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Year 6 - Surgery > Intro Wk: Vasc > Flashcards

Intro Wk: Vasc Flashcards

1
Q

Atherosclerosis RFs

A 
Elderly
Male
FHx
HTN
Diabetes
Hyperlipidaemia
Smoker
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2
Q

How does PAD px? (3)

A

Claudication: pain and cramping in the calf after a certain distance

Critical Limb Ischaemia: rest pain, night pain, tissue loss

Acute Limb Ischaemia: sudden onset <2wks, 6P’s

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3
Q

What is Leriche syndrome? (3)

A

Internal iliac vasc def: buttock claudication, impotence, reduced pulses

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4
Q

Ddx of claudication ie pain when you walk (2)

A

Spinal stenosis + post thrombotic syndrome

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5
Q

What is the perfusion pressure in critical limb ischaemia?

A

<40mmHg

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6
Q

Which of the 6P’s of ALI comes on early and starts to worry you?

A

Paraesthesia

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7
Q

How does the ABPI relate to PAD px?

A
  1. 7-0.9: claudication
  2. 4-0.7: critical limb ischaemia

<0.4: acute limb ischaemia

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8
Q

Why can reperfusing the leg be life threatening?

A

Cardiac arrest, VF, VT

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9
Q

What is the arterial blood supply to the lower leg?

A

Popliteal -> Anterior Tibial + Tibioperoneal Trunk -> Posterior Tibial + Peroneal

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10
Q

What are important components of your clerking when a pt presents w leg pain?

A

Timing, RFs, DHx, prev scars

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11
Q

Where do you amputate up to?

A

The level where there’s most blood supply ie dead foot below knee and dead ankle above knee

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12
Q

What is the surface anatomy landmark for the femoral artery?

A

The mid-inguinal point ie half way b/w ASIS + pubic symphysis

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13
Q

What is Buerger’s angle + test?

A

The angle at which the raised leg becomes pale where <20° is severe

If you get reactive hyperaemia seen as a sunset foot when the pt sits following the leg raise the test is pos

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14
Q

What are the two shapes of true aneurysms?

A

Fusiform + Saccular

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15
Q

Who is screened for AAA?

A

Single USS for males >65yrs

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16
Q

Ddx of left sided loin to groin back pain (2)

A

AAA + Renal Colic

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17
Q

When do you operate on an AAA?

A

2wk referral to vasc surgery for EVAR/open repair if: sx, >5.5cm, expansion rate >1cm per annum

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18
Q

What is the mortality rate for an emergency AAA repair?

A

Half will make it into hospital and half will make it out

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19
Q

What is the f/u for open vs EVAR?

A

Open - once at 5yrs vs EVAR - yearly

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20
Q

Aortic Dissection: Type A vs B

A

A: before left subclavian

B: beyond left subclavian

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22
Q

Mx of Aortic Dissection

A

Med: invasive bp monitoring + IV beta blockers and analgesia

Surg: gold standard for type A under cardiothoracics and if rupture, uncontrolled pain or malperfusion of aortic branches or lower extremities then also required for type B under vascular surgeons

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23
Q

What is the consequence of aiming for a SBP <120 when mx dissection?

A

Oliguric

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24
Q

Def of Oliguria

A

UO <0.5ml/kg/hr

25
Q

What is the risk of a long segment of phlebitis or if it’s close to groin?

A

DVT

26
Q

What is phlegmasia?

A

Extensive DVT preventing superficial venous system from draining causing painful oedema and may lead to arterial ischaemia and venous gangrene

27
Q

What is phlegmasia a/w?

A

Underlying malignancy + hypercoagulability

28
Q

What can you give a large proximal DVT within 2wks?

A

Thrombolysis vs after 2wks too high risk of post thrombotic syndrome

29
Q

Which pts would you consider a venous bypass in?

A

Unable to live their life due to recurrent ulceration and pain

30
Q

Ulcers: Venous v Arterial v Neuropathic - Background, Description, Location

A

Venous: chronic venous insufficiency, shallow flat margins w exudate, medial malleolus / gaiter region

Arterial: PAD, painful deep punched out w necrotic tissue, lateral malleolus / feet

Neuropathic: diabetics, deep insensate surrounded by callus, planter aspect of foot

31
Q

What is Marjolin’s ulcer?

