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RCSI SURGERY > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

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1
Q

causes of chronic limb ischema

A
  1. ATheroSCLeroSIS

other rare
1. FMD
2. radiation induced vascular injury
vasculides (Bueger disease and takayasu )

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2
Q

Rutherford (Fontaine ) system e

A 
I - asymptomatic 
II - I.C 
    a - claudication >200m
    b - claudication <200 m 
III - rest pain 
IV - ulcers , gangrene
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3
Q

definition of rest pain

A

SEVERE pain, typically in the sole of foot that is relieved at night and relieved by swinging the foot over the edge of the bed

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4
Q

critical limb ischemia

A

patient with rest pain >2 weeks and ulcers and gangrene

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5
Q

Leriche syndrome

A

occlusion at bifurcation of aorta causing TRAID

  • buttock/ thigh claudication
  • absent reduced femoral pulses
  • erectile dysfunction
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6
Q

what is the most common spot for I.C

A

distal superficial femoral artery - upper calf

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7
Q

Locations of I.C

A 
distal superficial femoral artery - upper calf 
popliteal artery - lower calf 
common femoral - thigh pain 
Aortoiliac - buttock and thigh pain 
Tibial / peroneal - foot pain
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8
Q

DDX of I.C

A
  1. Spinal stenosis
  2. Osteoarthritis
  3. Nerve root compression - sciatica
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9
Q

investigation of i.C

A
  1. ABI - < 0.8 in the affect limb
  2. Duplex US
  3. CT angio
  4. MRA
  5. Digital subtraction angiography - GOLD STANDARD - used only if surgery or endovascular intervention is considered
  6. AAA
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10
Q

what type of surgery can be used to unresponsive medical management of I.C or if they develop critical ischemia

A

Endarterectomy - isolated common femoral occlusion
Fem - fem bypass graft - unilateral femoral occlusion
Fem-pop bipass
Fem- distal bypass
Porto-bifem bypass

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11
Q

definition of acute lower limb schema

A

abrupt decrease in perfusion that threatens viability to the lower limb

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12
Q

Blue toe syndrome

A

Painful ischemic lesions of LL with intact pulses

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13
Q

Paradoxical emboli

A

from intracardiac shunts *PFO or AV malformation

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14
Q

Causes of acute limb ischema

A
  1. EMBOLI
  2. direct arterial damage
  3. Intra-arterial drug injection
  4. popliteal aneurysm
  5. iatrogenic
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15
Q

complication of reperfusion in acute lower limb ischemia

A
  1. Reperfusion injury
  2. Rhabdomyolysis
  3. Compartment syndrome
  4. Complicatiosn related to catheter
    - AV fistula
    - pseudoanneurysm
    - arterial dissection
    - arterial perforation
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16
Q

AAA

A

abnormal localized dilatation of aorta extending normal diameter by >50% or diameter > 3cm

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17
Q

screening for AAA

A

<5.5cm - US every 6 months

>5.5cm - Diameter repaired electively

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18
Q

AAA investigation

A
  1. US
  2. X-ray - calcification
  3. CT abdo
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19
Q

what are the findings you see on CT angio

A
  1. IV contrast with highly accurate in determining size and extent of aneurysm
  2. relation to renal artery
  3. presence of a leak
  4. if suitable for endovascular repair
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20
Q

Open surgery repair for AA

A

Dacron graft to repair the aneurysm

  • midline laparotomy
  • Aorta is clamped BELOW the renal artery to prevent renal ischema
  • graph is placed
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21
Q

Complication of AAA early

A 
EARLY 
- death, haemorrhage 
- MI , cardiac arythmies, cardiac failure 
- BOWL ischemia , abdominal compartment syndrome 
- Atelectasis , LRTI , ARDS 
- Endoleak 
- Renal dysfunction 
Limb ischemia, foot emboli 
Would infection 
Sexual impairment
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22
Q

Late complication of AAA

A
  1. Graft infection
  2. Graph occlusion
  3. graph migration
  4. Aortoembolic fistula
  5. Endoleak
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23
Q

Endoleak types

Study These Flashcards
A

TYPE 1: leak at attachment site of graph
TYPE 2: filling / aneurysmal sac by collateral vessels
TYPE 3: leak through defect in graph
TYPE 4: leak through the fabric of graph due to porosity
Type 5: expansion of aneurysm sac w/o evidence of leak on imaging

