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Med > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

How long can skeletal muscles tolerate ischemia?

A

6 h (unless acute on chronic ischemia)

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2
Q

Ischemia due to embolus vs thrombus

A 
Embolus:
Acute onset
Prominent loss of function/sensation
No Hx of claudication
No atrophic changes
Normal contralateral limb pulses

Thrombus:
Progressive onset or acute on chronic
Less profound loss of function/sensation(due to underlying collaterals)
May have Hx of claudication
May have atrophic changes
Decreased or absent contralateral limb pulses

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3
Q

Inv for acute limb ischemia

A 
ABI
ECG, troponin
CBC
PTT/INR
Echo
CT-Angio
Angio
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4
Q

Tx of acute limb ischemia

A

Immediate Heparinization:
5000 bolus,
Then continuous to PTT 70-90

If impaired neurovascular status:
Emergent revascularization

If intact neurovascular status:
Time for W/U (angio, CTA…)

If embolus: embolectomy

If thrombus: thrombectomy, bypass graft, endovascular therapy

If irreversible ischemia: amputation

Treat underlying

Continue heparin, ad warfarin

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5
Q

Reperfusion complications

A

Compartment syndrome

Arrhythmia

RF, MOF due to toxic metabolites

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6
Q

Major RFs for lower extremity chronic ischemia

A

DM
Smoking
Older age

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7
Q

Minor RFs for lower extremity chronic ischemia

A 
HTN
Hyperlipidemia
Obesity
Sedentary lifestyle
PMHx or FHx of CAD/CVD
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8
Q

Vascular claudication Sx

A

Pain with exertion (calf…)

Relieved by 2-5 min rest

No postural changes necessary

Reproducible

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9
Q

Critical limb ischemia

A

Rest pain

Night pain

Tissue loss

Pain most commonly over the forefoot

Wakes from sleep

Relieved by hanging the foot off bed

Ankle pressure < 40, ABI < 0.4, toe pressure < 30

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10
Q

Signs if chronic poor perfusion

A

Hair loss

Hypertrophic nails

Atrophic muscle

Ulceration

Infections

Slow capillary refill

Prolonged pallor on elevation

Prolonged rubor on dependency

Venous troughing (collapse of superficial veins)

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11
Q

Inv for chronic atrial insufficiency

A

Routine blood work

Fasting metabolic w/u

ABI

CTA/MRA (for planning intervention)

Arteriography (better than CTA/MRA, for tibial arteries

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12
Q

ABI interpretation

A

> 1.2: suspect wall calcification

> 0.95 normal

0.5 -0.8 claudication

< 0.4 critical

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13
Q

Tx of chronoc limb ischemia

A

RF modification

Exercise program (30 min x 3/w)

Foot care

Antiplatelet

Cilostazol

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14
Q

Indications of surgical intervention for chronic limb ischemia

A

Severe lifestyle impairing

Vocational impairment

Critical ischemia

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15
Q

Surgical interventions

A

Angioplasty +/- stenting

Endarterectomy

Bypass graft

Amputation, if:
Non suitable for above
Persistent serious infection, gangrene
Unremitted rest pain poorly controlled by analgesics

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16
Q

Mx of critical limb ischemia

A

If limb salvageable:
Arteriography
Duplex scanning

If not salvageable:
Amputation
(Analgesia in moribund pt)

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17
Q

Aortic dissection classification

A

Type A: involving ascending aorta

Type B: not involving ascending aorta

Acute: <2 wk

Chronic: >2 wk

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18
Q

What’s the most common etiology for aortic dissection?

A

HTN

19
Q

RFs for aortic dissection

A

HTN

Marfan, EDS, other CTDs

Atherosclerosis

Coarctation of aorta

Bicuspid aortic valves

PDA

Cystic medial necrosis

Syphilis

Trauma

Arteritis (Takayasu)

20
Q

Epidemio of AD

A

M> F

African-Canadian >…> asian

Peak age: 50-65 yr

If CTD: 20-40 yr

21
Q

Sx of aortic dossection

A

Tearing pain radiating to back +

HTN (Asymmetric BP/Pulse between limbs)

Ischemic syndromes (occlusion of branches)

