Vascular surgery Flashcards
(51 cards)
Define atherosclerosis
Chronic inflammation and activation of the immune system in the artery wall
Deposition of lipids in the wall –> fibrotic plaque formation
In atherosclerosis, what are the effects of plaque formation?
Stenosis –> reduced blood flow
Rupture –> thrombus which blocks a distal vessel –> ischaemia
What are risk factors of atherosclerosis?
Older age FHx Male Smoking and alcohol Poor diet Low exercise Obesity DM
Define peripheral arterial disease
Atherosclerosis causing stenosis of the arteries supplying the limbs and periphery
Define critical limb ischaemia
End stage of PAD where there is inadequate supply of blood to the limb to allow it function normally at rest
Define intermittent claudication
Symptoms of having ischaemia in a limb during exertion that is relieved by rest
What is Leriche’s syndrome
Clinical triad of
Thigh/buttock claudication
Absent femoral pulses
Male impotence
What is the Ankle-Brachial Pressure Index?
The ratio of systolic BP in the ankle vs the arm
What are the results of the ABPI?
>1.2 = calcified, stiffened arteries >0.9 = normal 0.6-0.9 = mild disease 0.3-0.6 = moderate/severe disease <0.3 = severe/critical ischaemia
What are the 6 P’s of critical limb ischaemia?
Pain Pallor Pulseless Paralysis Parathesia Perishingly cold
How can intermittent claudication be managed?
General lifestyle changes
Optomise medical treatments for co-morbidities (HTN, diabetes)
Medical treatment:
Atorvastatin
Clopidogrel
Naftidrofuryl oxalate (peripheral vasodilator)
Surgical:
Angioplasty and stenting
Bypass surgery
How should critical limb ischaemia be managed?
Urgent referral to vascular team
Analgesia
Urgent revascularisation (angioplasty and stenting or bypass surgery)
What are the features of critical limb ischaemia, and how many are required in order for a diagnosis to be made?
Rest pain in foot for >2 weeks
Ulceration
Gangrene
(1 or more)
How may a person with AAA present?
Asymptomatically - through screening Symptoms of PAD Non-specific abdominal pain Palpable expansile pulsation in the abdomen Incidental finding on AXR Diagnosed by US/angiography (MRI/CT)
What is the screening progress for AAA?
AUS for men at 65
AAA 3-4.4cm - AUS every 2 years
AAA 4.5-5.4cm - AUS every 3 months
AAA >5.5cm - surgery for repair
How should a patient with an AAA of less than 5.5cm be managed?
Treat reversible risk factors
Monitor size
Treat PAD
What surgical options are available in the management of AAA?
EVAR
Laparoscopic repair
Open repair
What are the ideal properties which make a patient more amenable to EVAR intervention for an AAA?
Long neck
Straight iliac vessels
Healthy groin vessels
How may a person with a ruptured AAA present?
Severe abdo pain (radiate to back)
Haemodynamically unstable
Collapse
Define a true aneurysm
Aneurysm affecting all three layers of the artery wall (intima, media and adventitia)
Define a false aneurysm
Single layer of fibrous tissue forms the aneurysm wall
What is an aortic dissection?
A break in the lumen of the aorta causes blood to flow between the layers of the wall of the aorta creating a false lumen
What risk factors for associated with an aortic dissection?
HTN
Ehlers-Danlos syndrome
Marfan’s syndrome
+ smoking, lack of exercise, increasing age etc
How may a patient with an aortic dissection present?
Sudden onset tearing chest pain Radiates to back HTN --> hypotension Paraplegia, angina etc Aortic regurgitation
