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Vascular Disease Flashcards

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1
Q

Treatment for atherosclerosis?

A 
Stop smoking
Exercise
Nutrition
Antiplatelet drugs
Beta blockers, statins, antihypertensives
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2
Q

Is there infection with wet gangrene? Dry gangrene?

A

Wet: yes; with cellulitis and purulent drainage
Dry: no; mummification without infection

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3
Q

What diagnostics do we need with peripheral vascular disease?

A

ABI: >9 is normal; less then 0.8 is claudication; less than 0.4 is rest pain or tissue loss-DO THIS
Color flow doppler ultrasound-DO THIS
Magnetic resonance angiography-gold standard

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4
Q

What does an ABI >1 indicate?

A

Calcification

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5
Q

Treat for mild to moderate claudication without rest pain or tissue loss?

A

Non-operatively:

  • Graded exercise (40-60 mins most days)
  • Antiplatelets
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6
Q

Treatment for severe claudication with interference?

A

Stop smoking; control HTN, DM, cholesterol
Antiplateets
Operative management

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7
Q

What is an acute arterial occlusion?

A
  • Sudden onset of pain
  • Usually an acute thrombosis from a chronically stenosed vessel; can be thromboembolism (a-fib; AA)
  • The 6 P’s
  • Treatment: immediate thrombectomy if ischemia; anticoagulation; if no ischemia thrombolytic therapy
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8
Q

How long does leg ischemia take to cause a reperfusion injury?

A

Over 6 hours

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9
Q

What is a reperfusion injury?

A
  • Leg ischemia over 6 hours

- Neutrophils migrate; limb swells; cell leakage leads to acidosis, hyperkalemia, ATN and free radical formation

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10
Q

Can you have carotid bruits without stenosis?

A

Yes, and you can have stenosis without a bruit

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11
Q

How do we diagnose/screen for carotid artery stenosis?

A

Carotid US
MRA?
Arteriography

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12
Q

Treatment for mild to moderate carotid artery stenosis?

A

Antiplatelet or anticoagulation: controversia
Routine surveillance
Tx of risk factors

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13
Q

Treatment for severe or symptomatic carotid stenosis?

A

Endarterectomy of carotid

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14
Q

When should we treat carotid artery stenosis?

A

Symptomatic patients with >50% stenosis

Asymptomatic, healthy patients with >60% stenosis

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15
Q

Contraindications to carotid artery endarterectomy?

A

Occluded artery
Severe neurologic deficit following CVA
Concurrent serious medical illnesses

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16
Q

Treatment for Buergher’s disease?

A

STOP SMOKING

Patients may have superficial thrombophlebitis of hands and feet

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17
Q

What can cause renal artery stenosis in young female patients?

A

Fibromuscular dysplasia

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18
Q

Treatment for renal artery stenosis?

A

Angioplasty w/ stenting

Endarterectomy

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19
Q

How doe we diagnose renal artery stenosis?

A

Renal US

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20
Q

Most common spots for aneurysms?

A

Infrarenal aorta
Iliac arteries
Popliteal arteries

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21
Q

What are false aneurysms associated with?

A

Injuries and infections

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22
Q

Which aneurysms tend to rupture?

A

AAA and iliac aneurysms

Popliteal and femoral rarely rupture; can cause thrombi that embolize arteries of the calf and foot

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23
Q

Best diagnostic for an asymptomatic aneurysm?

A

US

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24
Q

If elective surgery is planned on an aneurysm, what do we always need?

