Vascular Surgery Flashcards
What is the definition of an AAA?
Dilation of all arterial wall layers > 1.5 times the normal diameter
Normal = 2cm
Aneurysm = 3cm
(conservative treatment until > 5.5cm)
What are the risk factors for AAA?
Smoking, hypertension, hyperlipidaemia, male, positive family history
Diabetes is a protective factor
What are the complications of AAA?
Rupture, thrombosis, distal embolism, pressure on adjacent structures, fistula, infection
What are the important ranges of ankle brachial index (ABI)?
0.9-1.2 = normal
0.5-0.9 = claudication expected
< 0.5 = rest pain expected
> 1.2 = arterial calcification
What is the significance of toe pressures?
Indicates likelihood of wound / ulcer / stump to heal
>40mmHg required for healing
When would you perform a duplex ultrasound?
To assess arterial narrowing or dilation
Greyscale ultrasound detects vessel narrowing (>70% requires treatment)
Colour doppler detects flow velocity
On duplex ultrasound, a 75% stenosis is found. What is the next investigation to order?
Computed Tomography Angiography (CTA) to visualise arterial system
On duplex ultrasound, a 75% arterial stenosis is found. What is the next investigation to order?
Computed Tomography Angiography (CTA) to visualise arterial system
What imaging can be performed on the venous system?
CTA
Doppler ultrasound
Duplex ultrasound
Vein mapping
What is the treatment for mild vascular claudication?
Smoking cessation Exercise (to improve collaterals) Weight loss Aspirin +/- clopidogrel Statin \+/- ACEI (bypass or angioplasty reserved for serious occlusion)
When is surgical carotid endarterectomy indicated?
When arterial occlusion is 70% or greater
What is lipodermatosclerosis?
Inflammation of subepidermal fat occurring in venous disease where increased pressure causes fibrin to leak out of capillaries (causes brown-red pigmentation and skin thickening)
What are the skin complications of venous disease
Venous ulcers
Lipodermatosclerosis
Venous stasis eczema
Haemosiderin staining
What are the treatment options for varicose veins?
Compression stockings
Vein ligation + stripping
Laser therapy
Sclerotherapy (injection of sodium tetradecyl sulphate)
What are the six P’s of arterial ulcers?
Pallor Pain (relieved by dangling leg) Pulselessness Paraesthesia Paralysis Poikilothermia
Compare the common locations of venous, arterial and neuropathic ulcers.
Venous: gaiter area, medial leg
Arterial: between toes, bony prominences
Neuropathic: sole of foot, pressure points
Compare the appearance of venous, arterial and neuropathic ulcers.
Venous: irregular borders, large but shallow, oozing, yelllow fibrous base, venous skin changes surrounding
Arterial: punched-out, little bleeding, greyish, redness around bace, hairless/pale surrounding skin
Neuropathic: bleed briskly, pink/black/brown, irregular borders, often calloused surrounding skin
Where can the femoral pulse be located?
Halfway between the ASIS and pubic symphysis (along the ingiunal ligament)
What is Beurger’s Test?
Raise leg for 2-3 minute (should become pale) and then dangle off side of bed and look for colour change from red to purple
What test should be done prior to creating a radial renal fistula or performing a radial artery ABG?
Allen’s test for collateral arterial supply to hand
compress ulna + radial arteries until hand is pale, then release ulna artery and look for the colour to return
List 5 VTE risk factors.
Age >40 Pregnancy Malignancy Thrombophilia Previous DVT Obesity Immobility OCP Varicose veins Central venous catheter Hormone therapy IBD Infection / sepsis,
What is Virchow’s triad?
Stasis, hypercoagulability and endothelial damage
What are the complications of carotid endarterectomy?
Perioperative stroke MI Hyperperfusion syndrome Cervical haematoma (may compromise airway) Nerve injury Infection
