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Phase 2- Periop > Vascular Conditions > Flashcards

Vascular Conditions Flashcards

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1
Q

What are varicose veins?

A

Dilated segments of veins associated with valve incompetence. The blood flow from the deep venous system flows to the superficial venous system resulting in venous hypertension and dilatation of the superficial venous system

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2
Q

Give 4 causes of varicose veins

A 
Idiopathic (98%)
DVT 
Pregnancy 
Uterine fibroids
Ovarian masses
Arteriovenous malformations
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3
Q

Give 3 risk factors for varicose veins

A

Prolonged standing
Obesity
Pregnancy
Family history

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4
Q

How do varicose veins present?

A 
Often cosmetic complaint
Pain 
Itching 
Swelling 
Skin changes (varicose eczema) 
Ulceration 
Thrombophlebitis
Bleeding
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5
Q

What classification system is used in varicose veins?

A

CEAP classification

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6
Q

What is meant by C0 on the CEAP

chronic venous disorders classification score?

A

No visible or palpable signs of venous disease

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7
Q

What is meant by C1 on the CEAP chronic venous disorders classification score?

A

Telangiectasia or reticular veins

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8
Q

What is meant by C2 on the CEAP chronic venous disorders classification score?

A

Varicose veins

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9
Q

What is meant by C3 on the CEAP chronic venous disorders classification score?

A

Oedema

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10
Q

What is meant by C4a on the CEAP chronic venous disorders classification score?

A

Pigmentation or eczema

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11
Q

What is meant by C4b on the CEAP chronic venous disorders classification score?

A

Lipodermatosclerosis or atrophie blanche

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12
Q

What is meant by C5 on the CEAP chronic venous disorders classification score?

A

Healed ulcer

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13
Q

What is meant by C6 on the CEAP chronic venous disorders classification score?

A

Active venous ulcer

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14
Q

How is a varicose vein diagnosed?

A

Duplex ultrasound to assess valve competence and DVT risk

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15
Q

How are varicose veins managed conservatively?

A 
Avoid prolonged standing
Weight loss
Exercise
Compression stockings 
Bandage ulcers to compress leg
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16
Q

How are varicose veins managed surgically?

A

Vein ligation, stripping and avulsion
Foam sclerotherapy
Thermal ablation

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17
Q

Give 3 indications for surgery in varicose veins

A

Symptomatic primary or recurrent varicose veins
Lower limb skin changes
Superficial vein thrombosis
Venous leg ulcer

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18
Q

Give 3 post-op complications of varicose vein surgery

A 
Haemorrhage 
Thrombophlebitis
DVT 
Recurrence
Nerve damage
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19
Q

What is acute limb ischaemia?

A

Acute limb ischaemia is the sudden decrease in limb perfusion which threatens the viability of the limb. It results from partial or complete occlusion of arterial blood supply to the limb

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20
Q

Give the 3 main causes of acute limb ischaemia

A

Thrombosis
Embolism
Trauma

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21
Q

What are the symptoms of acute limb ischaemia?

A 
Pain 
Pallor
Paraesthesia
Pulselessness
Perishingly cold 
Paralysis
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22
Q

How is acute limb ischaemia classified?

A 
I = viable 
IIa = marginally threatened 
IIb = immediately threatened 
III = irreversible (major tissue loss, permanent nerve damage)
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23
Q

How is acute limb ischaemia initially managed?

A

High flow oxygen
IV access
Heparin infusion

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24
Q

How is acute limb ischaemia managed surgically?

