Vascular Surgery Flashcards
6 signs of acute limb ischaemia
Paralysis
Pulselessness
Pain
Paraesthesia
Pallor
Perishingly cold
management of acute limb ischaemia
analgesia, IV heparin
doppler
urgent vascular review
RF for acute limb ischaemia
AF
definition of chronic limb ischaemia
occlusion for 2+w
management of superficial thrombophlebitis
compression stockings
where is the pain in claudication of the femoral and iliac arteries
femoral –> calf
iliac –> buttocks
interpret an ABPI
more than 1.2: calcified/stiff arteries (DM)
1-1.2: normal (0.9-1 acceptable)
below 0.9: PAD (below 0.5 urgent)
management of mild and severe PAD
mild: exercise training
severe: endovascular/surgical revascularisation
medication to be started in PAD
clopidogrel 75mg
atorvastatin 80mg
screening for AAA
single USS screen at 65y
results of AAA screening
less than 3cm normal
3-4.4cm: small - rescan 12m
4.5-5.4: medium - rescan 3m
more than 5.5cm: large 2ww to vascular for endovascular repair
elderly gentleman with back pain and haemodynamic instability
AAA
blood for AAA
crossmatch 6 units
painless ulcer above the ankle with oedema, brown pigmentation, eczema and a champagne bottle leg
venous leg ulcer
pathophysiology of venous leg ulcers
venous HTN due to chronic venous insufficiency (or some neuromuscular disorders)
cause of a deep and superficial venous leg ulcer
deep: pmhx DVT
superficial: pmhx varicose veins
management and investigation of venous leg ulcer
USS (duplex and doppler)
ABPI (exclude arterial)
compression bandage - skin graft in extreme circumstances
painful ulcer on the toes/heel
cold and pulseless foot
gangrenous
arterial ulcer
investigation of an arterial ulcer
ABPI
ulcer on the plantar surface of the metatarsal head/hallux caused by pressure
neuropathic ulcer
management of a neuropathic ulcer
cushioned shoes
common cause for amputation in T2DM
what is a marjolin’s ulcer
SCC at a site of previous chronic inflammation e.g. burn
patient with IBD presents with ulcerative erythematous nodules/pustules around their stoma site
pyoderma gangrenosum
atheroma causing claudication, ulceration and gangrene
can lead to subclavian steal/acute limb ischaemia
arterial occlusion
colour change in raynauds
white to blue to red
treatment of raynauds
calcium antagonists
gradual onset upper limb swelling and discomfort with normal sensation and motor function in a patient with breast cancer or who has just painted the ceiling
venous thrombosis
management of venous thrombosis
duplex uss and anticoagulate
what is a cervical rib
congenital fibrous band from C7 requiring surgery to remove
how does cervical rib present
compression of the subclavian artery causes an absent radial pulse (positive adsons) or thoracic outlet syndrome
