Vascular surgery Flashcards
What are the symptoms of acute limb ischaemia?
6 P’s
- Pale
- Pulseless
- Painful
- Paralysed
- Parasthesia
- Perishing with cold
What are the causes of acute limb ischaemia?
- Embolism
- Thrombus / thrombosis
- Trauma
- Compartment syndrome
What is the management of acute limb ischaemia?
Embolic cause:
- Embolectomy
- Thrombolysis
Other:
- Open surgery
- Angioplasty
What are the indications for carotid endarterectomy?
➜ 50 - 99% stenosis of the internal carotid artery- < 50%: no need for surgery;- 50 - 70%: surgery beneficial;- 70 - 99%: surgery VERY beneficial;- 100% (ocludded): No benefit in surgery.
- 100% (ocludded): means no blood flow, hence no risk of emboli.
What are the symptoms of carotid artery stenosis?
- Loss of consciousness (cerebral hypoperfusion)
- TIA
- Stroke
What are the investigations done in carotid artery stenosis?
Initial test
- Duplex ultrasound
Gold standard
- CT/MR angiography
What are the NEONATAL symptoms of aortic coartaction?
- Presents within the first 3 weeks of life;
- Systolic murmur on left infraclavicular area;
- Poor feeding;
- Lethargy;
- Tachypnoea;
- Congestive heart failure.
What are the Late presentation symptoms of aortic coartaction?
- Usually asymptomatic;
- Hypertension;
- ⬆︎ BP in the arms and ⬇︎ in the legs;
- Radiofemoral delay (weak pulses in the lower extremities);
- Nose bleeds;
- Headaches.
Leg ulcers
In regards to venous ulcers, describe:
- Causes
- Location
- Presentation
- Rx
◉ Causes:
- Varicose veins
- DVT
- Pregnancy
◉ Location:
- Medial malleolus
◉ Presentation:
- Haemosiderin deposits
◉ Rx:
- Compression
- Elevation
- Mild exercises
- Dressing
- Surgical Rx of varicose veins.
In regards to arterial ulcers, describe:
- Causes
- Location
- Presentation
- Rx
◉ Causes➜ Peripheral artery disease: (risk factors)
- Smoking
- Hypertension
- DM
- ↑ cholesterol
◉ Location:
- Lateral malleolus
- Toes
- Feet
◉ Presentation:
- Deep and punched out
◉ Rx:
- Perform ABPI;
- Treat peripheral artery disease (statins, antiplatelets);
- Surgical revascularisation.
In regards to neurophatic (diabetic) ulcers, describe:
- Causes
- Location
- Presentation
- Rx
◉ Causes
- DM
- Pressure points on bottom of feet
◉ Location:
- Plantar surface of feet
- Toes
◉ Presentation:
- Deep
- Ulcer surrounded by callous
◉ Rx:
- Manage DM
- Remove pressure (podiatrist).
What are the causes of inferior vena cava syndrome?
- Tumours (renal cell carcinoma);
- Pregnancy;
- Thrombosis (within the vena cava itself).
What are the symptoms of inferior vena cava syndrome?
- Oedema in the lower extremities;
- Tachycardia.
What are the causes of superior vena cava syndrome?
Obstruction of blood flow through the SVC.
- Lung cancer;
- Malignacies affecting the lymph nodes of the chest:
◆ Lymphoma
◆ Breast cancer
◆ Oesophageal - Clot formation in the SVC.
What are the symptoms of superior vena cava syndrome?
- Difficulty breathing
- Coughing
Dilated (superficial) veins of:
- Neck
- Arms
- Anterior chest wall;
Oedema:
- Face
- Neck
- Upper limbs
What are the investigations done in superior vena cava syndrome?
- Chest X-ray;
Contrast CT
What is the management of superior vena cava syndrome?
Initial
- O₂
- Corticosteroids
Other:
- Stenting / angioplasty
- Treatment of specific cancer
- If clot: anticoagulants
What is the cause of peripheral artery disease?
Atherosclerosis.
What is the symptoms of peripheral artery disease?
-
Intermittent claudication(relieved by rest) - Weak or absent pulses
- Ulceration and gangrene
- Skin and hair changes
What is the risk factors for peripheral artery disease?
- Hypertension;
- DM;
- Smoking
- High cholesterol.
What is the investigation done in peripheral artery disease?
1st line
- Ankle brachial pressure index (ABPI)
After ABPI
- Doppler/duplex ultrasound
What is the management of peripheral artery disease?
Quit smoking- Exercise
- Treat hypertension
- Atorvastatin 80 mg
- Clopidogrel 75 mg
- Naftidrofuryl oxalate (if exercise failed and patient denies revascularisation)
- Angioplasty / stenting
- Bypass surgery
What is the management of ASYMPTOMATIC abdominal aortic aneurysm?
- < 5.5 cm without speedy growth ⟶ Ultrasound surveilance
- > 5.5 cm ⟶ endovascular repair
- > 4 cm with more than 1 cm yearly growth ⟶ endovascular repair
What are the symptoms of SYMPTOMATIC abdominal aortic aneurysm?
- Sudden severe abdominal and back pain
- Tender pulsatile abdominal mass
What is the management of SYMPTOMATIC abdominal aortic aneurysm?
Initial if SBP < 90
- Fluids
➜ Urgent surgical repair
How is the diagnosis of SYMPTOMATIC abdominal aortic aneurysm?
Unstable
- FAST scan
Stable
- CT
What is the symptom of femoral artery aneurysm?
Painless pulsatile mass in the groin.
Femoral hernia is non-pulsatile.
What is Buerger’s disease?
Thrombosis of small and medium size arteries.
What are the symptoms of Buerger’s disease?
Associated with SMOKING.
- Claudication pain (legs or hands)
- Discoloration of affected limb
- Numbeness and tingling
- Ulcers
- Gangrene
What is the management of Buerger’s disease?
- Quit smoking;
- Iloprost.
What are the symptoms of bilateral renal artery stenosis?
- Resistant hypertension
- Worsening renal function after starting ACEi/ARB
What are the causes of bilateral renal artery stenosis?
- Atherosclerosis
- Fibromuscular dysplasia
What is the investigation of bilateral renal artery stenosis?
Ultrasound: Bilateral reduced size of kidneys with smooth borders
Gold standard: Renal angiography
What is the management of bilateral renal artery stenosis?
- Angioplasty
- Stenting