A

CTA or arteriogram

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25
At what size do AAAs become pulsatile?
Over 5 cm
26
Classic triad of symptoms for ruptured AAA?
Sudden back pain Hypotension Pulsatile abdominal mass
27
When should we operate on an AAA?
-Asymptomatic: Over 5-5.5 cm in men Over 4.5 cm in women -Rapidly enlarging -Symptomatic
28
If patient presents with classic triad for ruptured AAA, should we get a CT?
No CT scan Call surgeon Get ready for bleed: large bore IVs, crystalloid, etc. Can do US if readily available and can be transported to patient
29
What is the elective surgery for an AAA?
Endovascular repair - Done with radiologist - Get CTA
30
Complications of AAA repair?
MI, renal failure, colonic ischemia | Graft infection, aorto-enteric fistula, endoleak (endovascular)
31
Most false aneurysms are found where?
Femoral artery: after arteriograms
32
When should we repair femoral aneurysms?
True> 2 cm if throwing emboli | Repair pseudo aneurysms if they don't resolve on own: US guided thrombin injection
33
What aneurysms are usually found with AAAs?
Iliac
34
When should we repair iliac aneurysms?
Over 4 cm | CTA needed if elective
35
Do popliteal aneurysms usually rupture?
NO But they can embolize Blue toe syndrome
36
When do we repair popliteal aneurysms?
Over 2 cm | CTA if elective
37
How do we diagnose a DVT?
Duplex US
38
Prevention for DVTs?
Ambulation LMWHm warfarin SCDs/IPC
39
How does a DVT present in the extremity?
Unilateral swelling or pain | Holman sign?
40
Risk factors for DVT?
``` OCPs HRT Neurologic disease Pregnancy Cancer ```
41
What are some genetic hyper coagulable states?
Deficiencies of antithrombin III, protein C or S Factor V Leiden Elevated factor VIII
42
What is phlegmasia alba dolens?
Pale, pulseless, cool skin
43
What is phlegmasia cerulea dolens?
Cyanosis then gangrene
44
What is criterion standard for diagnosing DVTs?
Venography
45
What imaging do we need if we suspect a DVT in the IVC or iliac vein?
CT
46
How does the Wells Rule apply to DVTs?
>3 points: high risk 75% 1-2 points: moderate risk 17% <1 point: low risk 3%
47
Prophylaxis for DVTs from surgery?
Mechanical therapy Early ambulation SQ heparin, LMWH, or warfarin
48
Pharm treatment for DVTs?
Anticoagulation: First LMWH or IV heparin Then long-term Warfarin Ist DVT: 3-6 months 2nd: Prolonged or lifelong; lifelong w/ risk factors Thrombectomy/thrombolysis if renal, subclavian, SVC, or iliofemoral
49
When should we initiate therapy for DVTs without diagnostic results?
If high suspicion: do it Intermediate suspicion: do if >4 hours till data Low suspicion: wait 24 hours
50
Treatment of what DVTs are controversial?
Calf DVTs | -Of you don't treat: need follow-up Doppler US
51
Main symptoms of PE?
Dyspnea, pleuritic chest pain, hemoptysis
52
Criterion standard for diagnosis of PE?
Pulmonary angiography
53
Imaging of choice for diagnosing a PE?
CT angiography | -Stable patients
54
When should we use a V/Q scan?
If there is renal insufficiency
55
How does Well's Prediction for PE work?
>6: high risk 2-6 points: moderate <2 points: low risk
56
How do we treat a PE?
Anticoagulation Thrombolytics if pt. stable but compromised IVC filter if pt. can't take above Last resort: embolectomy (80% mortality rate)
57
Treatment for superficial thrombophlebitis?
NSAIDS Heat Elevation Compression and walking
58
Treatment for varicose veins?
Stockings, elevation and exercise-1st line! | Surgery: recurrent thrombophlebitis; erosions; pain
59
What should we do if superficial thrombophlebitis is near saphenofemoral junction (SFJ)?
Full anticoagulation
60
What causes primary varicose veins?
Valve incompetence at SFJ
61
Recommended surgery for varicose veins?
Endovenous laser treatment (EVLT) | Radiofrequency ablation
62
What causes chronic venous insufficiency?
Venous HTN: - Obesity - Vein obstruction - Valve incompetence
63
Presentation of chronic venous ultrasound?
Swollen legs Hemosiderin deposits at ankles Venous stasis ulcers: medial or lateral malleolus
64
Treatment for chronic venous insufficiency?
``` Elevation Unna boots Leg elevation Exercise Surgery in rare cases ```
65
What is lymphedema?
Painless edema of LE Pitting first then rubbery Lymphangitis and cellulitis
66
Diagnostics/treatment for lymphedema?
Duplex US to rule out venous insufficiency and DVT Compression/massage/good skin care Elevation and diuretics DO NOT HELP
67
Color changes in Raynaud's syndrome?
White---->Blue (cyanosis)---->Red (hyperemia)
68
Difference between Raynaud disease and Raynaud phenomenon?
Disease: common and benign Phenomenon: older women: SLE and scleroderma; positive ANA and see rate; more severe w/ occasional tissue loss
69
Treatment for Raynaud's
Avoid OCPs, drugs that reduce CO | CCBs and ARBs

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