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Medicine finals > Vascular surgery > Flashcards

Vascular surgery Flashcards

1
Q

Define atherosclerosis

A

Chronic inflammation and activation of the immune system in the artery wall

Deposition of lipids in the wall –> fibrotic plaque formation

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2
Q

In atherosclerosis, what are the effects of plaque formation?

A

Stenosis –> reduced blood flow

Rupture –> thrombus which blocks a distal vessel –> ischaemia

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3
Q

What are risk factors of atherosclerosis?

A 
Older age
FHx
Male
Smoking and alcohol
Poor diet
Low exercise
Obesity
DM
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4
Q

Define peripheral arterial disease

A

Atherosclerosis causing stenosis of the arteries supplying the limbs and periphery

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5
Q

Define critical limb ischaemia

A

End stage of PAD where there is inadequate supply of blood to the limb to allow it function normally at rest

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6
Q

Define intermittent claudication

A

Symptoms of having ischaemia in a limb during exertion that is relieved by rest

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7
Q

What is Leriche’s syndrome

A

Clinical triad of
Thigh/buttock claudication
Absent femoral pulses
Male impotence

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8
Q

What is the Ankle-Brachial Pressure Index?

A

The ratio of systolic BP in the ankle vs the arm

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9
Q

What are the results of the ABPI?

A 
>1.2 = calcified, stiffened arteries
>0.9 = normal
0.6-0.9 = mild disease
0.3-0.6 = moderate/severe disease
<0.3 = severe/critical ischaemia
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10
Q

What are the 6 P’s of critical limb ischaemia?

A 
Pain
Pallor
Pulseless
Paralysis
Parathesia
Perishingly cold
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11
Q

How can intermittent claudication be managed?

A

General lifestyle changes
Optomise medical treatments for co-morbidities (HTN, diabetes)

Medical treatment:
Atorvastatin
Clopidogrel
Naftidrofuryl oxalate (peripheral vasodilator)

Surgical:
Angioplasty and stenting
Bypass surgery

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12
Q

How should critical limb ischaemia be managed?

A

Urgent referral to vascular team
Analgesia
Urgent revascularisation (angioplasty and stenting or bypass surgery)

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13
Q

What are the features of critical limb ischaemia, and how many are required in order for a diagnosis to be made?

A

Rest pain in foot for >2 weeks
Ulceration
Gangrene

(1 or more)

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14
Q

How may a person with AAA present?

A 
Asymptomatically - through screening
Symptoms of PAD
Non-specific abdominal pain
Palpable expansile pulsation in the abdomen
Incidental finding on AXR
Diagnosed by US/angiography (MRI/CT)
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15
Q

What is the screening progress for AAA?

A

AUS for men at 65

AAA 3-4.4cm - AUS every 2 years
AAA 4.5-5.4cm - AUS every 3 months
AAA >5.5cm - surgery for repair

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16
Q

How should a patient with an AAA of less than 5.5cm be managed?

A

Treat reversible risk factors
Monitor size
Treat PAD

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17
Q

What surgical options are available in the management of AAA?

A

EVAR
Laparoscopic repair
Open repair

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18
Q

What are the ideal properties which make a patient more amenable to EVAR intervention for an AAA?

A

Long neck
Straight iliac vessels
Healthy groin vessels

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19
Q

How may a person with a ruptured AAA present?

A

Severe abdo pain (radiate to back)
Haemodynamically unstable
Collapse

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20
Q

Define a true aneurysm

A

Aneurysm affecting all three layers of the artery wall (intima, media and adventitia)

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21
Q

Define a false aneurysm

A

Single layer of fibrous tissue forms the aneurysm wall

22
Q

What is an aortic dissection?

A

A break in the lumen of the aorta causes blood to flow between the layers of the wall of the aorta creating a false lumen

23
Q

What risk factors for associated with an aortic dissection?

A

HTN
Ehlers-Danlos syndrome
Marfan’s syndrome

+ smoking, lack of exercise, increasing age etc

24
Q

How may a patient with an aortic dissection present?

A 
Sudden onset tearing chest pain
Radiates to back
HTN --> hypotension
Paraplegia, angina etc
Aortic regurgitation
25
Q

What are the two types of aortic dissections?

