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Finals > Vascular surgery > Flashcards

Vascular surgery Flashcards

1
Q

what is intermittent claudication?

A

crampy, achy pain in the calf, thigh or buttock muscles associated with muscle fatigue when walking beyond a certain intensity and relieved by rest

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2
Q

what are the features of critical limb ischaemia?

A

Pain at rest
Non-healing ulcers and gangrene
Pain is worse at night

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3
Q

what are the features of acute limb ischaemia?

A

Pain
Pallor
Pulseless
Paralysis
Paraesthesia
Perishing cold

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4
Q

How does peripheral arterial disease present?

A

intermittent claudication

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5
Q

what is Leriche Syndrome?

A

occlusion in the distal aorta or proximal common iliac artery. There is a clinical triad of:
Thigh/buttock claudication
Absent femoral pulses
Male impotence

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6
Q

what are the signs of arterial disease on inspection?

A

Skin pallor
Cyanosis
Dependent rubor
Muscle wasting
Hair loss
Ulcers
Poor wound healing
Gangrene

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7
Q

what are some examination findings in peripheral arterial disease?

A

Reduced skin temperature
Reduce sensation
Prolonged capillary refill time
Changes during Buerger’s test

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8
Q

what are the colour changes of the legs in the Buerger’s test that indicated peripheral arterial disease?

A

pale when elevated
when lowered blue -> dark red

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9
Q

what are the features of arterial ulcers?

A

Are smaller than venous ulcers
Are deeper than venous ulcers
Have well defined borders
Have a “punched-out” appearance
Occur peripherally (e.g., on the toes)
Have reduced bleeding
Are painful

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10
Q

what are the features of venous ulcers?

A

Occur after a minor injury to the leg
Are larger than arterial ulcers
Are more superficial than arterial ulcers
Have irregular, gently sloping borders
Affect the gaiter area of the leg (from the mid-calf down to the ankle)
Are less painful than arterial ulcers
Occur with other signs of chronic venous insufficiency (e.g., haemosiderin staining and venous eczema)

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11
Q

what 3 investigations can be done in peripheral arterial disease?

A

Ankle-brachial pressure index (ABPI)
Duplex ultrasound
Angiography (CT or MRI)

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12
Q

how is ankle-brachial pressure index calculated?

A

ratio of systolic blood pressure (SBP) in the ankle (around the lower calf) compared with the systolic blood pressure in the arm
0.9 – 1.3 is normal

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13
Q

what is the management of intermittent claudication?

A

Lifestyle changes -> stop smoking, manage hypertension
Exercise training
Atorvastatin, Clopidogrel, Naftidrofuryl oxalate
Surgery -> Endovascular angioplasty and stenting, endarterectomy, bypass surgery

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14
Q

what are the management options for critical limb ischaemia ?

A

Endovascular angioplasty and stenting
Endarterectomy
Bypass surgery
Amputation of the limb if it is not possible to restore the blood supply

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15
Q

what are the management options for acute limb ischaemia?

A

Endovascular thrombolysis
Endovascular thrombectomy
Surgical thrombectomy
Endarterectomy
Bypass surgery
Amputation

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16
Q

state 5 VTE risk factors

A

Immobility
Recent surgery
Long haul travel
Pregnancy
Hormone therapy with oestrogen (combined oral contraceptive pill and hormone replacement therapy)
Malignancy
Polycythaemia
Systemic lupus erythematosus
Thrombophilia e.g. antiphospholipid syndrome

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17
Q

what is given as VTE prophylaxis?

A

low molecular weight heparin, such as enoxaparin

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18
Q

state 2 contraindications to VTE prophylaxis with LMWH?

A

active bleeding
existing anticoagulation with warfarin or a DOAC

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19
Q

what is the main contraindication to anti-embolic compression stockings?

A

significant peripheral arterial disease

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20
Q

what are the presenting symptoms of a VTE?

A

Calf or leg swelling
Dilated superficial veins
Tenderness to the calf (particularly over the site of the deep veins)
Oedema
Colour changes to the leg

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21
Q

how to you examine for leg swelling in DVT?

A

measure the circumference of the calf 10cm below the tibial tuberosity. More than 3cm difference between calves is significant

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22
Q

what is the diagnostic investigation for DVT?

A

Doppler ultrasound

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23
Q

what is the initial management of a DVT?

A

treatment dose apixaban or rivaroxaban
consider catheter-directed thrombolysis in patients with a symptomatic iliofemoral DVT and symptoms lasting less than 14 days.

24
Q

how long should you continue anticoagulation for following a DVT?

A

3 months if there is a reversible cause (then review)
Beyond 3 months if the cause is unclear, there is recurrent VTE, or there is an irreversible underlying cause such as thrombophilia (often 6 months in practice)
3-6 months in active cancer (then review)

25
Q

state 4 risk factors for chronic venous insufficiency

A

Increasing age
Family history
Female
Pregnancy
Obesity
Prolonged standing
Deep vein thrombosis

26
Q

what special tests can be done to assess varicose veins?

A

Tap test
Cough test
Trendelenburg’s test
Perthes test
Duplex ultrasound

27
Q

what are the management options for varicose veins?

A

Weight loss if appropriate
Staying physically active
Keeping the leg elevated when possible to help drainage
Compression stockings
surgical -> endothermal ablation, sclerotherapy

28
Q

what are the complications of varicose veins?

A

Prolonged and heavy bleeding after trauma
Superficial thrombophlebitis (thrombosis and inflammation in the superficial veins)
Deep vein thrombosis
Issues of chronic venous insufficiency (e.g., skin changes and ulcers)

29
Q

what are the 4 common types of ulcers?

A

Venous ulcers
Arterial ulcers
Diabetic foot ulcers
Pressure ulcers

30
Q

what score is used to assess risk of developing a pressure ulcer?

A

Waterlow score

31
Q

what sign can be used to assess for lymphoedema?

A

Stemmer’s sign

32
Q

what are the non-surgical treatment options for lymphoedema?

A

Massage techniques to manually drain the lymphatic system (manual lymphatic drainage)
Compression bandages
Specific lymphoedema exercises to improve lymph drainage
Weight loss if overweight
Good skin care

33
Q

how is abdominal aortic aneurysm defined?

A

dilation of the abdominal aorta, with a diameter of more than 3cm

34
Q

state 3 risk factors or AAA

A

Male
Increased age
Smoking
Hypertension
Family history
Existing cardiovascular disease

35
Q

who and when is screening for AAA offered?

A

men at ages 65 (ultrasound scan)

36
Q

how may AAA present?

A

when it ruptures
Non-specific abdominal pain
Pulsatile and expansile mass in the abdomen when palpated with both hands
As an incidental finding on an abdominal x-ray, ultrasound or CT scan

37
Q

what is the initial investigation for AAA?

A

Ultrasound

38
Q

How many cm is a large AAA?

A

above 5.5cm

39
Q

how often should you follow up patients with an AAA?

A

Yearly for patients with aneurysms 3-4.4cm
3 monthly for patients with aneurysms 4.5-5.4cm

40
Q

The NICE guidelines (2020) recommend elective repair for patients with any of:

A

Symptomatic aneurysm
Diameter growing more than 1cm per year
Diameter above 5.5cm

41
Q

when should patients inform the DVLA of their AAA?

A

Inform the DVLA if they have an aneurysm above 6cm
Stop driving if it is above 6.5cm

42
Q

what are the symptoms of a ruptures aortic aneurysm?

A

Severe abdominal pain that may radiate to the back or groin
Haemodynamic instability (hypotension and tachycardia)
Pulsatile and expansile mass in the abdomen
Collapse
Loss of consciousness

43
Q

what are the 2 types of aortic dissection according to the Stanford system?

A

Type A – affects the ascending aorta, before the brachiocephalic artery
Type B – affects the descending aorta, after the left subclavian artery

44
Q

what are some risk factors for aortic dissection?

A

Hypertension
Bicuspid aortic valve
Coarctation of the aorta
Aortic valve replacement
Coronary artery bypass graft (CABG)
Ehlers-Danlos Syndrome
Marfan’s Syndrome

45
Q

what are the presenting features of aortic dissection?

A

“ripping” or “tearing” chest pain
Hypertension
Differences in blood pressure between the arms
Radial pulse deficit
Diastolic murmur
Focal neurological deficit
Chest and abdominal pain
Collapse (syncope)
Hypotension as the dissection progresses

46
Q

what is the initial investigation to confirm a diagnosis of aortic dissection?

A

CT angiogram

47
Q

what are the key complications of aortic dissection?

A

Myocardial infarction
Stroke
Paraplegia (motor or sensory impairment in the legs)
Cardiac tamponade
Aortic valve regurgitation
Death

48
Q

How can the severity of carotid artery stenosis be classified?

A

Mild – less than 50% reduction in diameter
Moderate – 50 to 69% reduction in diameter
Severe – 70% or more reduction in diameter

49
Q

what may be heard on examination in carotid artery stenosis?

A

carotid bruit

50
Q

what is the initial investigation of carotid artery stenosis?

A

Carotid ultrasound

51
Q

what are the conservative management options of carotid artery stenosis ?

A

Healthy diet and exercise
Stop smoking
Management of co-morbidities (e.g., hypertension and diabetes)
Antiplatelet medications (e.g., aspirin, clopidogrel and ticagrelor)
Lipid-lowering medications (e.g., atorvastatin)

52
Q

what surgical interventions are considered in carotid artery stenosis?

A

Carotid endarterectomy
Angioplasty and stenting

53
Q

what is Buerger disease?

A

also known as thromboangiitis obliterans. It is an inflammatory condition that causes thrombus formation in the small and medium-sized blood vessels in the distal arterial system (affecting the hands and feet)

54
Q

who does Buerger disease typically affect?

A

men aged 25 – 35 and has a very strong association with smoking

55
Q

what are the presenting features of Buerger disease?

A

painful, blue discolouration to the fingertips or tips of the toes. The pain is often worse at night. This may progress to ulcers, gangrene and amputation

56
Q

what is the typical finding on angiograms of Buerger disease?

A

Corkscrew collaterals

57
Q

what is the management of Buerger disease?

A

Stop smoking
intravenous iloprost

Finals (21 decks)

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