Vascular Flashcards
What is this?
How can it be confirmed and rationale for this
What are the management priorities
**Phlegmasia cerulea dolens **
Confirm via:
* US lower limb - non compressable deep veins, no variance tp doppler pulse vein
* CT Venogram - assess clot burden and degree of clot. Map for intervention
Management
* Analgesia - dose and route
* Anti cogulation heparin infusion with loading
* Vascular surgery for embolisation
describe image and most likelt diagnosis
AAA approx 8cm
likely a bleed in the wall as fresh blood is white
what is the role of a CT in a ruptured AAA
if in a centre where endovascular is used CT is essential for planning and stent sizing
if laparatomy then it just delays time to theatre
collapse and abdo pain
?diagnosis
AAA
with an US confirmed AAA what would influence decision to do a CT
- are they shocked - if so then no
- proximitiy to CT
- pre surgical planning
- co-morbid status of patient
What are the definitive treatment options for AAA
Open repair
endovasculat stent
palliation
what are the CXR features of aortic dissection?
- Widening of the superior mediastinum
- Dilatation of the aortic arch
- Change in the configuration of the aorta on successive CXR
- Obliteration of aortic knob
- Double density of aorta (suggesting true and false lumen)
- Localised prominence along aortic contour
- Displacement of trachea to right
- Distortion of left main stem bronchus
- Pleural effusion
- Cardiomegaly
what featurs of bedside echo would differentiate acute MI from aortic dissection?
MI
* Regional wall motion abnormality
* hypokenesis
**
Aortic dissection**
* pericardial effusion
* dilated IVC (tampanade)
* Intimal flap
* AV incompetence
what are the classifications of aortic dissections?
Stanford
o A: Ascending aorta with or without descending
o B: Descending aorta only (distal to origin of left subclavian)
What is the management of acute aortic dissection
- Resus bay
- 2 large cannulas and send bloods and cross match
- IV analgesia
- IV rate control to 60 eg metoprolol
- IV BP control under 140 eg GTN
- Art line
- urgent transfer to centre which can have capacity for surgical fixing
major abnormality and diagnosis in chest pain
Large pericardial effusion
Thoracic aortic dissection with pericardial effusion, impending tamponade
what are the life threatening complications of aortic dissection
pericardia tampanade
stroke
MI
Severe AR
what are the risk factors for aortic dissection
- hypertension
- bicuspid aortic valve
- male
- increasing age
- CTD eg Ehlor danlos
- coarctation of aorta
why does aortic dissection cause hypotension
- pericardial tampanade
- aortic incompetence from aortic root dissection
- iatrogenic from drugs given
diagnosis
Type A aortic dissection
what are the clinical signs of aortic dissection
- loss of pulses
- neurology - from stroke or spinal ischaemia
- AR murmur
- becks triad - signs of tampadane (hypotension/muffled heard sounds and distended jugular veins)
- significant patient distress
type a thoracic dissection
4 findings and diagnosis
- necrotic 2nd toe
- pus
- cellulitis
- erythema with blister
Diagnosis
Diabetic foot infection with necrotic toe
diabetic foot:
Investigations and justifications
what are the causes of limb ischaemia with examples?
- thrombotic - atheroscletoric plaque
- embolic - AF, CCF, AAA
- other - dissection. septic embolic
Society for vascular surgery catergoes for limb ischaemia
what are the medications for limb ischaemia
- IV fentanyl aliquots and titrate to pain
- heparin infusion titrate to APTT
what are the interventional options for limb ischaemia
- Catheter-directed thrombolysis
- Embolectomy
- Bypass
features of limb ischaemia that suggests arterial embolism over thrombosis - on history
- sudden symptoms
- AF
- no history of atherosclerotic disease
- endocarditis
- atrial myxoma
