow wound healing and infection.
- Pneumonia.
- Phantom limb pain.
Discuss rehabilitation for patients following limb amputation
Physiotherapy.
Occupation therapy.
Describe function of valves in veins
Valves allow blood flow in one direction towards the heart. Leg muscles contract to squeeze blood upwards against gravity.
List some complications of varicose veins
- Prolonged and heavy bleeding after trauma.
- Superficial thrombophlebitis (thrombosis and inflammation in the superficial veins).
- Deep vein thrombosis.
- All the issues of chronic venous insufficiency (e.g., skin changes and ulcers).
Describe the features of a DVT
Unilateral symptoms:
- Calf or leg swelling.
- Dilated superficial veins.
- Tenderness to the calf (particularly over the site of the deep veins).
- Oedema.
- Colour changes to the leg e.g. redness.
How much is a significant difference in calf circumference between legs in a suspected DVT?
> 3cm
How would you diagnose a DVT?
- Doppler ultrasound of the leg.
- NICE recommends repeating negative ultrasound scans after 6-8 days if a positive D-dimer and the Wells score suggest a DVT is likely.
Describe the management of a DVT
- DOAC (apixaban or rivaroxaban) first line.
- Catheter-directed thrombolysis in patients with a symptomatic iliofemoral DVT and symptoms lasting less than 14 days.
- Long-term anticoagulation: DOAC, warfarin (target INR 2-3, first line in antiphospholipid syndrome), or LMWH (first line in pregnancy).
Name an intervention that can be used for patients with recurrent PEs or those unsuitable for anticoagulation
Inferior vena cava filter to filter any blood clots travelling from venous system towards heart and lungs.
What would you be investigating for in an unprovoked DVT/PE?
- Cancer.
- Antiphospholipid syndrome - check antiphospholipid Abs (after anticoagulation).
- Hereditary thrombophilias (only if they have a first-degree relative also affected by a DVT or PE, and after anticoagulation).
Define lymphoedema
A chronic condition caused by impaired lymphatic drainage, resulting in areas of the body being swollen with excess, protein-rich fluid.
Describe the types of lymphoedema
- Primary lymphoedema is a rare, genetic condition, which usually presents before aged 30. It is a result of faulty development of the lymphatic system.
- Secondary lymphoedema is due to a separate condition that affects the lymphatic system. The most common example is when patients develop lymphoedema after breast cancer surgery, due to the removal of axillary lymph nodes in the armpit.
A positive Stemmer’s sign suggests…
Lymphoedema
Describe the management of lymphoedema
Non-surgical treatments:
- Massage techniques (manual lymphatic drainage).
- Compression bandages.
- Specific lymphoedema exercises to improve lymph drainage.
- Weight loss.
- Good skin care.
Lymphaticovenular anastomosis: attaching lymphatic vessels to nearby veins, allowing the lymphatic vessel to drain directly into the venous system.
Antibiotics are required if cellulitis develops.
A young male smoker with painful blue fingertips
Buerger disease (thromboangiitis obliterans).
Define Buerger disease
- An inflammatory condition that causes thrombus formation in the small and medium-sized blood vessels in the distal arterial system (affecting the hands and feet).
- Affects men aged 25-35 and has a very strong association with smoking.
What is the most important aspect for managing Buerger disease?
Stop smoking
Define carotid artery stenosis
- Narrowing of the carotid arteries in the neck, usually secondary to atherosclerosis.
- There is a risk of parts of the plaque breaking away and becoming an embolus, travelling to the brain and causing an embolic stroke.
How would you investigate carotid artery stenosis?
Carotid US initially, then CT/MRI angiogram for more detail assessment.
What sign on examination would suggest carotid artery stenosis?
Carotid bruit
