Vascular Surgery Flashcards
What is peripheral arterial disease?
Significant narrowing of arteries distal to the arch of aorta, usually due to atherosclerosis
What are the RF of peripheral arterial disease?
Smoking, DM, hypertension, hyperlipidaemia, physical inactivity and obesity.
What are the symptoms of peripheral arterial disease?
Walking impairment, pain in buttocks and thighs relieved at rest.
What are the signs of peripheral arterial disease (PAD)?
Pale, cold leg
Hair loss
Ulcers
Poor wound healing
Weak or absent pulses
What are the investigations for PAD?
Full CVS risk assessment incl BP, FBC, blood glucose, lipids and ECG.
Ankle-brachial pressure index- uses doppler probe to find the systolic brachial blood pressure of the arms and comparing to ankle blood pressures
How do you non-surgically manage a patient with PAD?
Non-surgical: RF modification, supervised exercise program, smoking cessation and weight management
Managing CVS risk- clopidogrel 75mg, atorvastation 80mg, diabetes and HTN should be well controlled
Managing pain- Naftidrofuryl oxalate- vasodilator, only if exercise is ineffective and the pt does not want angioplasty or bypass
How do you surgically management a patient with PAD?
Intermittent claudication: endovascular revascularisation or surgical revascularisation, when RF modification has not improved sx
Critical limb ischaemia (rest pain, tissue loss etc.), referral to vascular MDT. Endovascular methods for small stenosis, surgical bypass for larger and more extensive stenosis and amputation if there no other option.
Define gangrene
Death of tissue specifically due to an inadequate blood supply
Define necrosis
Tissue death
Define ischaemia
Inadequate O2 supply due to inadequate blood supply
How does atherosclerosis cause ACS?
Plaques cause:
- stiffening of artery walls —> HTN and strain on the heart due to increased resistance
- stenosis —> reduced blood flow e.g. angina.
- plaque ruptures —> get thrombus in distal vessel —> cause ischaemia/ACS
What are non-modifiable RF for atherosclerosis?
Male gender, older age, FHx
What are modifiable RF for atherosclerosis?
Smoking
Alcohol consumption
Poor diet
Sedentary lifestyle
Obesity
Poor sleep
A patient who has a PMH of atherosclerosis is now presenting with chest pain. She also feels the pain in her abdomen and has mentioned her legs have been cramping. Braindump some differentials
Angina, MI, TIA, Stroke, PAD, Chronic mesenteric ischaemia
What is Leriche syndrome?
A term given for a group of symptoms caused by PAD of legs.
Occlusion in the distal aorta or proximal common illiac artery
What is the triad in Leriche syndrome?
thigh / buttock claudication, impotence and absence of femoral pulses.
How is Leriche syndrome managed?
Surgical revascularisation
Surgery - aortofemoral bypass or axillofemoral bypass with or without endartectomy (removing the plaque)
Describe the pathophysiology of Leriche syndrome
Severe atherosclerosis affecting the distal abdominal aorta, iliac arteries and femora-popliteal vessels. Can be bilateral depending on where the occlusion is.
What can PAD lead to?
Intermittent claudication.
What can intermittent claudication lead to?
Acute limb ischaemia or critical limb ischaemia.
Describe presentation of intermittent claudication
Crampy, achy, pain in calf, thigh or buttocks. Muscle fatigue when walking. Occurs at exertion and relieved at rest.
How can claudication be measured?
Claudication distance and Walking distance (maxima walking distance)
What is the claudication distance?
How long pt can walk until the pain starts
What is the walking distance (maximal walking)?
Once the pain has begun, this is how long the pt can continue to walk for
Define acute limb ischaemia
Rapid onset of ischaemia often due to a thrombus blocking blood supply to a limb
Define critical limb ischaemia
End stage of PAD - not enough blood supply to limb to allow a normal function at rest. Pt at risk of losing limb
How can pt present with critical limb ischaemia?
Pain at rest, non-healing ulcers, gangrene. Pain worse at night when leg raised. Pt hangs leg off bed to help. Burning pain.
What are the 6Ps of critical limb ischaemia?
Pain, pallor, pulselessness, paralysis, parasthesia, perishingly cold.
What is a VTE?
Formation of a blood clot in the venous system with potential to embolism causing a PE.
What is in Virchow’s triad?
Change in coagulability, stasis of blood, vessel wall injury
What are RF for VTE?
Immobility
Recent trauma
Long haul travel
Pregnancy
Hormone therapy containing oestrogen
Polycythaemia
SLE
Thrombophillia
What prophylaxis against VTE is given/carried out in hospital before surgical procedure?
VTE risk assessed
Prophylaxis given if risk is increased unless contraindicated.
Prophylaxis usually with LWMH - enoxaparin, dalteparin.
TED stockings given - unless contraindicated.