A

Aggressive SCC due to chronic ulceration/burns/osteomyelitis that becomes neoplastic w rolled edges

32
Q

How often do you rescan a AAA b/w 3-5.4cm?

A

3-4.4cm every 12m + 4.5-5.4cm every 3m

33
Q

What is the workup for intermittent claudication?

A

Hx, check lower limb pulses, ABPI, duplex US, MRA prior to any intervention

34
Q

Mx of PAD

A

Consv: stop smoking, exercise training, tx comorbidities

Med: atorvastatin 80mg + clopidogrel 75mg

Surg: angioplasty, stenting, bypass

35
Q

Mx of Superficial Thrombophlebitis

A

Perform USS to exclude concurrent DVT, if ABPI >0.8 compression stockings, LMWH 30d or oral NSAIDs 8-12d

36
Q

Mx of ALI

A

Surg intervention within 6hrs to revascularise the leg

37
Q

Dx of Critical Limb Ischaemia

A

> =1: rest pain in foot >2wks, ulceration, gangrene

38
Q

When would an ABPI be >1.2?

A

Usually in type two diabetics due to vessel calcification

39
Q

RFs for AAA

A

Smoking
HTN
Syphilis
CTD

40
Q

What is the biggest risk factor for ALI in pts w/o any prev claudication?

A

Embolus>Thrombus: AF

41
Q

What are the classic skin changes of chronic venous insufficiency and a/w venous ulcers?

A

Eczema
Oedema
Haemosiderin
Lipodermatosclerosis

42
Q

Mx of Venous Ulcers

A

Conserv: four layer compression banding after exclusion of arterial disease

Surg: skin grafting if >10cm^2 or fail to heal after 12wks

43
Q

Mx of Neuropathic Ulcers

A

Conserv: cushioned shoes to red callous formation

Surg: likely to lead to amputation

44
Q

What may a cervical rib cause?

A

Thoracic Outlet Syndrome

45
Q

What is subclavian steal syndrome?

A

Stenosis/occlusion of subclavian artery proximal to origin of vertebral artery resulting in retrograde flow and sx of CNS vascular insufficiency

46
Q

What are the branches off the arch of aorta?

A

L/R Coronary Arteries

Brachiocephalic: R Subclavian Artery + R Common Carotid

L Common Carotid: external + internal

L Subclavian Artery: vertebral, internal thoracic, thyrocervical trunk, costocervical trunk, axillary

47
Q

What is Takayasu’s arteritis? Px? Tx?

A

Large vessel granulomatous vasculitis in young asian females resulting in intimal narrowing

Px w features of mild systemic illness and then pulseless phase w sx of vascular insufficiency

Tx w systemic steroids

48
Q

What are the classical findings in aortic coarctation?

A

A/w congenital heart defect

Px w syncope, angina pectoris, leg claudication

Weak arm pulses, radiofemoral delay, BP mismatch, low ABPI

49
Q

How is ABPI derived?

A

Ankle/Branchial

50
Q

Ddx for Rib Notching: Inferior + Superior

A

Inferior: enlargement of structure in subcostal groove - aortic coarctation, Takayasu arteritis, Blalock-Taussig shunt, SVC obstruction, schwannoma, neurofibroma

Superior: disturbance of osteob/clastic activity - oesteogenesis imperfecta, hyperparathyroidism, intercostal muscle stress

51
Q

What does the urgency of tx for an aortic coarctation depend on?

A

Presence of congestive cardiac failure

52
Q

What is Roesler sign?

A

Inferior Rib Notching

53
Q

Why do you get inferior rib notching in long standing aortic coarctation?

A

The intercostal collateral vessels dilate to try and bypass the coarctation and supply the descending aorta

54
Q

What does Adson’s test and Wright’s test assess?

A

Presence of thoracic outlet syndrome

Adson’s: monitor radial pulse as pt extends arm backwards, turns their head toward sx side, takes deep breath and holds

Wright’s: monitor radial pulse and sx onset during abduct and ext rotation of arm for one min then hyperabduct

55
Q

Tx of Raynaud’s Disease: white -> blue -> red

A

CCB

56
Q

Why is the IMA not usually revascularised during AAA tx?

A

The cross over supply from the SMA and rectal arteries

57
Q

What are specific risks to an EVAR?

A

Ischaemia, Leak, Reop

58
Q

What are the specific risks to an open AAA repair?

A

Ischaemia, ED, Incisional Hernia

Year 6 - Surgery (27 decks)

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