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Year 3 > Week 21 - Aneurysms, Ischaemic Limb, occulsions, arterial thrombosis, DVT > Flashcards

Week 21 - Aneurysms, Ischaemic Limb, occulsions, arterial thrombosis, DVT Flashcards

1
Q

what is an aneurysm

A

is an artery that has a localised dilation, with a permanent diameter of >1.5x that expected of the particular artery

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2
Q

what is a false aneurysm

A

other surrounding tissues form the wall of the aneurysm

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3
Q

where do pseudoaneurysms most commonly occur

A

in the femoral artery following a femoral artery puncture.

if there is inadequate pressure to the entry site of the puncture, then blood can spill out and form a haematoma. eventually the surrounding soft tissue will form the wall of the aneurysm

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4
Q

what is the difference between a psuedo and real aneurysm

A

the difference is that in a pseudoaneurysm there is still communication between the lumen and the fluid collection, but in a haematoma, there is either no connection or just a one way ‘leakage’ of fluid

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5
Q

what are the the two shapes of aneurysm

A

fusiform and sac-like

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6
Q

what is a fusiform aneurysm

A

describes a shape that is tapered at both ends (a bit like a raindrop with a pointy bit at both ends)

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7
Q

what is a sac like aneurysm

A

describes a more rounded characterisitc

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8
Q

what are the risk factors for aneurysmal disease

A

Hypertension
Smoking
Age
Diabetes
Obesity
High LDL levels
Sedentary lifestyle
Genetic factors – are more important in aneurysmal disease than in atherosclerotic disease, although they have a role in both.
10% of cases have a first-order relative also with the condition

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9
Q

what is the main risk of aneurysms

A

they have a tendency to dissect and rupture

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10
Q

where does an aortic aneurysm most commonly rupture into

A

the retroperitoneal space

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11
Q

what is used to ‘stage’ the aneurysm

A

ultrasound

it is accurate at assessing the site of the aneurysm, and easy to follow up cases to assess development

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12
Q

an aortic aneurysm of what size should be treated

A

an aneurysm that is greater than 5.5cm

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13
Q

what is thought to be a risk for rupture in an AAA

A

pain

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14
Q

what is an open laparotomy

A

the affected segment of aorta may be clamped and replaced by a prosthetic segment

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15
Q

what is the most common graft done in an open lapraotomy

A

a Dacron graft

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16
Q

what is EVAR

A

Endoluminal surgery – EVAR – Endovascular aneurysm repair

n aortic graft is inserted through the femoral artery, and up into the abdominal aorta. This method is generally preferred (lower mortality 1.2%) but many patients are not suitable. There must be at least 2.5cm normal aorta between the aneurysm and the renal arteries to securely fix the graft in place.

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17
Q

when does acute limb ischaemia happen

A

when there is a blockage of a peripheral artery, either from a thromboembolism, or sometimes from an embolic plaque

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18
Q

As the MI is to coronary artery disease, acute limb ischaemia is to peripheral vascular disease

A
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19
Q

what are the classic 6 P’s of acute limb ischaemia

A

Pulseless
Paraesthesia
Pain – muscles also become tender to palpation after about 6-8hours
Paralysis
Pallor
Perishing cold

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20
Q

what is seen on the skin in acute limb ischaemia that implies irreversibility

A

fixed mottling

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21
Q

how is diagnosis of acute limb ischaemia given

A

you can roughly localise the blockage by locating the bifurcation distal to the last palpable pulse

diagnosis is clinical

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22
Q

what percentage of cases of ACI are fatal

A

22%

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23
Q

what is given via the local arterial catheter in acute limb ischaemia

A

tissue plasminogen activator - thrombolytic agent

24
Q

what can reperfusion injury lead to

A

compartment syndrome

25
Q

where are the common sites for occlusion

A

splanchnic arteries
superior mesenteric
coeliac arteries
renal arteries

bifurcation of the aorta

26
Q

what are the signs of renal artery occlusion

A

sudden onset flank pain
haematuria

27
Q

what test should you perform on all suspected ischaemic bowel patients

A

lactate - normal lactate makes the condition unlikely

28
Q

where does the thrombus travel in a DVT

A

travels from the deep veins, through the right side of the heart and into the lungs, where it becomes lodged in the pulmonary arteries

