Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 4 > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

(77 cards)

Start Studying
1
Q

How much blood should be cross matched when carrying out AAA repair?

A

4-6 units cross matched

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors associated with AAA?

A 
Hypertension 
Smoking 
Atherosclerosis 
>55 years 
Male 
Family history 
Connective tissue disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When is screening offered for AAA?

A

One of US at age 65.
If >3.4cm - 4.4cm = yearly ultrasound
if >4.4 - 5.4cm = 3 monthly
if >5.5cm = surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the criteria for surgery for AAA?

A

> 5.5cm

advanced more >1cm in a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the symptoms of a rupture AAA?

A

Severe sudden epigastric pain, radiating to:

  • loins
  • back

Episode of blackout

Hypotension

**any male >50 should with loin or back pain should be suspected for ruptured AAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What surgeries are there for AAA?

A

Open surgery

Endovascular aneurysm repair (EVAR)

  • advantageous because done laparoscopically
  • disadvantage - high early re-intervention needed. life long follow up.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What complications can occur with EVAR?

A

Endoleak ~24%

Type 1: leak at attachment site

Type 2: Retrograde flow into aneurysm

Type 3: Graft defect leading to leak

Type 4: porus graft

Type 5: enlargement of aneurysm with no known cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What classification system is used for thoracic-abdominal aneurysms?

A

Crawford classification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Broadly what type of aneurysms are there?

A

True
- all layers of vessel wall are affected

Pseudoaneurysm:

  • haematoma forms containing blood leaking from a damaged vessel
  • caused by trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What important investigation should be done following a stroke, which may lead to surgery?

A

Carotid colour duplex scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Following a stroke, a stenosed carotid artery is seen, what surgery should be conducted and when?

A

Within 2 weeks a carotid endarterectomy should be conducted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What classification system is used for chronic lower limb ischemia?

A 
Fontaine Classification: 
I - asymptomatic 
II - Intermittent claudication 
III - Rest pain 
IV - Ulcers/ Gangrene

Type III & IV are considered severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some differentials for claudication pain?

A

Spinal stenosis

O/A
- at hip joint

Sciatica

Popliteal artery entrapment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What numbers of the ABPI correlate with symptoms?

A 
0 -.4 = ulceration/ tissue loss 
.2-.4 = severe rest pain 
.4-.9 = claudication 
1- 1.1 = normal 
>1.1 = calcification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which disease can lead to a high ABPI > 1.1?

A

Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some symptoms which suggest severe limb ischemia?

A

Rest Pain
ABPI <0.5
Opiate management / not relieved by simple analgesia
Ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the management of PVD?

A

40% with claudication will have coronary/ cerebral vascular disease. thus the main goal of treatment is to prevent further complications.

All put on:
- clopidogrel or aspirin
+
- Statin - regardless of lipid status

+
- lifestyle changes

Endovascular treatment:
- angioplasty + stent

Surgical:
- by-pass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What investigations should be done in a patient with claudication?

A

Typically it is diagnosed via physical exam.

ABPI
- doppler

Duplex ultrasound

Exercise ABPI

ECG

CT angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a key features of severe limb ischemia?

A

Muscle tenderness.

just touching the muscle causes severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the immediate management following a ruptured AAA?

A 
ABCDE
Immediate senior surgical assistance 
Cross match  - 10 units 
FFP 
Platelets

IV access
High flow O2
Modest amount of morphine

*do not chase normal blood pressure at risk of destabilizing clot

Straight to theatre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where does the superficial veins of the leg drain into the deep veins?

A

Saphenous- femoral junction

Mid- thing perforators

Short-saphenous - popliteal junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the typical classification system of varicose veins?

A

CEAP

C - clinical features C1 = telangiectasia veins, C6 = active ulcer

E - aEtiology

A - Anatomical

P - Pathophysiology
- reflux, obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the symptoms of varicose veins and how are they investigated?

A 
Pain 
aching 
heaviness 
swelling 
oedema

Eczema
Phlebitis
lipodermatosclerosis

*Colour duplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the treatment options for varicose veins?