A

Type A: Ascending aorta

Type B: Origin of left subclavian artery

26
Q

How should a type A aortic dissection be managed?

A

IV beta-blockers

Emergency surgical repair

27
Q

How should a type B aortic dissection with no end organ effects be managed?

A

Medically - analgesia, IV beta blockers and monitoring

28
Q

How might an aortic dissection appear on CXR?

A

Wide mediastinum

29
Q

What is carotid artery stenosis?

A

Stenosis of the carotid artery secondary to atherosclerosis

30
Q

How can carotid artery stenosis be diagnosed?

A

Carotid ultrasound

Angiography (CT/MRI)

31
Q

How can a person present with carotid artery stenosis?

A 
Asymptomatic
Syncope
TIAs
Amaurosis fulgax
Carotid bruit
Cognitive impairment
32
Q

What is amaurosis fulgax

A

Painless, temporary loss of sight in one/both eyes (like a curtain)

33
Q

How can carotid artery stenosis be managed?

A

Treat modifiable risk factors
Carotid endarterectomy if stenos >70%
Angioplasty and stenting

34
Q

Describe the development of varicose veins

A

Deep veins and superficial veins are connected by perforators which have valves

The valves in the perforators become incompetent so blood can flow from the deep veins to the superficial veins

Superficial veins become overloaded with blood –> dilate and engorge - a varicose vein

35
Q

The superficial veins become leaky due to the higher pressures, what is the result of this?

A

Haemosiderin deposited into shins –> brown discolouration –> legs become dry and inflamed –`> varicose eczema

36
Q

How can varicose veins present?

A

Cosmetically unappealing dilated superficial leg veins

Heavy/dragging sensation in legs

Muscle cramps

37
Q

What are the complications associated with varicose veins?

A

Ulcers
Infection
Thrombophlebitis
DVT

38
Q

How can varicose veins be managed?

A

Mobilise, elevate legs, compression bandages

Surgery:
Endothermal ablation
Sclerotherapy
Stripping of veins

39
Q

What is lipodermatosclerosis

A

in varicose veins, the skin and soft tissue becomes fibrotic so the lower legs become tight and narrowed

40
Q

What is the pathophysiology of arterial ulcers?

A

Poor blood supply to the skin due to PAD

41
Q

What is the typical appearance of arterial ulcers?

A 
smaller, punched out 
sloughy base
pallor
absent pulses
painful 
pain worse when elevated, relieved when hanging
42
Q

What is the pathophysiology of venous ulcers?

A

Pooling of blood and waste products in the skin secondary to venous deficiency (varicose veins, DVT, phlebitis)

43
Q

What is the typical presentation of venous ulcers?

A 
Gaitor region
Oedematous flushed skin
Hyperpigmentation in skin
Varicose eczema
More likely to bleed
Tend to be larger than arterial ulcers
Pain relieved by elevation, worse when hanging
44
Q

How should ulcers be managed?

A

Treat underlying cause
Good wound care
Debridement, cleaning, dressing
Antibiotics if infected
Tissue viability nurse and district nurses
Plastic surgery input if severe ?skin grafts

45
Q

What is a Marjolin’s ulcer?

A

Squamous cell carcinoma in a chronic ulcer

46
Q

What is lymphoedema?

A

Chronic, oedematous condition secondary to disruption or inadequate lymph drainage of an area

47
Q

What is primary lymphoedema?

A

Idiopathic condition which usually presents in the first 3 decades of life
More common in girls
Result of a congenital lymphatic abnormality

48
Q

What is secondary lymphoedema?

A

Lymphoedema caused due to infection, malignancy, radiotherapy, surgery

49
Q

What are signs of lymphoedema?

A

Swollen limb
Thick, scaly skin
Lymphadenopathy - ?malignancy

50
Q

If a person has lymphoedema, what infection are they prone to?

A

Cellulitis

51
Q

How can lymphoedema be managed?

A

Massage - manually drain the lymphatic system
Compression bandages
Surgery - rare with generally poor outcomes

Medicine finals (12 decks)

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