29
Q

what happens when a DVT travels to the pulmonary arteries

A

it blocks blood flow to areas of the lungs and this is called a PE

30
Q

what happens if the patient has a hole in their heart

A

the blood clot can pass through the left side of the heart and into the systemic circulation. it can travel to the brain and cause a large stroke

31
Q

what are thrombophilias

A

conditions that predispose patients to develop blood clots

32
Q

what are examples of thrombophilias

A

Antiphospholipid syndrome
Factor V Leiden
Antithrombin deficiency
Protein C or S deficiency
Hyperhomocysteinaemia
Prothombin gene variant
Activated protein C resistance

33
Q

if you can remember one cause of recurrent VTE what should it be

A

antiphospholipid syndrome.

the common association you may come across in exams is recurrent miscarriage. the diagnosis can be made with a blood test for antiphopholipid antibodies

34
Q

what is VTE prophylaxis usually in the hospital

A

low molecular weight heparin such as enoxaparin

35
Q

what are the contraindications for VTE prophylaxis

A

active bleeding or existing anticoagulation with warfarin or a DOAC

36
Q

what is the main contraindication for anti-embolic compression stockings

A

peripheral arterial disease

37
Q

how does one examine for leg swelling

A

measure the circumference of the calf 10cm below the tibial tuberosity. more than 3cm difference between calves is significant

38
Q

what is the scoring system used to predict risk of patient who is presenting with symptoms of having a DVT or PE

A

the Wells score

it includes risk factors such as a recent surgery, clinical findings such as unilateral calf swelling 3cm greater than the other leg

39
Q

what is required to diagnose DVT

A

doppler ultrasound of the leg

NICE recommends repeating negative ultrasound scans after 6-8 days if a positive D dimer and Well’s score suggest a DVT is likely

40
Q

what is initial management of a suspected or confirmed DVT or PE

A

starts with anticoagulation

41
Q

what are two examples of anticoagulation

A

apixaban or rivaroxaban

42
Q

what do NICE recommend considering for patients with a symptomatic iliofemoral DVT and symptoms lasting less than 14 days

A

catherter-directed thrombolysis

43
Q

what are the options for long term anticoagulation in VTE

A

DOAC, warfarin or LMWH

44
Q

what are DOACs

A

oral anticoagulants that do mot need monitoring

45
Q

give four examples of DOACs

A

apixaban
rivaroxaban
edoxaban
dabigatran

46
Q

what is warfarin

A

a vitamin K antagonist

47
Q

what is the target INR for warfarin when treating PEs and DVTs

A

between 2 and 3

48
Q

in which patients is warfarin first line

A

in patients with antiphospholipid syndrome

49
Q

what is the first line anticoagulant in pregnancy

A

LMWH

50
Q

how long do you continue anticoagulation if there is a reversible cause

A

3 months

51
Q

how long do you continue anticoagulation if the cause is unclear, there is a recurrent VTE, or there is an irreversible underlying cause such as thrombophilia

A

beyond 3 months

52
Q

how long do you continue anticoagulation for in patients with active cancer

A

3-6 months

53
Q

what are inferior vena cava filters

A

devices inserted into the IVC, designed to filter the blood and catch any blood clots travelling from the venous system, towards the heart and lungs

they act as a sieve, allowing blood to flow through whilst stopping larger blood clots

54
Q

when are inferior vena cava filters used

A

in unusual cases of patients with recurrent PEs or those who are unsuitable for anticoagulation

55
Q

what is investigated when patients have their first VTE witihout a clear cause,

A

NICE guidlines recommend reviewing the medical history, baseline blood results and physical examination for evidence of cancer

56
Q
A

Year 3 (63 decks)

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