A

Medical:

  • keeping legs raised
  • compressional bandages

Surgical:

  • Stripping veins
  • Ablation - radiofrequency
  • Sclerotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the definition of claudication?
Pain experienced in distal muscle groups Relieved by rest Reproducible - no good or bad days, always the same
26
During an exercise ABPI in someone with PVD, what would you expect the number to do?
Go down due to post stenosis dilation
27
What is the first line medical management for PVD?
Clopidogrel/ Aspirin + Statin Lifestyle changes Exercise regime - to improve collaterals
28
What is the criteria for critical limb ischemia?
> 2 weeks rest pain Need for opioid analgesia <50mmHg ankle systolic pressure / ABPI <0.5 or Non healing wound or gangrene
29
What is the management for critical limb ischemia?
Analgesia Endovascular intervention Surgical intervention Palliation
30
Following treatment for Acute limb ischemia, what other surgical procedure may need to be done to prevent further complication?
fasciectomy
31
High light some clinical signs seen for a non-viable limb:
Fixed staining of tissue Lack of blanching upon pressure of the limb Anaesthesia of the limb Rigor mortis
32
What are the risk factors for varicose veins?
Family history Standing for long periods of time Pregnancy Obesity
33
What has a cough impulse and may be mistaken for a femoral hernia?
Salpena Varix - varicose vein of the great saphenous vein at the femerol-saphenous junction
34
What is the diagnostic choice for varicose veins?
Duplex scan - 2secs retrograde flow after compression of limb/ tissue distal
35
What is the management of varicose veins?
Compressive stalking - only if surgical intervention is not indicated Surgical: - vein ligation - vein stripping - Foam sclerotherapy - Thermal ablation
36
What are the indication for surgery of varicose veins?
symptomatic Skin changes Ulceration Superficial vein thrombosis
37
What investigations should be done when there is acute limb ischemia?
Bloods: - Lactate - establish degree of hypoperfusion - group and save - coagulation studies ECG - assess for AF Imaging: D - doppler - CT Angiogram ** gold standard
38
What is the management of acute limb ischemia?
ABCDE assessment: - Provide O2 - Stabilise BP • Analgesia - opioid based * IV fluids * NIL by mouth * all patients are given LMWH * monitor APTT every 4-6 hours This is actually dependent on the severity and cause of the occlusion. All start on, typically for Rutherford 1-2a Rutherford Classification: • Heparin IV infusion For more severe types: >2b Rutherford Classification: * Embolectomy * Local intra-arterial Thrombolysis * Angioplasty * By - pass Irreversible Damage/ Rutherford >3 Here there will be mottled skin which is non blanching • Amputation
39
What are the complications of acute limb ischemia?
Mortality rate of 20% • Reperfusion injury = compartment syndrome • Release of substances from necrotic muscle - K+ - H+ Myoglobulins - AKI
40
What classification system is used for claudication?
Fontaine Classification I - Asymptomatic II - Intermittent claudication III - Rest pain IV - ulceration/ Gangrene
41
What is the 5 year mortality in those with chronic limb ischemia?
50%
42
What are the differentials for acute limb ischemia?
Critical limb ischemia DVT Trauma Spinal stenosis Slipped disc
43
What is the long term management following acute limb ischemia?
Reduce risk factors - hypertension management (beta blockers may not be indicated due to lower BP) - Diabetes management Aspirin + Atorvastatin Exercise programs + OT *rehabilitation if amputation
44
What is a type of varicose vein that develops at the sapho-femoral venous junction? and what is it often mistaken for?
Saphena varix
45
What are the risk factors for varicose veins?
Prolonged standing pregnancy Obesity Family history
46
When should varicose veins be treated?
Symptomatic Skin changes Ulceration Venous embolism
47
What is a syndrome that affects the aortic bifurcation leading to buttock pain?
Leriche syndrome - where there is obstruction a the bifurcation causing: - Buttock pain - Erectile dysfunction - Absent femoral pulses
48
What is the definition of critical limb ischemia?
Ischemic rest pain for greater than 2 weeks duration Presence of ischemic lesions - gangrene ABPI <0.5