A 
Embolectomy 
Local intra-articular thrombolysis
Bypass surgery 
Angioplasty 
Amputation of limb
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25
Give 3 complications of acute limb ischaemia
Compartment syndrome Hyperkalaemia Acidosis Rhabdomyolysis
26
What is an ulcer?
Break in the skin or mucous membrane
27
What is the most common type of ulcer?
Venous ulcer (80%)
28
What is the pathophysiology of a venous ulcer?
Retrograde flow of blood in the venous system causes venous dilation. Blood pools distally and oxygen delivery to the skin is impaired. Ulcers form over the path of the long and short saphenous veins.
29
What do venous ulcers look like?
Shallow Irregular borders Granulating base Other signs of venous insufficiency present --> varicose veins, oedema, lipodermatosclerosis, atrophie blanche, telangiectasia
30
Give 3 risk factors for venous ulcer formation
``` DVT Varicose veins Trauma Pregnancy Obesity ```
31
How are venous ulcers managed?
Conservative --> leg elevation, increased exercise, emollients, antibiotics, 4-layer compression bandaging Medical --> antibiotics, radiofrequency ablation Surgical --> varicose vein surgery
32
What is the pathophysiology of an arterial ulcer?
Reduction in arterial blood flow leading to reduced perfusion of the tissues and poor wound healing.
33
What do arterial ulcers look like?
Small, deep lesions Necrotic base Found at pressure areas and sites of trauma
34
Give 3 risk factors for arterial ulcers
``` Smoking Type II diabetes Hypertension Hyperlipidaemia Old age Family history Obesity ```
35
What symptoms are associated with an arterial ulcer?
``` Intermittent claudication Critical limb ischaemia Pain Cold limbs Necrotic toes Hair loss ```
36
How is an arterial ulcer managed?
Conservative --> stop smoking, weight loss, increase exercise Medical --> statins, aspirin, optimise blood pressure and blood glucose Surgical --> angioplasty, bypass grafting, skin reconstruction
37
What is the pathophysiology of a neuropathic ulcer?
Peripheral neuropathy causes a loss of sensation in the feet which then leads to unnoticed injuries and repeated stress causing painless ulcers at the pressure points.
38
Give 2 risk factors of developing a neuropathic ulcer?
Concurrent vascular disease Diabetes B12 deficiency
39
What do neuropathic ulcers look like/present as?
``` Variable in size and depth Punched out appearance Warm feet Good pulses Tingling in feet ```
40
How is a neuropathic ulcer managed?
``` Diabetic foot team Control diabetes Reduce CV risk Antibiotics Amputation in severe cases ```
41
What is Charcot's foot?
Commonly seen alongside neuropathic ulcers. Neuroarthropathy where a loss of joint sensation results in unnoticed trauma. The foot becomes deformed and the deformity predisposed to ulcers. Presents with pain, swelling, distortion and loss of function.
42
What is a DVT?
Blood in the deep veins of the legs or pelvis clots and forms a mass.
43
Give 5 risk factors for a DVT
``` Immobility Surgery Obesity Heart failure Trauma Infection Sepsis Pregnancy Diabetes Smoking Malignancy Thrombocytopenia ```
44
What criteria is used to predict DVT risk?
Wells criteria
45
What factors are included in the Well's score?
All score 1 point: Active cancer Paralysis or immobilisation of lower limb Bedridden for >3 days or major surgery <12 weeks Localised tenderness along route of the deep veins Swelling of the entire leg Calf swelling at least 3cm larger than other leg Pitting oedema in affected leg Collateral superficial veins Previously documented DVT -2 points: Alternative diagnosis at least as likely as DVT
46
Give 4 signs of a DVT
Swollen calf Red, hot, tender leg Prominent superficial veins Oedematous feet
47
Give 4 signs of a PE
``` Pleuritic chest pain Tachycardia Tachypnoea Cough Haematemesis Venous eczema ```
48
Give 4 ways to prevent a DVT
``` Exercise TED stockings Pneumatic compression boots Heparin Warfarin Remove COCP ```
49
How is a DVT diagnosed?
D-dimer Ultrasound CT
50
How is a DVT treated?
Anticoagulation for 12 weeks (heparin) Compression stockings Thrombolysis
51
What is an abdominal aortic aneurysm?
Dilatation of the aortic aneurysm greater than 3cm
52
Give 4 risk factors for an AAA
``` Trauma Infection Connective tissue disease Inflammatory disease Smoking Hypertension Hyperlipidaemia Family history Male Elderly ```
53
How can an AAA present?
Most are asymptomatic Abdominal pain, back or loin pain, limb ischaemia, syncope
54
Who is screened for AAA?
Men over the age of 65
55
Give 3 complications of AAA
Aortoduodenal fistula Embolism Retroperitoneal leak AAA rupture
56
How is an AAA managed?
<5.5cm --> monitor via USS, smoking cessation, control blood pressure, statins, aspirin, weight loss >5.5cm --> open repair (midline laparotomy), endovascular repair (use a graft and stent) >6cm --> stop driving
57
What is the main surgical complication of endovascular treatment of an AAA?
Endovascular leaking: incomplete seal around the aneurysm results in blood leaking around the graft. Aneurysm can continue to grow and can rupture.
58
How would a patient present with a ruptured AAA?
Back pain, syncope, vomiting, hypotension, pulsatile abdominal mass
59
How is a ruptured AAA treated?
High flow oxygen, IV access, group and save, blood transfusion If stable --> CT scan If unstable --> straight to surgery for endovascular repair
60
What is ABPI?
Non-invasive method of assessing the extent of chronic arterial disease in the lower limbs. Ratio of the blood pressure in the brachial artery and the pressure in the dorsalis pedis and posterior tibial arteries.
61
In ABPI what does a value >1.2 mean?
Abnormally hard vessel
62
In ABPI what does a value <0.9 mean?
Arterial disease
63
What is gangrene?
Serious condition where loss of blood supply causes visible necrosis.
64
Give 3 risk factors for gangrene
Diabetes Atherosclerosis Peripheral artery disease Raynauds
65
Give 5 symptoms of gangrene
``` Redness Swelling Loss of sensation Pain Blisters Cold and pale skin Fever Loss of appetite Tachycardia Dizziness Shivering ```
66
What is dry gangrene?
Blood flow to the extremity is blocked
67
What is wet gangrene?
Combination of injury and bacterial infection
68
What is gas gangrene?
Infection develops deep inside the body and bacteria release gas
69
How is gangrene treated?
``` Debridement surgery Amputation Treat infection (antibiotics) Bypass surgery Angioplasty ```
70
What is claudication?
Pain or discomfort on walking which is relieved at rest. It is caused by narrowed arterial supply to the legs due to atherosclerosis which leads to peripheral artery disease.
71
Give 4 risk factors for leg claudication
``` Smoking Diabetes >70 yrs old Male Hypertension Hypercholesterolaemia Afro-caribbean descent Heart disease ```

Phase 2- Periop (5 decks)

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