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Vascular > Vascular Teaching > Flashcards

Vascular Teaching Flashcards

1
Q

What are the complications of varicose veins?

A

Phlebitis - 20%
Bleeding - 3%
Skin changes - 25%
Ulcers 5-10%

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2
Q

History - varicose veins

A

Symptoms -
Previous treatment
Medical history inc DVT, diabetes, anticoagulants

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3
Q

Physical exam for varicose veins

A

Site of varicosities
Signs of venous hypertensive complications - eczema, oedema, ulcers, scars from surgery, muscle wasting immobility
Palpate arterial pulses, look for tender and lumpy veins
Control at SFJ/SPJ - supine vs standing
Percuss - tapping test
Auscultation - trial or bruit over SFJ
Auscultation for reflux using hand-held Doppler

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4
Q

Key investigation in varicose veins?

A 
Duplex ultrasound scan 
Confirms or establishes source of reflux
Provides a roadmap
Assesses the deep veins
Allows treatment planning and helps guide treatment
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5
Q

Colour Doppler - physiology

A
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6
Q

Treatment of varicose veins - conservative

A

Leg elevation, exercise and weight loss
Compression stockings - difficult for patients to integrate into daily routine but are uncomfortable, lengthy treatment and do not cure the underlying problem
NOT TED stockings
NICE not recommended alone, but in
- pregnancy (40% increase in blood volume)
- pts unsuitable for invasive treatment

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7
Q

Truncal varicosities

A
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8
Q

Disconnection procedures for varicose veins

A
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9
Q

Endovenous therapy - laser vs radio frequency in varicose veins

A
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10
Q

Endovenous surgery - radiofrequency ablation

A
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11
Q

Cyanoacrylate embolisation - glue

Varicose vein

A
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12
Q

Venous ulcers - management

A
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13
Q

Assessment of the ulcer

A
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14
Q

Sensible dressing selection

A
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15
Q

Compression therapy - venous ulceration

A
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16
Q

Compression therapy - mechanism of action and art to successful compression??

A
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17
Q

Aetiology of DVT - … triad

A

Virchow triad

Changes to flow
Changes to blood coaguability
Changes to vessel wall

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18
Q

Management of DVT

A 
Prevention is the best management
Risk assess
Periop prophylaxis
Mechanical - TED stocking, early mobilisation, active intermittent mechanical compression
Coaguability - LMWH heparin

Manage DVT itself - anticoagulation, compression hosiery 2 week minimum

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19
Q

Role of thrombolysis

A

catheter directed thrombolysis
- mechanical clot disruption/aspiration, pharmacological lysis agents - e.g. alteplase
Iliofemoral DVT (only)
Venous infaction - beware, persistence of symptoms e.g. swelling

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20
Q

Post-thrombotic syndrome

A

A combination of patient reported symptoms and objective findings such as swelling and skin changes in patients following DVT of the upper or lower extremity
20-50% of patients after symptomatic DVT
5-10% will suffer severe PTS

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21
Q

Pathophysiology of PTS and CVI

A
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22
Q

Venous infarction

A
23
Q

Preventing upper extremity PTS

A
24
Q

Aneurysm - define

A

Permanent and irreversible, localised dilation of a blood vessel to at least 50% more than its expected normal diameter

25
Q

Ectasia - define

A

Permanent and irreversible, localised dilation of less than 50% of the normal diameter

26
Q

Arteriomegaly - what is this ?

A

Diffuse ectasia involving multiple arterial segments

27
Q

Aetiology of aneurysm

A 
Degenerative
Familial 
Vasculitic
Connective tissue abnormalities
Infected ‘mycotic’
28
Q

Age and gender distribution for aneurysm

A

More common in men

29
Q

Why Infra-renal aorta?

A
30
Q

Presentations of AAA

A 
Asymptomatic
Rupture
Compression
Embolism
Thrombosis
Fistulation
Infection
31
Q

Diagnosis of aneurysms ?

A

Clinical exam
Ultrasound imaging
Cross-sectional imaging

32
Q

Diagnosis of aneurysms - asymptomatic?

A

Ultrasound in asymptomatic individuals - highly reliable, cheap, portable

33
Q

Ruptured AAA

A
34
Q

Rupture risk - AAA

A
35
Q

When to treat AAA

A
36
Q

Screening for AAA

A 
Common condition, serious condition
Detectable at an asymptomatic stage 
Reliable test for diagnosis
Non-invasive test
Inexpensive - £63 per person
Men over 65 years target
Effective treatment - open and endovascular
Better outcome with early treatment
37
Q

UK national screening for AAA

A
38
Q

Open repair vs endovascular repair for AAA

A
39
Q

EVAR vs OPEN repair?

A
40
Q

Ischaemia - define

A

Deficiency in supply of blood flow (perfusion) to the tissue bed

41
Q

Absolute ischaemia - define

A

Insufficient perfusion to continue normal cellular process - is limb threatening

42
Q

Relative ischaemia - define

A

Insufficient perfusion to permit full function, ok at rest

43
Q

Acute ischaemia - define

A

Sudden occurrence of absolute ischaemia - 6PS

44
Q

Chronic ischaemia - define

A

Established insufficient perfusion > 2 weeks
Absolute - critical ischaemia - gangrene, rest pain
Relative - depends on need, asymptotic, claudication

45
Q

6 Ps of acute ischaemia

A 
A sudden decrease in limb perfusion causing a potential threat to limb viability
Pale
Painful
Pulseless
Perishingly cold
Paraesthetic
Paralysed
46
Q

Algorithm for limb ischaemia

A
47
Q

Acute limb ischaemia - causes

A

Embolisation - AF, endocarditis, proximal aneurysm
Thrombotic - rupture of an atherosclerotic plaque
Aneurysm - e.g. popliteal thrombosis
Trauma - fracture/dislocation, knife/gunshot wound, IV drug use, iatrogenic

48
Q

Thrombotic disease

A

Involves acute clot on underlying atherosclerosis
Thrombosis can clear acute clot and allow angioplasty/stent of underlying plaque
Surgery usually involves bypass

49
Q

Trauma management - limb ischaemia

A
50
Q

Compartment syndrome

A

When ischaemia muscle gets re-perfumed
Muscle oedema, pressure in compartment increases, causes micro vascular compromise and muscle necrosis
Intense pain - especially to passive movement
Paraesthesia in feet
Lack of pulse is late sign

51
Q

Chronic ischaemia (PVD, PAD, PAOD)

A

Risk factor mods
- smoking, antiplatelets, statin, ACEi, claudication clinic
Try not to intervene unless critical = absolute ischaemia

52
Q

Critical ischaemia - treatment options

A

Angioplasty +/- stent often first option
Long segment occlusion, vein conduit - bypass
Amputation if tissue loss is advanced, low chance of revascularisation succeeding
Palliative if frail and not compos mantis

53
Q

Angioplasty

A

Seldinger technique
Trans-luminal
Sub-intimal
Technical innovations - crossing devices, debunking, lithoplasty
Stent developments - drug elution, covered stents
Trials against surgery, favour surgery slightly

54
Q

Bypass surgery - anatomical

A

Vascular (17 decks)

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