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Flashcards in Vascular Surgery Deck (50):
1

Causes: Surgically Repairable Hypertension

A. Vascular Causes
B Endocrine Causes

2

Vascular causes: Surgically repairable hypertension

1. Renal artery stenosis
- atherosclerosis
- fibromuscular dysplasia
2. Renal artery aneurysm
3. Renal arteriovenous malformation/fistula
4. Renal artery dissection
5. Renal artery emboli
6. Renal artery trauma
7. Neurofibromatosis affecting kidney
8. Takayasu's arteritis affecting renal artery
9. Coarctation of Aorto
- congenital
- large vessel arteritis
10. Occulsive aortic disease

3

Endocrine causes: Surgically repairable hypertension

1. Adrenals
- phaeochromocytoma
- primary hyperaldosteronism (Conn's syndrome)
- Cushing's syndrome
2. Pituitary
- Cushing's Disease
3. Thyroid
- hyperthyroidism
- hypothyroidism
4. Parathyroid
- hyperparathyroidism (1, 2, 3)
5. Pre-eclampsia

4

Define Aneurysm

Localised permanent dilatation of an artery >150% of its normal diameter

5

Define Dissection

Progressive separation of the vessel wall layers resulting in a false lumen

6

True vs False Aneurysms

True involves all vessel wall layers,
False does not involve the layers of vessel wall - surrounding tissues form the wall of the aneurysm

7

Morphologies of Aneurysm

1. saccular
2. fusiform

8

Aetiology: Aneurysms

1. Degenerative
2. HIV
3. Mycotic
4. Dissection
5. Trauma
6. Genetic
7. Inflammatory

9

How HIV causes vascular disease

- increased dyslipidemia
- increased endothelial damage
- opportunistic mycotic infections
- autoimmune response

10

Risk factors: AAA

smoking
hypertension
first-degree relative with AAA

11

Types of AAA rupture

Free, into retroperitoneum
Aortacaval fistula
Rupture into GIT

12

Indications for AAA repair

1. Rupture
2. Size >5.5cm
3. Expansion >0.5cm in 6/12 or >1cm in year
4. Symptomatic: pain, thromboembolism, infection
5. Prevent complications

13

Increased risk of AAA rupture

Females
Hypertensive
Young patient
Renal failure

14

Complication: AAA Endovascular Repair

Recurrence
Delayed rupture
Endoleak
Thrombosis
Renal artery occlusion
Pelvic ischaemia (impotence!)
Groin haematoma
Access site infection

15

Complications: AAA Surgical Repair

Myocardial infarction
Arrhythmias
Renal failure
Ischaemic colitis
Prosthetic graft infection
Limb loss
Erectile dysfunction
Bowel adhesions
Paraplegia

16

Symptoms: Iliac Aneurysm

ureteric obstruction
compression neuropathy
unilateral leg swelling

17

Aetiology: Carotid Artery Disease

Atherosclerosis
Kink and coil
Fibromuscular dysplasia
Internal carotid artery dissection
Carotid artery aneurysm
Radiation arteritis
Takayasu's arteritis
Carotid body tumour

18

Clinical manifestations: Carotid Artery Disease

Asymptomatic
TIA
RIND
CVA
Ophthalmic artery embolus
Vertebrobasilar disease

19

Complications: Carotid Angioplasty and Stenting

Distal embolisation
Restenosis
Bradycardia, hypotension
Carotid artery dissection
Access site complications

20

Avoid Carotid Angioplasty and Stenting:

Extensive calcification
Polypoid/globular lesions
Severe tortuosity of common carotid
Long stenotic segments
Carotid artery occlusion
Severe intimal thrombus
Extensive MCA atherosclerosis

21

Complications: Carotid Endarterectomy

Acute ipsilateral stroke
Excessive bleeding
Cranial nerve palsies
Neck haematoma

22

Risk factors: Atherosclerosis

Advanced age
Male gender/post-menopausal women
Hypertension
Hypercholesterolaemia
Smoking
Diabetes/obesity
Hypothyroidism

23

Aetiology: Peripheral Arterial Disease

1. Atherosclerosis
2. Takayasu's Arteritis
3. Thromboangitis Obliterans
4. Popliteal fossa conditions
5. Ionising radiation
6. Cyclists' iliac syndrome
7. Persistent Sciatic Artery