24
Q

how does a patient with thoraco-abdominal anneyrsm present

Study These Flashcards
A

Chest pain , back pain ,acute aortic regard and acute cardiac failure

WIDEN mediastinum on CXR

25
how does a patient with femoral anneyrsm present
pulsate groin swelling ± lower limb ischemia
26
visceral anneursm
Splenic artery aneurysms
27
RIND
reversible ischaemic neurological deficit - last > 24 hours from which recovery is complete
28
contraindication to carotid endarterectomy
Severe neurological deficit after cerebral infraction Occluded carotid artery severe comorbidities
29
carotid endarterectomy
LA or GA 1. incision along anterior boarder of SCM 2. smooth plane in the media of the artery 3. smooth tappering endpoint on internal carotid is obtained 4. endarterectomy is closed primarily OR with a patch - technical results is verified with angiography or duplex
30
Complication of surgical treatment
``` CVA OR MI - increase risk in stenting or endartectomy Death Would hematoma --> airway obstruction Recurrent stenosis CN 9,10,11 damage ```
31
cause of aterial ulcers
1. ARTHEROSCLEROSIS 2. ARTERIAL EMBOLIZATION Rarer: - vasospasm - trauma - prolonged exposure to cold Leads to; schema and ulcerations of the skin
32
cause of venous ulcers
Valvular impotence + adequate muscle pump action --> venous HTN 1. Venous stasis - capillaries distension and leakage of fibrin around surrounding vessels and prevents Oxygen and nutrients getting to the tissue 2. Increase Venous pressure --> damage of endothelial --> release of free radicals and enzymes --> destroys the tissue
33
what is linked to venous ulcers
Popliteal vein compression and obesity
34
treatment of venous ulcers
multilayer compression dressings that control exudates and colonization Antibiotics if cellulite present graduated compression stocking (RULE OUT ARTERIAL ) Skin grafting saphenofemoral ligation and varicose vein stripping
35
neuropathic ulcers cute
by trauma unnoticed by patient
36
features of neuropathic ulcer
- PAINLESS - punched out appearance - located over pressure points / calluses surrounded by inflammatory process
37
Diabetic ABI
- false elevated b/c diabetic foot
38
Diabetic ulcer RF
1. previous RF 2. Peripheral Neuropathy (Stocking distribution or Charcots) 3. Ass. PAD 4. Callusus 5. living aline 6. Other diabetic related complications
39
before angiography what must you tell that patient with diabetes
STOP METFORMIN 48 hours before to prevent lactic acidosis
40
how to treat an infected diabetic ulcers
1. BS antibiotics 2. + debridement of dead tissue 3. amputation 4. get x-ray to outrun osteomyltitis
41
venous system of let is comprised of three groups
1. superficial veins - long and short system and tributaries 2. deep venous system - running b/w muscular compartment of the leg 3. perforators in the calf and thigh - connects superficial and deep system
42
definition of saphenous veins
- tortuous dilatation segments of veins > 3mm in size ass/ w/ venous HTN caused by incompetent valves
43
complication of varicose veins 7
1. tortuous veins on exam 2. statsis dermatitis // eczema 3. phlebitis 4. lipoermatosclerosis - fibrosi dermatitis of subcutaneous tissue 4. skin pigmentation - due to heamosiderin deposition 6. Ulceration 7. Bleeding
44
saphena varix
thrill located at the SFJ
45
Perthes maneuver
test to dertmine potency of deep venous system - normally when tourniquet is one - you get patient to walk / toe stands - which empty veins - if deep vein obstruction exist - MORE CONGESTED
46
Trendelenburg test
used to distinguish patient with superficial venous reflux - empty veins while supine - close off varicose vein - just below SFJ - ask patient to stand - slow filling - superficial vein problem - if rapid filling = reflux pathway is involved
47
most accurate way to dx outpatient reflux of veins
Hand held doppler auscultation
48
Gold standard test for varicose beings
COLOR DUPLEX
49
surgical treatment for Varicose veins
1. Local stab avulsion 2. SF / SP ligation 3. LSV stippling 4. Endoscopic perforator ligation 5. radio frequency ablation 6. laser ablation
50
Complication post Varicose veins
1. Hematoma 2. Bleeding 3. Damage to rural and saphenous vein 4. recurrence 5. damage to surrounding artery 6. Infection
51
Homan's sign
Calf pain on dorsiflexion of foot (unreliable and should NOT be performed
52
when do you give an IVC filter
``` inserted percutaneously via jugular / femoral vein to catch and prevent PE's Used in: recurrent PE despite treatment C/I anticoagulant - major surgery ```
53
risk of IVC filter
``` PAH BIA pneumothorax Air embolism Heamothorax Bleeding IVC obstruction Arrhythmia ```
54
When do you use thrombolysis in DvT
1. ACUTE limb schema 2. Venous thrombi 3. Acute surgical graph occlusion 3. thromboses popliteal artery aneurysm
55
how do you give thrombosis in a patient with DVT who qualifies and what is the complication
``` give via a low dose intra-arterial infusion - allergy cather leak and occlusion nursing major bleed and stroke ```
56
complication of venous gangrene
1. PE | 2. venous gangrene

RCSI SURGERY (7 decks)

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