Vascular Flashcards by Belle Storey

What is the definition of an arterial aneurysm?

Abnormal dilation >150% original diameter of blood vessel due to weakness in the vessel wall

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What is the difference between a true aneurysm and a false aneurysm?

True: abnormal dilation of blood vessel

False: collection of blood around the vessel wall communicating with the lumen

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What is the meaning of a ‘number needed to screen’ in screening programs

Number of patients who will need to be screened by the programme to prevent one excess death

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Why may the number needed to screen be quite high in AAA

Relatively rare disease

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Screening outcome:

<3cm
3-4.4cm
4.5-5.4cm
>5.5cm

<3cm no further action
3-4.4cm rescan every 12 months
4.5-5.4cm rescan every 3 months
>5.5cm - refer within 2 weeks to vascular

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Name 2 causes of AAA

Atheromatous degeneration (smoking, HTN)
Connective tissue disorders (e.g. Marfan’s)

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List 4 CVD risk factors

Smoking
FH
DM
HTN
Hyperlipidaemia
Increasing age
Male

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Name 4 possible complications of AAA surgery

Bleeding
Infection
DVT/PE
MI

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a) What factor would make a pt with AAA a candidate for endovascular aneurysm repair as opposed to laparotomy?

b) What are the possible disadvantages of using EVAR?

a) Multiple co-morbidities

b) Long-term follow up, high re-intervention rate

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Sudden-onset severe abdominal and back pain, low BP, tachycardic, tender expansile mass

Most important diagnosis to consider? Name 2 other diagnoses

Ruptured AAA

Acute pancreatitis, acute MI

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Diagnostic imaging in stable AAA

CT angiogram

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Name 2 investigations important in AAA

FBC
Cross-match at least 6 units
Amylase
U&E
ECG

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A pt loses 4L of blood intraoperatively

Name 2 blood products that Barry requires

RBC
Fresh frozen plasma
Platelets

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2 days post-op, mottled skin and darkened segments in toes - what is this phenomenons name and what is it due to?

Cholesterol embolism - atheromatous debris shed during surgery travels and lodges in distal vessels

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Innermost layer to outermost layer, name the 4 layers of an arterial vessel wall

Endothelium (intima)
Tunica media
Tunica externa
Adventitia

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Name a cell type that may be present in an aneurysmal wall

Fibroblasts
Macrophages
Lymphocytes

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Sudden-onset severe lower leg pain, absent limb pulses

Serious diagnosis to consider?

Acute limb ischaemia

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Other than pain, name 4 other symptoms associated with peripheral vascular disease

Pallor
Perishingly cold
Paraesthesia
Paralysis

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What are the 2 commonest causes of acute limb ischaemia

Acute thrombosis
Emboli

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What 2 treatments can you institute in the interim before surgical treatment in acute limb ischaemia?

High flow oxygen
IV opioids
IV unfractioned heparin infusion
IV fluids

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Name 2 possible definitive treatments for acute limb ischaemia

Why must definitive treatment be performed urgently?

Intra-arterial thrombolysis
Surgical embolectomy
Angioplasty
Bypass surgery
Amputation

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Explain how heparin prevents blood clots

activation of anti-thrombin III (inactivates thrombin and factor Xa)

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Name 2 potential disadvantages using a heparin infusion

frequent monitoring of APTT and dose adjustment
increased risk of haemorrhage
heparin-induced thrombocytopenia

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Burning pain in calf and thigh that develops when walking 50 yards and pt needs to stop and rest until it goes away - name of symptom?

Intermittent claudication

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What disease is intermittent claudication a symptom of? What other diseases is he at risk of?

Peripheral vascular disease Atherosclerotic diseases: - Stroke - MI - Mesenteric ischaemia - Acute limb ischaemia

Conservative treatment for PVD

Smoking cessation Weight loss Diet and exercise

Pain in leg at rest and pt has to hang leg out of bed at night to relieve his pain - symptom of PVD?

Critical ischaemia

Explain 2 possible locations of an arterial stenosis causing impotence and buttock pain

Internal iliac artery Common iliac

Diagnostic investigations for PVD

ABPI Doppler duplex Angiogram CT/MRI angiogram

1 blood test a pt may undergo before angioplasty and stenting

U&E (IV contrast and renal disease) clotting (as using arterial puncture) group and save glucose, lipids (RFs) FBC

Guide wire fed from arterial puncture in the common femoral into the aorta - list the arteries it would have to travel through

common femoral external iliac common iliac aorta

What does incidence rate mean?

number of new cases in a given population in a given time frame

Why might the incidence of TIAs be decreasing?

Better AF control with anticoagulation Better control of CVD RFs

What may an ECG reveal about a TIA

AF Old infarcts - both can cause emboli

Name 2 radiological investigations indicated in TIA

MRI head Carotid doppler Echo

What criteria make up the ABCD2 score?

