Vascular surgery Flashcards
Explain the screening programme for AAA (who is eligible, age of eligibility, mode of imaging used, frequency of screening etc)
Men over 65y, once off abdominal US
< 3 cm= normal - No further action (does not require a repeat US)
3 - 4.4 cm = small - US every **12 **months
4.5 - 5.4 cm = medium - US every 3 months
≥ 5.5cm = large - 2 week referral to vascular surgery for intervention
Regarding AAA’s, what indications would require a 2 week referral to vascular surgery? (3)
AAA >5.5cm
AAA that have grown more than 1cm within 1 year
Symptomatic AAA’s
A 66y/o male attends a follow-up clinic for an US of his abdominal aorta. His aorta width is measured and found to be 4.9 cm. It was 3.5 cm during his initial free screening appointment the previous year. He is asymptomatic.
What is the next step in his management? - why?
2 week referral to vascular surgery
~ his aneurysm has grown more than 1cm within the year
A 65y/o man attends an AAA screening offered by his GP. On US, it is revealed that he has a supra-renal aneurysm that is **4.9 **cm in diameter. When questioned he says he has no symptoms.
How should this patient be managed?
~ state the AAA diameter range that would require this follow-up timeframe:
3 monthly US surveillence
~ AAA’s between 4.5-5.4cm = 3 monthly US
A 65y/o man attends an AAA screening offered by his GP. On US, it is revealed that he has a supra-renal aneurysm that is **2.9 **cm in diameter. When questioned he says he has no symptoms.
How should this patient be managed?
No follow-up required as AAA is* below 3cm*
A 65y/o man attends an AAA screening offered by his GP. On US, it is revealed that he has a supra-renal aneurysm that is **3.6 **cm in diameter. When questioned he says he has no symptoms.
How should this patient be managed?
~ state the AAA diameter range that would require this follow-up timeframe:
12 monthly US surveillence
~ AAA’s between 3-4.4cm = 12 monthly US
A 65y/o man attends an AAA screening offered by his GP. On US, it is revealed that he has a supra-renal aneurysm that is **5.5 **cm in diameter. When questioned he says he has no symptoms.
How should this patient be managed?
~ state the AAA diameter range that would require this follow-up timeframe:
2 week referral to vascular surgery
~ AAA’s 5.5cm or larger require intervention as they’re high risk of rupture!!
A 65y/o man attends an AAA screening offered by his GP. On US, it is revealed that he has a supra-renal aneurysm that is **5.9 **cm in diameter. When questioned he says he has no symptoms.
How should this patient be managed?
~ state the AAA diameter range that would require this follow-up timeframe:
2 week referral to vascular surgery
~ AAA’s 5.5cm or larger require intervention as they’re high risk of rupture!!
A 65y/o man attends an AAA screening offered by his GP. On US, it is revealed that he has a supra-renal aneurysm that is **3.2 **cm in diameter. When questioned he says he has had intermittent abdominal pain for 2 months.
How should this patient be managed?
2 week referral to vascular surgery
~ Symptomatic AAA’s have high risk of rupture
The ankle-brachial pressure index (ABPI) is the ratio of the systolic blood pressure in the lower leg to that in the arms. Lower blood pressure in the legs (eg, ABPI < 1) indicates what condition?
Periheral vascular disease
Why is it important to check the ankle-brachial pressure index in patients with leg ulcers?
To differentiate between a venous or arterial cause of the ulcer.
Venous ulcers (usually due to venous insufficiency) are treated with compression bandages to aid venous return, however compression bandages in a patient with peripheral arterial disease would further restrict the blood supply to the limb!!!
What is regarded as a normal ABPI (ankle-brachial pressure index)? (eg in someone without any peripheral vascular disease)
An ABPI of what value suggests peripheral arterial disease?
An ABPI of what value suggests stiffened, calcified arteries?
~ what condition is this commonly seen in?
1-1.2
< 0.9
> 1.2
~ diabetes
A 43y/o man presents to the ED with a painful left leg. He reports the pain come on suddenly 2 hours ago and has been constant since. For the past couple of months, he has had pain in his calf when walking, which becomes better with rest. He is otherwise asymptomatic and has no PMH.
O/E: his left leg is cool and pale. His anterior tibialis pulse on the left** cannot be palpated**, but his popliteal can be felt and is normal. Both pulses on his right leg are normal.
What is the likely diagnosis?
What is the most appropriate next step in the management of this patient?
Acute limb ischaemia
Arterial doppler scan of of pulses to confirm that the pulses are absent
6P’s
List the presentation of someone with acute limb ischaemia:
What is the 1st line investigation used to confirm this condition after a standard examination?
State the 2 categories of causes of an ischaemic limb:
- pale
- pulseless
- painful
- paralysed
- paraesthesia
- ‘perishingly cold’
Arterial doppler to confirm** absent pulses**
Embolic & thrombus
State the buzzwords in a history that would indicate either an embolic (4) or thrombotic (3) cause of an acute limb ischaemia:
Embolic:
* Sudden onset of pain (< 24h usually)
* * No history of claudication
* Obvious source of emboli (e.g. AF, recent MI)
* No evidence of peripheral vascular disease (eg, normal pulses in other limb)
Thrombus:
* History of claudication
* NO obvious source of emboli
* Widespread vascular disease (eg, reduced/absent pulses in other limb, stroke, TIA etc)
Name the skin change seen below:
What condition is this seen in?
Lipodermatosclerosis
Chronic venous insufficiency
