Vascular Surgery Flashcards
What are some causes of embolic acute limb ischaemia?
MI AF Vegetation from heart valve Atherosclerosis Aneurysm all plaque Graft thrombus
What are some causes of thrombotic acute ischaemia?
Graft closure
Atherosclerosis
Popliteal aneurysm
Thrombogenic conditions
What investigations should be done in someone with a potentially acutely ischaemia limb?
ECG in case of AF
Baseline bloods, including AF
Assess for any underlying aetiology including cardiac and atherosclerotic risk factors
How should somebody with acute limb ischaemia be managed?
Oxygen therapy BP optimisation Analgesia IV heparin Prepare for surgery
What are the signs found in somebody with intermittent claudication?
Diminished or absent leg pulses or pulses that diminish on exercise
Leg that appears ischaemia
What are some important risk factors for intermittent claudication?
Smoking Hypercholesterolaemia Hypertension Diabetes mellitus Family history Ischaemic heart disease Increasing age Make Cerebrovascular disease
If somebody has bilateral buttock pain on walking, erectile dysfunction and pulse less legs, what could the problem be?
Leriche syndrome: bilateral aortoiliac claudication
How should intermittent claudication be investigated?
Ankle brachial pressure index
Treadmill test if history of disease but normal ABPI
Duplex scan to locate and assess stenosis
How should intermittent claudication be managed?
Encourage to stop smoking Exercise Correct risk factors Anti platelet therapy (75mg aspirin or clopidogrel daily.) Cholesterol lowering therapy ie statins
What factors increase the risk of amputation in someone with intermittent claudication?
Continuing to smoke
Having diabetes
Severe claudication and ABPI less than 0.5
Multilevel or distal disease
What are the symptoms and signs of critical limb ischaemia?
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
How can critical limb ischaemia be managed medically?
Assess and treat any heart failure, infection or anaemia
Control diabetes
Analgesia
Anticoagulant
What are some hard signs of arterial injury?
External arterial bleeding
Rapidly expanding haematoma
Palpable thrill or audible bruit
Obvious ischaemia not resolved by reduction or realignment of orthopaedic cause
What are some ‘soft’ signs of arterial injury?
History of bleeding at scene of incident Proximity of wound to major artery Unilaterally diminished pulse Small, non pulsating haematoma Neurogenic deficit
Name 3 risk factors for AAA?
Hyperlipidaemia Hypertension Increasing age Male Family history
When should an AAA be operated on?
If large (>5.5cm or >6cm in unfit pt)
If expanding >1cm per year
If symptomatic in otherwise fit patient
If ruptured
What are the benefits of endovascular aortic repair?
Reduced length of stay
Reduced 30 day mortality
What are the disadvantages of endovascular aortic repair?
Increased rate of reintervention required
Increased rate of rupture
Requires surveillance for endoleak
Give 3 complications of surgery for AAA
Graft infection Haemorrhage Embolic event Cardiac event Respiratory failure Renal failure Ureteric injury Impotence Graft leak
What are the three types of varicose vein?
Trunk
Reticular
Telangiectasia
What are the 3 different aetiologies of varicose veins?
Primary from valvular failure
Secondary from obstruction of neighbouring deep vein so superficial vein compensates
AV fistula causing engorgement due to continued high pressure
Give 3 risk factors for varicose veins
Prolonged standing
Obesity
Family history
Pregnancy
Name 3 skin changes that can occur in varicose veins
Haemosiderin staining Oedema Varicose eczema Lipodermatosclerosis Ulceration Atrophie blanche
What conservative measures can be used to treat varicose veins?
Patient education on avoiding prolonged standing, increasing exercise and weight loss
COmpression stockings if interventions deemed unsuitable
Compression bandaging if ulceration without arterial insufficiency
What surgical options are there to treat varicose veins?
Saphenofemoral disconnection with saphenous stripping and multiple avulsions under GA
Endovenous laser ablation involving heating vein from inside
Foam sclerotherapy to close off vain
Give 3 complications of varicose vein surgery
Haemorrhage Thrombophlebitis DVT Visual symptoms Recurrence Nerve symptoms
What are the features of a stroke from the internal carotid artery?
Anterior circulation - hemisensory and motor deficit
Higher cortical dysfunction eg dysphasia
When should carotid artery stenosis be operated on?
If symptomatic
+/- stenosis >50%
Prospect of recovery
At which point is acute limb ischaemia irreversible?
Usually around 8 hours after onset
If there’s skin mottling that doesn’t blanch under pressure
If there is skin blistering
Name 3 common causes of embolism causing acute limb ischaemia
AF Mitral stenosis Valvular vegetation Mural thrombus Athersclerotic plaque
What are the clinical signs of acute limb ischaemia?
Pain Pallor Cold Pulseless Paraesthesia Paralysis
How should acute limb ischaemia be managed?
High flow oxygen
Analgesia
IV heparin
Embolectomy +/- fasciotomy
Give 5 risk factors for peripheral vascular disease
Smoking Obesity Hypertension Hyperlipidaemia Diabetes mellitus Physical inactivity Family history
Which artery is most commonly affected in peripheral vascular disease?
Superficial femoral artery
Name 3 differentials for intermittent claudication
Spinal stenosis Lower limb arthritis DVT sciatica MSK sprain
What are the features of critical limb ischaemia?
Rest pain, worse at night
Pain relieved by hanging lef out of bed
May be skin breakdown
How is critical limb ischaemia managed?
Angioplasty
Surgical bypass
Amputation
What ABPI result indicates arterial disease?
<0.9
