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Y4 Surgery > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

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1
Q

what is an aneurysm?

A

focal dilatation of a blood vessel to more than 1.5x its normal diameter

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2
Q

what sex is most commonly affected by AAA?

A

males

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3
Q

what co-exists in around 25% of patients with a AAA?

A

femoral or popliteal aneurysms

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4
Q

what is the main cause of an AAA?

A

degenerative changes

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5
Q

Describe the 369 rule for bowel obstruction on AXR

A

Describes the cm of dilation that suggests diagnosis on a scan

Small bowel >3cm
Large bowel >6cm
Caecum >9cm

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6
Q

What investigation is done in the case of a suspected AAA rupture, and when would this not ne done?

A

CT angiography

Not done if the patient is haemo-dynamically unstable = straight to theatre

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7
Q

What are the two surgical options for managing a ruptured AA?

A

Open surgical repair
EVAR

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8
Q

What is the target systolic BP in patients with a ruptured AAA?

A

70-80mmHg

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9
Q

What is an aneurysm?

A

Abnormal dilatation of a blood vessel by more than 50% of its normal diameter

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10
Q

At what diameter is a AAA diagnosed?

A

> 3cm (normal is 2cm)

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11
Q

What effect does diabetes have on the risk of AAA?

A

Reduces

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12
Q

Name three risk factors for AAA?

A

Smoking
Male sex
Hyperlipidaemia

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13
Q

How do the vast majority of AAA’s present?

A

Asymptomatic, found at screening (75%)

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14
Q

What triad of symptoms can be seen in symptomatic, inflammatory AAA?

A

Low back pain
Weight loss
Raised ESR

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15
Q

What is the mortality rate for AAA rupture?

A

90%

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16
Q

What is the classic triad of symptoms of a ruptured AAA?

A

Abdominal or back pain
Hypovolaemia
Pulsatile abdominal mass

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17
Q

What test is done for AAA screening?

A

Abdominal USS

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18
Q

What size of AAA should be rescreened and when?

A

25-39mm
At 5-10 years

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19
Q

What is the gold standard investigation when planning management for AAA?

A

CTA

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20
Q

What medications should a patient with a AAA be put on to minimise risk factors?

A

Anti-platelet
Statin
Anti-hypertensives

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21
Q

What medication may have an effect on AAA growth rate?

A

Metformin

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22
Q

When should a AAA that is 30-44mm be measured?

A

Anually

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23
Q

When should a AAA that is 45-54mm be measured?

A

3 monthly

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24
Q

When is repair of a AAA indicated?

A

Diameter >55mm
Symptomatic = urgent repair
Rapid expansion (>10mm/year)

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25
What are the two options for surgical repair fo a AAA?
OSR EVAR
26
What is an endoleak?
A surgical complication The persistence of blood flow outside the lumen of an endo-vascular stent graft
27
What are the rules about driving with a AAA for car drivers?
Inform DVLA when >60mm Suspended when >65mm
28
What are the rules about driving with a AAA for HGV drivers?
Inform when >55mm, suspended until repaired
29
What are acute aortic syndromes?
A group of conditions that affect the thoracic aorta
30
Name the three acute aortic syndromes?
Aortic dissection Intra-mural haematoma (IMH) Penetrating aortic ulcer (PAU)
31
What is an aortic dissection?
A tear in the intima of the aorta, allowing blood to form a false lumen between the intima and the adventitia
32
What are the two classification systems for aortic dissection?
Stanford system DeBakey system
33
Describe the Stanford system for classifying aortic dissection
A = proximal to the left subclavian B = distal to the left subclavian
34
Which type of aortic dissection, according toe the Stanford system, is an acute emergency?
A
35
Describe the DeBakey system for classifying aortic dissection
1 = ascending to descending aorta 2 = ascending only
36
Describe the DeBakey system for classifying aortic dissection
1 = ascending to descending aorta 2 = ascending only 3a = beyond the origin of the LSA, above the diaphragm 3b = beyond the origin of the LSA, below the diaphragm
37
What is the best test for an aortic dissection?
CT angiogram
38
How is a type A aortic dissection managed?
Emergency surgery - usually involves aortic root replacement with bypass
39
How is an uncomplicated type B aortic dissection managed?
IV beta blockade
40
How is a complicated type B aortic dissection managed?
TEVAR
41
How is a chronic type B aortic dissection managed?
Annual surveillance Beta blocker and CCB
42
What is an intramural haematoma (IMH)?
Clotted blood in the intramural space in the absence of an obvious intimal tear
43
What condition is IMH associated with?
Hypertension
44
What are the possible complications of IMH?
Dissection Rupture
45
What is the least common acute aortic syndrome?
Penetrating aortic ulcer (PAU)
46
What causes a PAU?
Focal ulceration of a plaque into the media
47
Which has a better prognosis - PAU or dissection?
Dissection
48
What is acute limb ischaemia?
A sudden reduction in perfusion to a limb, causing a potential threat to limb viability
49
What classification system is used for acute limb ischaemia?
Rutherford classification
50
What is the classical presentation of acute limb ischaemia (the 6 P's)?
Pain Pallor Paraesthesia Paralysis Perishingly cold Pulseless
51
Why is calf tenderness in acute limb ischaemia concerning?
Suggests there is severe muscle ischaemia
52
What bloods should be done for acute limb ischaemia?
FBC U+Es Coagulation
53
What is the first line imaging for acute limb ischaemia?
CTA
54
What medication should be given initially for acute limb ischaemia?
Unfrac1tionated heparin - 5000 unit bolus followed by an infusion
55
What is the first line imaging for carotid disease?
Duplex scan
56
What is the primary intervention in carotid disease?
Risk factor control
57
What medications should be started in carotid artery disease?
Low dose aspirin (clopidogrel if intolerant) Atorvastatin 40-80mg
57
How does diabetic peripheral neuropathy present?
Progressive, symmetrical loss of sensation in the distal lower extremities Can be painful
58
What classification systems can be used for diabetic foot ulcers?
SINBAD WIFI system
59
Describe the foot of a patient with a neuropathic ulcer
Warm, well perfused Bounding pulse Distended veins Callus present
60
Where do neuropathic ulcers tend to form?
Sites of repetitive trauma
61
What is the most important initial step in neuropathic ulcers?
Pressure offloading - best method is with a total contact cast
62
What can precipitate an ischaemic ulcer?
A minor infection
63
How is osteomyelitis in a diabetic foot managed?
Up to 6 weeks of antibiotics Amputation if this fails

Y4 Surgery (6 decks)

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