Vascular Surgery Flashcards
(27 cards)
Definition of PAD
Narrowing of the arteries leading to reduced blood supply, often resulting in claudication
Differences between neurogenic and vascular claudication
Vascular is worse uphill
Vascular is relieved by rest
Vascular has a positive bike test
Neurogenic is worse downhill (lordosis)
Neurogenic can be painful at rest
Neurogenic has a negative bike test
Neurogenic has a positive trolley sign
Weakness after walking
What is critical limb ischemia?
End-stage PAD where normal function is impaired at rest
What are the signs of critical limb ischemia?
Pain at rest (may be worse at night), non-healing ulcers and gangrene
What is acute limb ischemia?
“MI of the leg” - rapid onset ischemia
Signs of acute limb ischemia?
6Ps - pallor, pulselessness, pain, paraesthesia, perishing cold and paralysis
What is Leriche syndrome?
Occlusion of the distal aorta/proximal common iliac artery leading to male impotence, absent femoral pulses and thigh/buttock claudication
Investigations for PAD?
- ABPI
- Doppler US
- Angiography
What is Bueger’s test?
Lie flat and legs held at 45 degrees at the hip joint; pallor indicates obstruction > arterial system. Then legs over the side of the bed; pink is healthy, blue shows deoxygenated blood and dark red shows vasodilation from metabolic products
ABPI numbers and their meanings?
> 1.3 - calcification (diabetes)
0.9 - 1.3 - normal
0.6 - 0.9 - mild
0.3 - 0.6 - moderate to severe
<0.3 - severe to critical
Management of intermittent claudication
- lifestyle
- exercise training
- medical: atorvastatin 80mg, clopidogrel 75mg, naftidrofuryl oxolate (5-HT2 ant –> vasodilator)
- surgery: endovascular, endarterectomy or bypass
Management of critical limb ischemia
Surgery including amputation if needed
Management of acute limb ischemia
Acutely - A to E with UFH and analgesia
Surgery including amputation or thrombectomy if needed
Common features of an arterial ulcer
Occur distally
Small, deep and punched out
Less likely to bleed and paler
Well defined borders
Management of arterial ulcers
Atorvastatin, clopidogrel and naftidrofuryl oxolate (5-HT2 ant –> vasodilator), as per PAD
Common features of venous ulcers
Gaiter area
Larger, superficial and slopped edges
More likely to bleed
Less painful
Management of venous ulcers
Wound care - TVN or district nurses
Compressions stockings
Abx and analgesia as needed (avoid NSAIDs)
What is an aortic dissection?
A break or tear in the intima creates a false lumen in which blood can tract
Two types of aortic dissection?
Type A and B, affecting the ascending aorta and descending aorta
Three biggest risk factors of aortic dissection
HTN, surgery near the aorta and CTDs
Investigations for an aortic dissection
BPs on each arm
ECG and CXR
CT angio
Management of aortic dissection
Control BP and HR, usually with labetalol and consult vascular
Type As often need emergency surgery
Complications of an aortic dissection
- CVA
- MI
- Cardiac tamponade
- Aortic regurgitation
- Rupture
- Death
What is carotid stenosis?
Plaque formation of the carotid arteries leading to narrowing of the vessels