24

Common features: Takayasu's Arteritis

Hypertension
Retinopathy
Aortic incompetence
Angina
Abdominal pain
Claudication

25

Clinical presentation: Thromboangitis obliterans

Claudication
Raynaud's phenomenon
Migratory superficial thrombophlebitis

26

Popliteal fossa conditions causing PAD

Popliteal artery aneurysm
Popliteal artery entrapment
Popliteal artery adventitious cys

27

Differential: extremity pain suggesting PAD

Spinal stenosis
Nerve root compression
Chronic compartment syndrome
Nocturnal calf cramps
Peripheral neuropathy
Venous claudication
Hip arthritis

28

Aetiology: Acute Limb Ischaemia

Embolism
Thrombus
Trauma
Aneurysm complcations

29

Symptoms: Acute Limb Ischaemia

Pain
Pallor
Pulselessness
Parasthesia
Paralysis
Poikilothermia

30

Signs of irreversable ischaemia

total motor loss
total sensory loss
muscle rigidity
fixed skin changes
absent capillary refill
inaudible AV doppler flow
Symptoms >6hours

31

Leriche's Syndrome

Impotence
Buttock claudication
Absent femoral pulses

32

Critical Limb Ischaemia Features

Gangrene
Non-healing ulcers
Pallor on elevation, rubor on dependency
Rest Pain

33

Signs: Chronic Limb Ischaemia

Decreased/absent pulses
Bruits
Skin changes (hair loss, onychymosis, atrophy)
Muscle atrophy
Pallor on elevation
Rubor
Reactive hyperaemia
Decreased limb temperature
Ulcers

34

Aetiology: Carotid Artery Disease

Atherosclerosis
Kink and coil
Fibromuscular dysplasia
Internal carotid artery dissection
Carotid artery aneurysm
Radiation arteritis
Takayasu's arteritis
Carotid body tumour

35

Clinical manifestations: Carotid Artery Disease

Asymptomatic
TIA
RIND
CVA
Ophthalmic artery embolus
Vertebrobasilar disease

36

Complications: Carotid Angioplasty and Stenting

Distal embolisation
Restenosis
Bradycardia, hypotension
Carotid artery dissection
Access site complications

37

Avoid Carotid Angioplasty and Stenting:

Extensive calcification
Polypoid/globular lesions
Severe tortuosity of common carotid
Long stenotic segments
Carotid artery occlusion
Severe intimal thrombus
Extensive MCA atherosclerosis

38

Complications: Carotid Endarterectomy

Acute ipsilateral stroke
Excessive bleeding
Cranial nerve palsies
Neck haematoma

39

Risk factors: Atherosclerosis

Advanced age
Male gender/post-menopausal women
Hypertension
Hypercholesterolaemia
Smoking
Diabetes/obesity
Hypothyroidism

40

Aetiology: Peripheral Arterial Disease

1. Atherosclerosis
2. Takayasu's Arteritis
3. Thromboangitis Obliterans
4. Popliteal fossa conditions
5. Ionising radiation
6. Cyclists' iliac syndrome
7. Persistent Sciatic Artery

41

Common features: Takayasu's Arteritis

Hypertension
Retinopathy
Aortic incompetence
Angina
Abdominal pain
Claudication

42

Clinical presentation: Thromboangitis obliterans

Claudication
Raynaud's phenomenon
Migratory superficial thrombophlebitis

43

Popliteal fossa conditions causing PAD

Popliteal artery aneurysm
Popliteal artery entrapment
Popliteal artery adventitious cys

44

Differential: extremity pain suggesting PAD

Spinal stenosis
Nerve root compression
Chronic compartment syndrome
Nocturnal calf cramps
Peripheral neuropathy
Venous claudication
Hip arthritis

45

Aetiology: Acute Limb Ischaemia

Embolism
Thrombus
Trauma
Aneurysm complcations

46

Symptoms: Acute Limb Ischaemia

Pain
Pallor
Pulselessness
Parasthesia
Paralysis
Poikilothermia

47

Signs of irreversable ischaemia

total motor loss
total sensory loss
muscle rigidity
fixed skin changes
absent capillary refill
inaudible AV doppler flow
Symptoms >6hours

48

Leriche's Syndrome

Impotence
Buttock claudication
Absent femoral pulses

49

Critical Limb Ischaemia Features

Gangrene
Non-healing ulcers
Pallor on elevation, rubor on dependency
Rest Pain

50

Signs: Chronic Limb Ischaemia

Decreased/absent pulses
Bruits
Skin changes (hair loss, onychymosis, atrophy)
Muscle atrophy
Pallor on elevation
Rubor
Reactive hyperaemia
Decreased limb temperature
Ulcers