Vascular Surgery Flashcards
Normal size of the abdo aorta?
What is a generalised enlargement of an artery termed?
What about a localised enlargement that is between 1 and 1.5 x normal?
Arteriomegally
Ectasia
Differentiate true and false aneurysms?
True - pathological degeneration of all or part of the vessel wall
False - leakage of blood from artery into the adventitia.
Causes of aneurysms
Congenital Degenerative Familial Connective tissue disease Trauma Arthroma Infection Inflammation
What is the characteristic of a AAA swelling?
Expansile
At what point should a AAA be considered for repair?
> 5.5 cm or expanding >1cm per yr or symptomatic
Complications of AAA repair
Death 5%
Spinal or viceral ischemia
Distal trash
Advantages and disadvantages of stenting an AAA rather than open repair
Lower mortality
Increased complications such as stent failure (leakage into aneurysm)
Types of thoracic aortic aneurysm
Type A - arch
Type B - decending
Signs of critical ischemia in pvd
Rest pain - night time relieved by hanging leg off edge of bed
Ulceration
Gangrene
Classification system for peripheral arterial disease
Fontaine 1 - asymptomatic 2 - intermittent claudication 3 - ischemic rest pain 4 - ulceration or gangrene
Presentation of arterial ulcers
Punched out - dry necrotic bed
Painful - increases on leg elevation
Distal over pressure points
In the situation of pallor, pulseless limb
Normal ABPI
0.9-1.3
Blood tests to run on a suspected periperal arterial disease patient and why?
FBC - anaemia
U+Es - renal involvement
Glucose - DM
Lipids - dyslipidaemia
What imagining in suspected peripheral arterial disease?
Duplex uss
Angiography if considering intervention
Management of peripheral arterial disease
Conservative - stop smoking, exercise,
Medical - htn DM and cholesterol control, clopidogrel, pain relief
Surgical - bypass graft, angiography (balloon, stent), amputation
Reasons for amputation in peripheral arterial disease?
Irritractable pain
Risk of sepsis from gangrene or ulcers
Signs of leg venous insufficiency
Oedema Eczema Ulcers Haemosiderin staining Phlebitis Varicosity Lipodermosclerosis Atrophie blanche
Presentation of venous ulcers
Gaiter region Sloping Sloughy and exudative Large Little pain
Examination tests for varicose veins?
EXAMINE STANDING Inspect - signs of venous insufficiency Palpate - tenderness (thrombophlebitis), hardness (thrombosis), tap (percussion wave to SFJ) Auscultate - bruits Special tests - trendelenbergs
Treatment options for varicose veins
Underlying cause
Conservative - Avoid prolonged standing, elevate legs, compression stockings, loose weight, exercise
Endovascular - radiofrequency ablation, lazer ablation, injection sclerotherapy
Surgical - ligation, multiple avulsions,
Secondary causes of varicose veins
Obstructions - DVT, ovarian tumours
Valve destruction
AV malformation
Constipation
Definition of an aneurysm
Permanent localised dilation of an artery greater than 50% of normal