49
What tests out with vessel analysis (CT angiograms, duplex) should be conducted into critical limb ischemia?
Metabolic profile - Blood pressure - Lipids - Glucose - ECG
50
What is the criteria for intermittent claudication?
Pain in the muscle Pain on activity Pain relieved by rest
51
When should surgical intervention be considered in critical limb ischemia and what type of surgery is usually performed?
When medical management is failing When Exercise program has been completed - Angioplasty - By- pass graft
52
What percentage of below knee amputation die within 2 years?
30%
53
What are the complications of critical limb ischemia?
Sepsis - gangrene Acute on chronic ischemia Reduced mobility and quality of life
54
What are the signs associated with critical limb ischemia?
``` Pale Cold Absent/ minimal pulses Nail changes Lack of hair Evidence of gangrene Loss of muscle Poor capillary refill ```
55
What investigations should be done into venous insufficiency?
Doppler US Scan to assess venous Reflux *gold standard ABPI MR Venogram - if pelvic Ultrasound Bloods: - FBC - LFTs - U&Es * rule out other causes of oedema
56
Prior to use of compression bandages in venous ulcers what important investigation should be done?
ABPI +/- Investigation into the arterial circulation. If the arterial circulation is compromised then bandaging should be avoided.
57
What is a complication of a DVT other than P.E?
Post thrombotic syndrome - Heaviness - cramps - Pruritus - Ulcertation Villalta Score
58
What are the treatment options into venous ulceration?
Lifestyle changes, increased exercise - use of muscle pump Elevation of the leg Multicomponent compression bandages Dressing - colloid dressing Surgical: - removal of varicose veins. Improves healing rates
59
How would a venous ulcer be described?
``` Shallow irregular ulcer Granulation tissue located: - medially - gaiter area ```
60
In a young person with venous ulceration what should be considered?
Coagulopathies
61
What is the management for Arterial ulceration?
Lifestyle changes Medical - aspirin - Statin - glucose control Surgical: - angioplasty - by-pass - Skin graft
62
How does aortic dissection present?
Severe central pain Radiates to the back Hypertension + tachycardia Uneven limb pulses
63
What the two types of aortic dissection and how are they treated?
Type A: - ascending aorta *treated with surgical repair Type B: - Descending aorta *treated conservatively
64
What are the symptoms of Venous ulcers?
Aching Bursting like pain Pruritus Cellulitis
65
What two tests can be performed during an examination to test the competence of the valves when assessing for venous insufficiency?
Trendelenburg test Cough impulse *both these test the pressure on the valves
66
What are some complications of a AAA?
Rupture Aorta duodenal Fistula formation Embolim - causing distal embolism Pain
67
What are the differentials for atherosclerosis of the carotid causing TIA?
Carotid dissection Fibromuscular dysplasia - hyperproliferation of the muscle - usually young females * affects kidneys as well Vasculitis - Giant arteritis
68
Following the Doppler Ultrasound duplex done at the time of the stroke - what further investigation is done?
CT Angiography
69
What patients should be referred for assessment of carotid endarterectomy?
Any patients with symptoms or TIA with stenosis of: 50-99% - typically >70% will have immediate surgery
70
What are the main complications of endarterectomy?
Stroke Nerve damage: - Vagus - Hypoglossal - Glossopharyngeal
71
How many layers are used in compressional bandages?
4 layers Changed weekly
72
What is the ulcer that develops with varicose veins which is a type of squamous carcinoma?
Marjolin's ulcer
73
How much do you need to elevate the leg by in Buerger's test before symptoms?
30 degrees
74
What is the calculation for the ABPI?
Ankle pressure / Brachial pressure
75
Following Arterial duplex scan, what additional imaging should be done?
Digital Subtraction Angiogram | - remove the bone and soft tissue images
76
What are the differentials for chronic limb ischemia?
OA Spinal Stenosis Sciatic Diabetic neuropathy
77
When is by-pass graft preferred to angioplasty?
Large extensive disease

Phase 4 (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions