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Vascular Surgery Flashcards

1
Q

Define acute limb ischemia

A

Sudden decrease in arterial limb perfusion causing threat to limb viability - present within 2 weeks - no time for collaterals

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2
Q

Aetiology of acute limb ischemia

A
  1. Acute arterial embolism ( healthy vessel)
  2. Acute arterial thrombosis (diseased vessel)
  3. Acute arterial injury
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3
Q

Commonest sites of impaction of an embolus

A
  1. Femoral bifurcation 40%
  2. Aortic bifurcation
  3. Popliteal bifurcation
  4. Brachial bifurcation
  5. Carotid bifurcation
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4
Q

Major difference between acute embolic and thrombotic limb ischemia is?

A

Presence of collaterals in the case of a thrombotic event!

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5
Q

Mention causes of acute embolic ischemia

A

Cardiogenic:
MS with AF
MI (mural thrombus)
Sub acute bacterial endo on diseased valve

Noncardiogenic:
Air emboli
Fat emboli
Amniotic emboli
Malignant cell emboli
Parasitic emboli
Theraputic emboli
Paradoxical emboli
Large artery emboli: from athero, aneurysm

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6
Q

features found in acute embolic ischemia that helps differentiate a thrombotic cause

A
  1. Dramatic sudden onset of pain
  2. Normal pulse on the other limb
  3. Absence of previous claudication
  4. No skin trophic changes
  5. Symptoms of cause of emboli
  6. No arterial collaterals
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7
Q

Symptoms of acute ischemia

A

6P
1. Pain (cardinal)
2. Progressive coldness (cardinal)
3. Pallor
4. Pulselessness
5. Paresis then paralysis
6. Paresthesia

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8
Q

When does an acute embolic limb ischemia present with absent pulseless in both limbs?

A

Aorto-ileal emboli

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9
Q

Color change in acute limb ischemia

A

Pale -> reversible cyanosed then mottled (6-12hrs) -> fixed irreversible cyanosed

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10
Q

What is the catheter used in embolectomy?

A

Fogerty catheter

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11
Q

Why is heparin given in acute limb ischemia

A

To prevent clot propagation

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12
Q

Investigation of acute limb ischemia

A
  1. Site of impaction:
    -Doppler / duplex
    - angiography
  2. Of cause:
    - ECG, Echo, TEE
    - xRay (fractures)
    -US (aneurysm)
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13
Q

Urgent care of acute limb ischemia

A
  1. IV heparin
  2. Analgesia: Morphine
  3. Aide limb perfusion
  4. Stabilize patient
  5. Start Treating the cause
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14
Q

What are some measure to improve existing perfusion in ischemic limb

A
  1. Keep limb dependent
  2. Avoid external pressure
  3. Avoid extremes of temperature: cold (vasospam) heat (increase metabolic rate)
  4. Maximum oxygenation
  5. Correct hypotension
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15
Q

What explains a pale ischemic limb becoming pinkish?

A

Functional collaterals

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16
Q

Classification of acute limb ischemia

A

Viable <3hrs
Threatened 3-6 hrs
Irreversible: fixed colour and muscle turgid

17
Q

Absolute Contraindications of thrombolitic therapy

A
  1. Cerebrovascular stroke withing previous 2 months
  2. Active bleeding/recent GI bleed within previous 10 days
  3. Intracranial trauma or neurosurgery within previous 3 months
18
Q

Relative contraindications of thrombolytic therapy

A
  1. Uncontrolled hypertension
  2. Major surgery/ trauma within 10 days
  3. CPR within previous 10 days
19
Q

Mention possible etiologies that could result in occlusion of arterial tree

A

Atherosclerosis
Diabetes
Burger’s ds
Raynaud’s
Aortic aneurysm
Thoracic outlet syndrome

20
Q

What are the defining symptoms of critical limb ischemia

A
  1. Rest pain
  2. Gangrene
  3. Ulcer
21
Q

Mention the Fontaines classification of chronic limb ischemia

A

1: asymptomatic
2: claudication ->
2a: when walking > 200 meters
2b: when walking < 200 meters
3: rest pain
4: gangrene / ulcer

22
Q

Stage 3&4 of fontaines classification are also known as?

A

Critical limb ischemia

23
Q

DD of intermittent claudication:

A
  1. Neurospinal claudication: lumbar disc/ spinal canal stenosis
  2. Venous claudication: chronic ileo-femoral DVT
24
Q

Explain the rubber colour of foot in critical limb ischemia

A

When performing buerger’s test the limb is elevated until pale then dropped dependent presenting the red-purple colour (rubber colour) due to metabolite induced vasodilation quickly consuming oxygen when foot dropped -> pooled reduced hemoglobin gives the characteristic colour

25
Q

What is the triad of Leriche syndrome?

A
  1. Buttock and thigh claudication
  2. Absent bilateral femoral pulse
  3. Impotence in males

Triad indicates infra-renal aorto-iliac occlusive disease

Clinical Flashcards (10 decks)

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