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FINALS > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

What is the screening of AAA?

A

Single Abdo US at aged 65

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2
Q

What is the screening outcomes for AAA?

A

<3cm - Normal
3cm - 4.4cm - Rescan every 12 months
4.4 - 5.4cm - Rescan every 3 months
5.5cm - Refer within 2 weeks for intervention

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3
Q

What are high rupture risks for AAA?

A
  • Symptomatic
  • Rapidly enlarging: >1cm every year
  • Needs referral within 2 weeks for vascular intervention
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4
Q

How is AAA treated?

A
  • Treat with EVAR or open repair if unsuitable
  • If evidence of rupture, immediate vascular review with emergency surgery needed
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5
Q

What causes venous leg ulcers?

A
  • Mostly due to venous HTN due to chronic venous insufficiency
  • Above the ankle and painless
  • Managed with compression banding or surgery
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6
Q

What are arterial ulcers?

A
  • Occur on the toes and heel
  • Have a deep, punched out appearance
  • Painful
  • Low ABPI measurements
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7
Q

What are the 3 main presentations of PAD?

A
  • Intermittent claudication
  • Critical limb ischaemia
  • Acute limb-threatening ischaemia
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8
Q

What are the features of limb-threatening ischaemia

A

Pain, pallor, pulseless, paraesthesia, paralysis, perishing cold

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9
Q

How to investigate limb-threatening ischaemia?

A
  • Handheld arterial doppler FIRST
  • ABPI
  • Assess whether this is due to thrombus or embolus (AF)
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10
Q

How is limb-threatening ischaemia managed?

A
  • Vascular review
  • Analgesia + IV Heparin
  • Angioplasty/Intra-arterial thrombolysis
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11
Q

What is critical limb ischaemia?

A
  • Rest pain in foot for more than 2 weeks
  • Ulceration
  • Gangrene
  • Hang legs out of bed at night to help with pain
  • ABPI < 0.5
  • Tx includes manage risk factors
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12
Q

What is intermittent claudication?

A
  • Aching or burning in muscles after walking
  • Relieved by stopping and not present at rest
  • Check foot pulses, ABPI, US scan
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13
Q

How is peripheral arterial disease managed?

A
  • Stop smoking
  • Atorvastatin 80mg
  • Clopidogrel
  • Exercise training
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14
Q

Management options for PAD?

A

Endovascular revascularization: angioplasty used for short stenosis, high risk patients
Surgical revascularization: surgical bypass used for long lesions, multifocal lesions

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15
Q

What is superficial thrombophlebitis?

A
  • Inflammation/thrombosis of one of the superficial veins: long saphenous vein
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16
Q

What is immediate management of suspected superficial thrombophlebitis?

A

US scan to exclude DVT

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17
Q

What are other management options for superficial thrombophlebitis?

A
  • NSAIDs
  • Compression stockings
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18
Q

What are varicose veins?

A

Dilated, superficial veins which occur secondary to incompetent venous valves - commonest in great saphenous and small saphenous vein

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19
Q

What are risk factors for varicose veins?

A
  • Increasing age
  • Female
  • Pregnancy
  • Obesity
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20
Q

How should varicose veins be investigated?

A

Venous duplex US which will show retrograde venous flow

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21
Q

How are varicose veins managed?

A
  • Leg elevation, weight loss, compression stockings
  • Refer if ulcers, troublesome symptoms
22
Q

What is an arterial aneurysm?

A

Abnormal dilatation to more than 150% of the original diametes of the blood vessel due to weakness in the vessel wall

23
Q

True vs false aneurysm

A

True - abnormal dilatation of the vessel
False - collection of blood around the vessel

24
Q

What is the number needed to screen?

A

A number needed to screen is a reference to the number of patients who will need to be screened by the program me to prevent one excess death /morbidity

25
Q

Causes of AAA

A
  • Ehlers-Danlos/Marfans
  • Atheromatous degeneration
26
Q

What are disadvantages of using EVAR?

A
  • Long term follow up needed
  • Not suitable for every type of aneurysm
  • High reintervention rate
27
Q

What is trash foot?

A

Cholesterol embolism which occurs after vascular surgery where debris is shed and lodges in distal vessels causing local ischaemia

28
Q

When does irreversible tissue ischaemic occur?

A

Within 6 hours

29
Q

How does heparin work?

A

Activates anti-thrombin III which inactivates Xa preventing the clotting cascade

30
Q

What type of pain will be in compartment syndrome?

A

Pain on dorsiflexion

31
Q

Acute limb ischaemia with no history of claudication?

A

Think embolic cause -> AF rather than smoking

32
Q

What are ABPI results?

A

1 - Normal
0.6 - 0.9 - Claudication
0.3 - 0.6 - Rest pain (critical limb)
<0.3 - impending concerns

33
Q

What are causes of AAA?

A
  • Marfans
  • Atherosclerosis
  • Ehlers-Danlos
  • Abdo trauma
34
Q

What is Virchow’s triad?

A
  • Endothelial injury (trauma, surgery)
  • Stasis of blood flow (AF, immobility)
  • Hypercoagulability (pregnancy, malignancy)
35
Q

What are some chronic venous changes which can occur?

A
  • Varicose veins
  • Varicose eczema
  • Lipodermatosclerosis
36
Q

What are the 2 classification systems for aortic dissection?

A

Stanford
De Bakey

37
Q

Varicose vein + venous ulcer?

A

Refer to vascular

38
Q

What is permisive hypotension?

A

Strategy used in the resus of bleeding trauma patients - advocates for cautious use of fluid as large increases in BP can lead to clot formation, tear the aorta or increase blood loss

39
Q

What is the 2 classifications of varicose veins?

A

Primary - degeneration of valve leaflets
Secondary - valve destruction

40
Q

What are risk factors for varicose veins?

A
  • Female
  • Pregnancy
  • Pelvic/Abdominal mass
  • FH
41
Q

Early vs late signs of compartment syndrome

A

Early - pain out of proportion to injury, absent pulse, swelling
Late - paralysis, pale limb, cold limb

42
Q

ABPI > 1 can indicate what?

A

Calcified, stiff arteries - commonly seen in diabetes

43
Q

How do neuropathic ulcers form?

A

Commonly due to increased pressure e.g tight fitting shoes or unnoticed trauma and will be painless

44
Q

Claudication in femoral vessels vs iliac vessels?

A

Femoral - Calf pain
Iliac - Buttock pain

45
Q

What is a non pharmacological management option for PAD?

A

Exercise training

46
Q

Patients with diabetes with PVD can get what?

A

Falsely high ABPI measurements due to abnormal hardening of the arteries

47
Q

Dry gangrene vs wet gangrene?

A

Dry is a complication of critical limb ischaemic where the tissue necroses
Wet - infection of the dry

48
Q

Embolic vs thrombotic cause of acute ischaemia?

A

Embolic will develop over minutes whereas thrombotic will develop over hours - days

49
Q

What programme should be offered to all those with intermittent claudication?

A

Supervised exercise programme

50
Q

What is a paradoxical embolus?

A

Where a VTE travels through inferior vena cava and then crosses septal defect to enter left heart circulation and cause an arterial embolus

51
Q

Long saphenous system vs short saphenous system?

A

Long - side of long toe - medial malleolus
Short - side of short toe - lateral malleolus

52
Q
A

FINALS (36 decks)

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