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Surgery > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

What are some causes of embolic acute limb ischaemia?

A 
MI
AF
Vegetation from heart valve
Atherosclerosis
Aneurysm all plaque
Graft thrombus
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2
Q

What are some causes of thrombotic acute ischaemia?

A

Graft closure
Atherosclerosis
Popliteal aneurysm
Thrombogenic conditions

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3
Q

What investigations should be done in someone with a potentially acutely ischaemia limb?

A

ECG in case of AF
Baseline bloods, including AF
Assess for any underlying aetiology including cardiac and atherosclerotic risk factors

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4
Q

How should somebody with acute limb ischaemia be managed?

A 
Oxygen therapy
BP optimisation 
Analgesia 
IV heparin 
Prepare for surgery
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5
Q

What are the signs found in somebody with intermittent claudication?

A

Diminished or absent leg pulses or pulses that diminish on exercise
Leg that appears ischaemia

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6
Q

What are some important risk factors for intermittent claudication?

A 
Smoking 
Hypercholesterolaemia 
Hypertension
Diabetes mellitus
Family history
Ischaemic heart disease
Increasing age
Make
Cerebrovascular disease
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7
Q

If somebody has bilateral buttock pain on walking, erectile dysfunction and pulse less legs, what could the problem be?

A

Leriche syndrome: bilateral aortoiliac claudication

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8
Q

How should intermittent claudication be investigated?

A

Ankle brachial pressure index
Treadmill test if history of disease but normal ABPI
Duplex scan to locate and assess stenosis

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9
Q

How should intermittent claudication be managed?

A 
Encourage to stop smoking
Exercise 
Correct risk factors
Anti platelet therapy (75mg aspirin or clopidogrel daily.)
Cholesterol lowering therapy ie statins
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10
Q

What factors increase the risk of amputation in someone with intermittent claudication?

A

Continuing to smoke
Having diabetes
Severe claudication and ABPI less than 0.5
Multilevel or distal disease

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11
Q

What are the symptoms and signs of critical limb ischaemia?

A

Rest pain needing analgesia for over 2 weeks
Relieved by hanging leg out of bed/ walking on cold floor
Ankle pressure less than 50 mmHg
Possible ulceration/infection
Red limb

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12
Q

How can critical limb ischaemia be managed medically?

A

Assess and treat any heart failure, infection or anaemia
Control diabetes
Analgesia
Anticoagulant

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13
Q

What are some hard signs of arterial injury?

A

External arterial bleeding
Rapidly expanding haematoma
Palpable thrill or audible bruit
Obvious ischaemia not resolved by reduction or realignment of orthopaedic cause

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14
Q

What are some ‘soft’ signs of arterial injury?

A 
History of bleeding at scene of incident
Proximity of wound to major artery
Unilaterally diminished pulse 
Small, non pulsating haematoma
Neurogenic deficit
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15
Q

Name 3 risk factors for AAA?

A 
Hyperlipidaemia
Hypertension
Increasing age
Male
Family history
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16
Q

When should an AAA be operated on?

A

If large (>5.5cm or >6cm in unfit pt)
If expanding >1cm per year
If symptomatic in otherwise fit patient
If ruptured

17
Q

What are the benefits of endovascular aortic repair?

A

Reduced length of stay

Reduced 30 day mortality

18
Q

What are the disadvantages of endovascular aortic repair?

A

Increased rate of reintervention required
Increased rate of rupture
Requires surveillance for endoleak

19
Q

Give 3 complications of surgery for AAA

A 
Graft infection
Haemorrhage
Embolic event
Cardiac event
Respiratory failure
Renal failure
Ureteric injury
Impotence
Graft leak
20
Q

What are the three types of varicose vein?

A

Trunk
Reticular
Telangiectasia

21
Q

What are the 3 different aetiologies of varicose veins?

A

Primary from valvular failure
Secondary from obstruction of neighbouring deep vein so superficial vein compensates
AV fistula causing engorgement due to continued high pressure

22
Q

Give 3 risk factors for varicose veins

A

Prolonged standing
Obesity
Family history
Pregnancy

23
Q

Name 3 skin changes that can occur in varicose veins

A 
Haemosiderin staining
Oedema
Varicose eczema
Lipodermatosclerosis
Ulceration
Atrophie blanche
24
Q

What conservative measures can be used to treat varicose veins?

A

Patient education on avoiding prolonged standing, increasing exercise and weight loss
COmpression stockings if interventions deemed unsuitable
Compression bandaging if ulceration without arterial insufficiency

25
Q

What surgical options are there to treat varicose veins?

A

Saphenofemoral disconnection with saphenous stripping and multiple avulsions under GA
Endovenous laser ablation involving heating vein from inside
Foam sclerotherapy to close off vain

26
Q

Give 3 complications of varicose vein surgery

A 
Haemorrhage
Thrombophlebitis
DVT
Visual symptoms
Recurrence
Nerve symptoms
27
Q

What are the features of a stroke from the internal carotid artery?

A

Anterior circulation - hemisensory and motor deficit

Higher cortical dysfunction eg dysphasia

28
Q

When should carotid artery stenosis be operated on?

A

If symptomatic
+/- stenosis >50%
Prospect of recovery

29
Q

At which point is acute limb ischaemia irreversible?

A

Usually around 8 hours after onset
If there’s skin mottling that doesn’t blanch under pressure
If there is skin blistering

30
Q

Name 3 common causes of embolism causing acute limb ischaemia

A 
AF
Mitral stenosis
Valvular vegetation
Mural thrombus
Athersclerotic plaque
31
Q

What are the clinical signs of acute limb ischaemia?

A 
Pain
Pallor
Cold
Pulseless
Paraesthesia
Paralysis
32
Q

How should acute limb ischaemia be managed?

A

High flow oxygen
Analgesia
IV heparin
Embolectomy +/- fasciotomy

33
Q

Give 5 risk factors for peripheral vascular disease

A 
Smoking
Obesity
Hypertension
Hyperlipidaemia
Diabetes mellitus
Physical inactivity
Family history
34
Q

Which artery is most commonly affected in peripheral vascular disease?

A

Superficial femoral artery

35
Q

Name 3 differentials for intermittent claudication

A 
Spinal stenosis
Lower limb arthritis
DVT
sciatica
MSK sprain
36
Q

What are the features of critical limb ischaemia?

A

Rest pain, worse at night
Pain relieved by hanging lef out of bed
May be skin breakdown

37
Q

How is critical limb ischaemia managed?

A

Angioplasty
Surgical bypass
Amputation

38
Q

What ABPI result indicates arterial disease?

A

<0.9

Surgery (4 decks)

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