Unseating of aortic valve cusps ( new diastolic murmur)

Rupture into pleura, pericardium, retroperitoneum

Syncope

22
Q

Inv for AD

A

CTA (mainstay)

ECG, troponin

CXR:
Pleural cap (pleural effusion in lung apices)
Widened mediastinum
Left pleural effusion

TEE:
Visualizes aortic valve and thoracic aorta

Lactate
Amylase

23
Q

Mx of aortic dissection

A

Type A:
Urgent surgery

Type B:
Medical Mx:
IV antihypertensives
Transition to oral meds
( BB, if BBs contraindicated, CCB)
\+/- ACEI

Selective interventions for complications or refractory symptoms

+/- aortic stent-grafting

24
Q

Aortic aneurism definition

A

Diameter at least x1.5 that of expected

25
Q

RFs for AA

A 
Smoking
HTN
PVD
CAD
CVD
Age>70
FHx
Degenerative
Traumatic
Mycotic (salmonella, staph)
CTD
Vasculitis
Infectious (syphilis, fungal)
Ascending thoracic aneurysms are associated with bicuspid aortic valve
26
Q

Most common Sx of aorta aneurism

A

Asymptomatic

27
Q

Most common site of AA

A

Abdominal

28
Q

Inv for AA

A 
CBC
Lytes
Urea
Cr
PTT,INR
Type and cross

Abdominal U/S (screening, surveillance)

CT with contrast

Peripheral arterial doppler/duplex (R/O aneurisms elsewhere)

29
Q

Screening for AAA

A

Men 65-74

Women 65 yr with cardiovascular disease and FHx of AAA

Men >50 with FHx of AAA

30
Q

Indications for surgical Tx of AA

A

Ruptured

Symptomatic

Size > 5-5.9 cm

Ascending thoracic aorta aneurism if:
> 6cm
> 2x normal
> 4.5 cm + aortic regurgitation/marfan

31
Q

RFs of carotid stenosis

A 
For atherosclerosis:
Smoking
HTN
DM
Hyperlipidemia
CVD
CAD
Older age
32
Q

Inv for carotid stenosis

A

CBC

PTT/INR

Fundoscopy:
Cholesterol emboli in retinal vessels

Carotid bruit

Carotid duplex

CTA, MRA

33
Q

Tx of carotid stenosis

A

RF modification:
Control DM, HTN, lipids

ASA +/- dipyridamole
Clopidogrel

Surgical

34
Q

Indication fo carotid endarterectomy

A

Symptomatic and > 70% stenosis

35
Q

Factors aggrevating Sx of varicose veins

A

Prolonged standing

PMS

36
Q

Tx of varicose veins

A

Coservative:
Elastic compression stocking

Surgery

37
Q

Indications for surgery of varicose veins

A

Failure of conservative treatment

Symptomatic varix:
Pain
Bleeding
Recurrent thrombophlebitis

Tissue changes:
Hyperpigmentation
Ulceration

Cosmetic

38
Q

Inv for chronic venous insufficiency

Venous insufficiency and skin damage

A

Not required

Doppler U/S for pre-operative assessment

39
Q

Tx of chronic venous insufficiency

A

Conservative:

Elastic compression stocking
Periodic rest/elevation
Avoid prolonged standing

Ulcer: multilayer compression bandage. ABx PRN

Surgical

40
Q

Indications of surgical Tx for chronic venous insufficiency

A

If conservative measures fail

Recurrent large ulcers

41
Q

Most common form of primary lymphedema

A

Lymphedema praecox

Starts in adolescence

42
Q

Types of primary lymphedema

A

Milroy’s syndrome

Lymphedema praecox, starts in adolescence

Lymphedema tarda: starts after 35 yr

43
Q

The most common cause of secondary lymphedema worldwide

A

Filariasis

The most common cause in north America: surgery, RT

44
Q

Tx of lymphedema

A

Avoid limb injury

Early treatment of cellulitis

Skin hygiene:
Daily moisturizers
Early Tx of fungal/bacterial infection

Compression bandage
Compression garment

Gentle daily exercise of affected limb
Gradual increase in ROM
Must wear compression bandage when doing exercise

Massage (manual lymph drainage therapy)

Med (25 decks)

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