Vascular surgery Flashcards
(44 cards)
What is intermittent claudication?
Symptoms of ischaemia, occurs during exertion and is relived by rest, crampy/achy pain in calf/thigh/buttock (equivalent to stable angina)
What is critical limb ischaemia?
End stage of peripheral arterial disease, inadequate blood supply to limb results in pain at rest, non-healing ulcers and gangrene (equivalent to unstable angina)
What is acute limb ischaemia?
Rapid onset of ischaemia in a limb typically due to thrombus blocking the arterial supply of a distal limb (equivalent to MI)
What are the risk factors for peripheral vascular disease?
Older age, family history, male, smoking, alcohol consumption, poor diet, low exercise, poor sleep, obesity, stress
What are the 6 P’s of acute limb ischaemia?
Pain, pallor, pulselessness, paralysis, paraesthesia, perishingly cold
What ABPI indicates mild, moderate and severe peripheral vascular disease?
Normal = 0.9-1.3
Mild = 0.6-0.9
Moderate = 0.3-0.6
Severe = <0.3
What investigations are done in peripheral vascular disease?
1st line = duplex USS
CT/MRI angiography can be used to investigate following duplex USS
What medical management should everyone with peripheral arterial disease be taking?
Atorvastatin 80mg
Clopidogrel 75mg
How is critical limb ischaemia managed?
Urgent vascular referral, analgesia, surgery including stenting or bypass
How is acute limb ischaemia managed?
Urgent vascular referral, analgesia, IV heparin, surgical management
What are the risk factors for AAA?
Male, increased age, smoking, hypertension, family history, existing cardiovascular disease
Who is screened for AAA?
All men are offered screening USS at age 65 to detect asymptomatic AAA
What diameter of aorta requires referral and at what point does it become urgent?
> 3cm need referring
5.5cm urgent (within 2 weeks)
What investigation other than USS is done in AAA?
CT angiogram - gives more detailed picture of aneurysm and helps guide elective surgery to repair
For people with identified AAA how often are they rescanned?
Yearly in those 3-4.4cm
3 monthly in those 4.5-5.4
When is a AAA booked in for elective repair?
Symptomatic, diameter growing more than 1cm a year, diameter >5.5cm
What is the presentation of a ruptured AAA?
Severe abdo pain that may radiate to back or groin, hypotension and tachycardia, pulsatile and expansile mass in abdomen, loss of consciousness
What is the management of ruptured AAA?
Permissive hypotension, immediate surgical repair
What is aortic dissection?
Break or tear forms in the inner layer of the aorta allowing blood to flow between the layers, a false lumen is created
What is type A/type B aortic dissection?
A = ascending
B = descending
What are the risk factors for aortic dissection?
Hypertension, age, male, smoking, poor diet, connective tissue disorders
What is the presentation of aortic dissection?
Sudden onset severe ripping/tearing chest pain, may have large differences in BP between arms, may have abdo pain, hypotension
What investigations are done in aortic dissection?
ECG and CXR to exclude other causes
CT angiogram = initial investigation
MRI angiogram provides greater detail
How is aortic dissection managed?
Analgesia, BP and HR need to be well controlled to reduce stress on aortic walls (use beta blockers), surgery
