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Finals > Vascular surgery > Flashcards

Vascular surgery Flashcards

1
Q

What is intermittent claudication?

A

Symptoms of ischaemia, occurs during exertion and is relived by rest, crampy/achy pain in calf/thigh/buttock (equivalent to stable angina)

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2
Q

What is critical limb ischaemia?

A

End stage of peripheral arterial disease, inadequate blood supply to limb results in pain at rest, non-healing ulcers and gangrene (equivalent to unstable angina)

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2
Q

What is acute limb ischaemia?

A

Rapid onset of ischaemia in a limb typically due to thrombus blocking the arterial supply of a distal limb (equivalent to MI)

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3
Q

What are the risk factors for peripheral vascular disease?

A

Older age, family history, male, smoking, alcohol consumption, poor diet, low exercise, poor sleep, obesity, stress

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4
Q

What are the 6 P’s of acute limb ischaemia?

A

Pain, pallor, pulselessness, paralysis, paraesthesia, perishingly cold

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5
Q

What ABPI indicates mild, moderate and severe peripheral vascular disease?

A

Normal = 0.9-1.3
Mild = 0.6-0.9
Moderate = 0.3-0.6
Severe = <0.3

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6
Q

What investigations are done in peripheral vascular disease?

A

1st line = duplex USS
CT/MRI angiography can be used to investigate following duplex USS

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7
Q

What medical management should everyone with peripheral arterial disease be taking?

A

Atorvastatin 80mg
Clopidogrel 75mg

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8
Q

How is critical limb ischaemia managed?

A

Urgent vascular referral, analgesia, surgery including stenting or bypass

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9
Q

How is acute limb ischaemia managed?

A

Urgent vascular referral, analgesia, IV heparin, surgical management

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10
Q

What are the risk factors for AAA?

A

Male, increased age, smoking, hypertension, family history, existing cardiovascular disease

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11
Q

Who is screened for AAA?

A

All men are offered screening USS at age 65 to detect asymptomatic AAA

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12
Q

What diameter of aorta requires referral and at what point does it become urgent?

A

> 3cm need referring
5.5cm urgent (within 2 weeks)

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13
Q

What investigation other than USS is done in AAA?

A

CT angiogram - gives more detailed picture of aneurysm and helps guide elective surgery to repair

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14
Q

For people with identified AAA how often are they rescanned?

A

Yearly in those 3-4.4cm
3 monthly in those 4.5-5.4

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15
Q

When is a AAA booked in for elective repair?

A

Symptomatic, diameter growing more than 1cm a year, diameter >5.5cm

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16
Q

What is the presentation of a ruptured AAA?

A

Severe abdo pain that may radiate to back or groin, hypotension and tachycardia, pulsatile and expansile mass in abdomen, loss of consciousness

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17
Q

What is the management of ruptured AAA?

A

Permissive hypotension, immediate surgical repair

18
Q

What is aortic dissection?

A

Break or tear forms in the inner layer of the aorta allowing blood to flow between the layers, a false lumen is created

19
Q

What is type A/type B aortic dissection?

A

A = ascending
B = descending

20
Q

What are the risk factors for aortic dissection?

A

Hypertension, age, male, smoking, poor diet, connective tissue disorders

21
Q

What is the presentation of aortic dissection?

A

Sudden onset severe ripping/tearing chest pain, may have large differences in BP between arms, may have abdo pain, hypotension

22
Q

What investigations are done in aortic dissection?

A

ECG and CXR to exclude other causes
CT angiogram = initial investigation
MRI angiogram provides greater detail

23
Q

How is aortic dissection managed?

A

Analgesia, BP and HR need to be well controlled to reduce stress on aortic walls (use beta blockers), surgery

24
Q

How do diabetic ulcers present?

Who gets them, why they occur

A

Present in patients with diabetic neuropathy, lose sensation in feet and are more prone to injury, impaired wound healing due to damage to vessels (osteomyelitis is complication)

25
Q

Who develops pressure ulcers?

A

Occur in patients with reduced mobility where prolonged pressure on particular areas lead to the skin breaking down

26
Q

What scoring system is used to assess risk for pressure ulcers?

A

Waterlow score

27
Q

What are the features of arterial ulcer?

A

Occur distally, occur in those with PAD, small and deep with well defined border, punched out appearance, pale, painful, worse at night or when elevating leg

28
Q

What are the features of venous ulcers?

A

Most common between top of foot and bottom of calf, associated with venous eczema and lipodermatosclerosis, large superficial with irregular, gently sloping border, pain relieved by elevation

29
Q

What investigations are done in those with leg ulcers?

A

ABPI (assess to arterial disease)
Charcoal swab of ulcer
Skin biopsy if skin cancer is suspected

30
Q

What is the management of arterial ulcers?

A

Same as for peripheral arterial disease, may require surgical revascularisation

31
Q

What is the management of venous ulcers?

A

Clean wound, debridement, dressing, compression therapy (once arterial disease ruled out)

32
Q

What are the risk factors for chronic venous insufficiency?

A

Increasing age, family history, female, pregnancy, obesity, prolonged standing, DVT

33
Q

What is the presentation of chronic venous insufficiency?

A

Varicose veins, heavy dragging sensation in legs, aching, itching, burning, oedema, cramps and restless legs

34
Q

What is the management of chronic venous insufficiency?

A

Weight loss, physical activity, elevating legs, compression stockings, surgery

35
Q

What is carotid artery stenosis?

A

Narrowing of the carotid arteries in the neck usually secondary to atherosclerosis

36
Q

How is carotid artery stenosis classified?

A

Mild - less than 50% reduction
Moderate - 50-69% reduction
Severe - 70% or more

37
Q

How is carotid artery stenosis diagnosed?

A

Usually diagnosed after TIA/stroke
Carotid USS is 1st line
CT/MRI angiogram may be used to assess stenosis in more detail

38
Q

What is the management of cartoid artery stenosis?

A

Manage co-morbidities
Antiplatelet medication
Atorvastatin
Carotid endarterectomy

39
Q

What is Buerger’s disease/thomboangiits obliterans?

A

Inflammatory condition that causes thrombus formation in the small and medium blood vessels in distal arterial system

40
Q

Who is typically affected by Buerger’s disease/thomboangiits obliterans?

A

Males aged 25-35 who smoke (strong association with smoking)

41
Q

What is the presentation of Buerger’s disease/thomboangiits obliterans?

A

Painful blue discolouration to fingertips, pain is often worse at night, may process to ulcers/gangrene

42
Q

What is the management of Buerger’s disease/thomboangiits obliterans?

A

Angiogram - shows corkscrew collaterals
Completely stop smoking (NRT or cutting down does not improve the condition)

43
Q

What murmur is heard in aortic dissection?

A

Aortic regurgitation

Finals (21 decks)

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