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Surgery > vascular surgery > Flashcards

vascular surgery Flashcards

1
Q

taking a vascular history

A

Where do you have pain?
locating the source of the pain

How long have you been in pain?

How long can you walk before
–> helps look at the progression of a disease

you become symptomatic?

Does it resolve with rest?
–> rest pain OR claudication

Does the pain wake you up at night?
–> if they have to get up or dangle their foot that is rest pain

Do you have any wounds/gangrene
Smoker, DM2, HTN, CAD, hyperlipidemia

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2
Q

PAD spectrum

A

claudication
chronic limb ischemia
acute limb ischemia

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3
Q

calf cramping think problem with

A

superficial femoral or politeal artery

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4
Q

claudication

A

Cramping/tiredness in the calves or thighs that comes on with ambulation and is relieved with rest.

Where the pain is located helps to differentiate where the disease is.

Symptoms tend to be just distal to the lesion is. Pain in the thighs/buttocks corrolates with aortio-iliac disease

disabling or non disabling

typically these symptoms have been present for months to years

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5
Q

non-disabling picture

A

Does not interfere with desired activities
Symptoms have been present for months to years

Pulse exam - Typically palpable pulses, may be diminished

No wounds/gangrene

2+ pulses

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6
Q

treatment of non -disabling claudication

A

Baseline ABI/TBI

Smoking cessation,

ASA,

statin,

Beta blocker,

control DM

Exercise Regimen

Consider Pletal (anti-platelet)

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7
Q

what is Pletal (Cilostazol)

A

relaxes muscles in your blood vessels to help them dilate as well as keep platelets from sticking together. Can help patients walk longer without pain

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8
Q

mild to moderate peripheral artery disease ABI

A

.41-.90

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9
Q

disabling claudication picture

A

Still not having pain at rests

but symptoms interefe with ADLS

no wounds

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10
Q

treatment for disabling claudication

A

Smoking cessation, ASA, statin,

Beta blocker

control DM

Arterial Duplex with an ABI

CT Angiogram**

Angiogram

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11
Q

post angiogram pt needs to

A

Patient to remain flat with the treated leg straight for 6 hours.

Monitor for hematoma, distal perfusion

Check Cr due to the contrast given

Post op check and new baseline ABI/TBI

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12
Q

if a stent is placed what is the management of a patient after

A

– Plavix load 300mg and then daily Plavix 75 mg for at least three months

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13
Q

chronic limb ischemia

A

Unable to walk short distances without pain
Forefoot pain that wakes them up at night (Rest Pain)

Cyanosis, dependent rubor, elevation pallor

Decreased pulses, doppler signals

Ulceration, gangrene

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14
Q

diagnostic for chronic limb ischemia

A

Arterial Duplex with ABI

Vein mapping

CT Angiogram – surgical planning

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15
Q

treatment for chronic limb ischemia

A

Endovascular Intervention – Angiogram with PTA/stent

Femoral Endarterectomy-router rooter

Lower Extremity Bypass

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16
Q

when would a LE bypass be used

A

Indications are for a total occlusion we can’t get through during an angio

distal target to sew to
–> need to have something for bipass

Preference is to use a reversed greater saphenous vein. (greatest longevity wiht vein)

17
Q

bypass grafting with veins involves

A

reverse the vein so that the valves are not functioning

18
Q

acute limb ischemia

A

acute pain

you have 6 hours

19
Q

5 p’s in order

A

pain, pulselessness, pallor

followed by parathesias and paralysisi

20
Q

two sources of acute limb ischemia (which is the most common)

A

60% caused by a thrombosis – hx of PAD

30% caused by an embolic source – A. fib, recent MI, proximal aneurysm

21
Q

classes of acute limb ischemia

who is a candidate for thrombolysis

A

I and II a

Typically done with each other where we will pull out the major clot and leave a catheter in place overnight dripping TPA to break up any little emboli that have traveled distally.

22
Q

why would you do a 4 compartment fasciotomy folowing a thrombectomy

A

complications can include compartment syndrome because of the sudden increase in blood flow

23
Q

typical picture of arterial ulcers

A

Located on the outer ankles, feet, toes
Painful

Irregularly shaped, punched out appearance

Necrotic tissue present

Little to no bleeding

24
Q

treatment of arterial ulcers

A

Treat underlying PAD to improve blood flow

Ulcers – debride necrotic tissue

25
Q

which gangrene is stable

A

dry gangrene

Wet Gangrene – infected and needs amputation
Toe amputation, transmetatarsal amputation

26
Q

picture of venous ulcers

A

Located on the ankles, calf

Shallow with flat margins

Slough at the base and moderate to heavy exudate (yellow slough)

Swelling of the lower extremity

Stasis dermatitis

27
Q

management of venous ulcers

A

Debridement to clean wound bed

Manage drainage

Compression therapy

Treat underlying venous insufficiency to decrease healing time and prevent reoccurrence

need to use these wraps to decrease fluid collection

28
Q

what is the pathophys of venous insufficiency

A

valves are weakened or damages causing backflow (refluc) and enlargement

29
Q

drainage of venous ulcers is with what products

A

Manage drainage with foam dressings

Unna boots, circ aids, stockings for compression

30
Q

h and p needed for varicose veins

A

Hx of DVT, previous vein surgery, family hx of VV, occupation, hx of bleeding veins.

Have them stand while you examine them

Document location and size of the veins

Pulse exam

Hemosiderin staining

Ulcers

31
Q

imaging of varicose vein

A

venous reflux uLS

Evaluates the superficial and deep system as well as perforators.

Rules Out DVT

Directs our treatment

if they don’t have veins that are working distally you can’t have surgical tx

32
Q

non surgical treatment for varicose veins include these 4 things

A

Compression stockings (20-30mm Hg )

Leg elevation

Calf exercises

Elevating the end of the bed at night
Elevating their legs for 30 minutes 4 times a day

33
Q

old treatment of varicose veins

A

Vein Ligation/stripping – Treats GSV, not done as frequently due to newer techniques

34
Q

now the surgical treatment of varicose veins are

A

Endovenous Ablation – Treats GSV, SSV

Phlebectomy

35
Q

injections for varicose veins

A

Sclerotherapy – treats small reticular veins and telangiectasias.

high concentrated saline or detergent that causes inflammation and causes them to stick together

36
Q

three endovenous ablation techniques

A

RFA/LASER uses heat to collapse vein

venaseal (can be done in OR or clinic and uses a glue)

varithena-foam sclerotherapy for filling larger veins

37
Q

where would you not be able RFA or laser

A

groin to knee (you have important veins below the knee and can’t use a hot laser here

38
Q

Phlebectomy

A

tiny incisions
work out the vein can do this for veins that are not the greater or lesser saphenous

can be done on smaller veins in clinic

Surgery (18 decks)

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