Age Blood pressure Clinical features (weakness, speech w/o weakness) Duration (> 60 min) Diabetes

Pt feels like a curtain fell over left-eye vision which lasted about 10 minutes - name of symptom and what causes it

Amaurosis fugax Blocking of central retinal artery

Name 2 specific risks of carotid endarterectomy

Death Major disabling stroke MI Wound haematoma

For a carotid endarterectomy, an incision is made anterior to the sternomastoid and the carotids are dissected and clamped - what structures are at risk of damage in this area?

Hypoglossal nerve Vagus nerve internal jugular

Why does doing a carotid endartectomy under regional anaesthetic have advantages

Patient can stay awake and respond to command sto look for neurological deficits Avoids risks of GA

What is the definition of an ulcer?

Abnormal break in an epithelial surface

List 4 possible vascular complications of long-term diabetes

Nephropathy Retinopathy Neuropathy MI Stroke PVD

List 4 causes of skin ulceration

Venous disease Arterial disease Vasculitis Infection Trauma Neuropathy

Ulcers may be neuropathic or ischaemic - how would you distinguish

Neuropathic: sensory loss Ischaemia: cold foot and absent pulses

What 2 things can help a pt prevent ulcers

Improve diabetic glycaemic control Chiropody for callus removal and pressure area care Education (don't walk bearfoot, right shoes)

Why must metformin be stopped for 48h before angiogram

It can interact with IV contrast precipitating lactic acidosis

Left-toe ulcer becoming increasingly painful and leaking offensive pus Principles of management?

Broad-spectrum antibiotics for underlying osteomyelitis Debridement of dead tissue Drainage of pus

What should be used for prevention of DVT in surgical patients at high risk of DVT?

LMWH Compression stockings Early mobilisation

What are the clinical features of a unilateral DVT?

Swelling and warmth Redness Pain Mild fever Tachycardia Pitting oedema

Name 4 risk factors for DVT

Long haul flight COCP Immobility Cancer Recent surgery

What are the 3 aspects of virchows triad?

Stasis Vessel damage Hypercoagulability

Why should a D-dimer be used with caution in DVT?

sensitive but not specific

Investigation warranted if pelvic or lower-limb DVT is suspected

Duplex USS of leg

Treatments for DVT a) short term b) long term

a) DOAC (apixaban or rivaroxaban) b) DOAC, warfarin, LMWH

What are 2 possible complications of complete DVT?

PE, chronic venous insufficiency

Apart from oral anticoagulant therapy, what further mechanical treatment may be possible for DVT

IVCF

List 3 indications for an amputation

gangrene major trauma necrotising fasciitis

Name 2 examples of each of the following that are transected in a below-knee amputation: bones, arteries and muscles

Bones: tibia, fibula Arteries: common peroneal, posterior tibial Muscles: soleus, gastrocnemius, tibialis anterior

What is important to ensure with regard to the operative site?

Ensure correct limb is marked Ensure no cellulitis at operative site

Burning pain where the limb used to be after amputation - what is it and what is the bases

phantom limb - hypersensitivity of divided nerves

What sort of medical treatments are available for neuropathic pain?

ADs e.g. amitriptyline Antiepileptics e.g. gapapentin, carbamazepine

Broadly, what are the main stages of the model of wound healing?

Haemostasis (fibrin plug) Inflammation (cytokines recruit macrophages - ECM) Proliferation (angiogenesis and collagen production) Remodelling (scar tissue)

How do varicose veins arise?

Incompetent valves, dilation of veins - this leads to venous HTN causing worsening valve incompetence and further dilation

List 2 risk factors for varicose veins

Family history Prolonged standing Obesity Pregnancy

Name 2 conditions that may cause varicose veins

Gravid uterus Ovarian mass Pelvic tumour DVT

What skin changes would you look for in varicose veins?

Eczema Venous ulceration Oedema Lipodermatosclerosis

Where is the saphenovenous junction located?

5cm below and medial to femoral pulse

What non-medical interventions could you advise a pt of for varicose veins

Support stockings Avoid prolonged standing Weight loss Regular walking

What complications may arise in long-term varicose veins?

Bleeding Pain Ulceration Psychological

Saphenofemoral ligation and long saphenous tripping a) what nerve could get damaged? b) what symptoms would this produce below the knee?

a) Saphenous nerve b) Loss of sensation and paraesthesia in medial and anterior aspect of calf

Major bleeding - first 3 things to assess

Airway (w/ cervical spine protection) Breathing Circulation (haemorrhage control)

What can be done immediately for a life-threatening wound?

Direct pressure to wound Elevation of wound

a) What are the boundaries of the femoral triangle? b) What structures are at risk from an injury to this region?

Inguinal ligament, adductor longus, sartorius Femoral artery, femoral vein, femoral nerve, lymphatics

What signs on examination suggest vascular injury?

Absent or reduced pulses Expanding or pulsatile mass Audible thrill over mass

What complications can arise from a vascular injury?

Gangrene Amputation

12 hours post-op, excruciating pain in leg Surgical emergency?

Compartment syndrome Fasciotomy

Medical management of PVD

Antihypertensives Statin therapy Antidiabetic therapy if required Antiplatelets

Vascular Flashcards

(77 cards)