Podcast
Questions and Answers
Which type of amputation has the best chance of allowing a patient to walk again?
Which type of amputation has the best chance of allowing a patient to walk again?
The first phase of Raynaud's phenomenon results in the hands appearing red.
The first phase of Raynaud's phenomenon results in the hands appearing red.
False
What are two early complications that can occur after an amputation?
What are two early complications that can occur after an amputation?
Hemorrhage, Infection
In Raynaud's phenomenon, the second phase results in hands appearing ______ and being painful.
In Raynaud's phenomenon, the second phase results in hands appearing ______ and being painful.
Signup and view all the answers
Match the amputation techniques with their descriptions:
Match the amputation techniques with their descriptions:
Signup and view all the answers
What is the most common site for an abdominal aortic aneurysm?
What is the most common site for an abdominal aortic aneurysm?
Signup and view all the answers
A descending thoracic aortic aneurysm has a critical diameter of 5.5 cm.
A descending thoracic aortic aneurysm has a critical diameter of 5.5 cm.
Signup and view all the answers
What is the most common cause of mycotic aneurysm?
What is the most common cause of mycotic aneurysm?
Signup and view all the answers
The most common risk factor for abdominal aortic aneurysm is __________.
The most common risk factor for abdominal aortic aneurysm is __________.
Signup and view all the answers
Match the types of aneurysms with their respective critical diameters:
Match the types of aneurysms with their respective critical diameters:
Signup and view all the answers
What is the primary goal of conservative management in the arterial system?
What is the primary goal of conservative management in the arterial system?
Signup and view all the answers
Conservative management is only applicable for patients who have undergone amputation.
Conservative management is only applicable for patients who have undergone amputation.
Signup and view all the answers
What is one potential complication that may arise from poor management of arterial conditions?
What is one potential complication that may arise from poor management of arterial conditions?
Signup and view all the answers
In conservative management, the emphasis is on minimizing ______ before considering surgical options.
In conservative management, the emphasis is on minimizing ______ before considering surgical options.
Signup and view all the answers
Match the following management strategies with their descriptions:
Match the following management strategies with their descriptions:
Signup and view all the answers
What is a common clinical feature of chronic arterial occlusion resulting from intermittent claudication?
What is a common clinical feature of chronic arterial occlusion resulting from intermittent claudication?
Signup and view all the answers
Rest pain from chronic arterial occlusion is relieved by elevating the leg.
Rest pain from chronic arterial occlusion is relieved by elevating the leg.
Signup and view all the answers
What is the management procedure to relieve compartment syndrome?
What is the management procedure to relieve compartment syndrome?
Signup and view all the answers
Intermittent claudication leads to a progressive decrease in the distance one can walk, known as the ______.
Intermittent claudication leads to a progressive decrease in the distance one can walk, known as the ______.
Signup and view all the answers
Match the following conditions with their symptoms:
Match the following conditions with their symptoms:
Signup and view all the answers
What does a decrease in the Ankle Brachial Pressure Index (ABPI) greater than 20% after exercise indicate?
What does a decrease in the Ankle Brachial Pressure Index (ABPI) greater than 20% after exercise indicate?
Signup and view all the answers
A TBI less than 0.6 indicates significant arterial lesions.
A TBI less than 0.6 indicates significant arterial lesions.
Signup and view all the answers
What is the primary indication for performing a procedure that includes the Cattell-Braasch Maneuver?
What is the primary indication for performing a procedure that includes the Cattell-Braasch Maneuver?
Signup and view all the answers
Cardiovascular complications are the most common cause of death after aneurysm surgeries.
Cardiovascular complications are the most common cause of death after aneurysm surgeries.
Signup and view all the answers
What are two common causes of arterial disease?
What are two common causes of arterial disease?
Signup and view all the answers
What is the common complication of aneurysm surgeries that can lead to bloody diarrhea?
What is the common complication of aneurysm surgeries that can lead to bloody diarrhea?
Signup and view all the answers
A decrease of 0.1 in ABPI increases the risk of ____ mortality by 10%.
A decrease of 0.1 in ABPI increases the risk of ____ mortality by 10%.
Signup and view all the answers
The instrument typically used in open graft surgery is a __________ graft.
The instrument typically used in open graft surgery is a __________ graft.
Signup and view all the answers
Match the following diseases with their primary characteristics:
Match the following diseases with their primary characteristics:
Signup and view all the answers
Match the following surgical maneuvers to their descriptions:
Match the following surgical maneuvers to their descriptions:
Signup and view all the answers
What is the primary pharmacological treatment for managing Raynaud's phenomenon?
What is the primary pharmacological treatment for managing Raynaud's phenomenon?
Signup and view all the answers
Primary Raynaud's is associated with autoimmune rheumatic disease (AIRD).
Primary Raynaud's is associated with autoimmune rheumatic disease (AIRD).
Signup and view all the answers
What condition can result from retrograde blood flow during exercise in subclavian steal syndrome?
What condition can result from retrograde blood flow during exercise in subclavian steal syndrome?
Signup and view all the answers
Secondary Raynaud is generally associated with __________.
Secondary Raynaud is generally associated with __________.
Signup and view all the answers
Match the features of Raynaud's phenomenon with their correct descriptions:
Match the features of Raynaud's phenomenon with their correct descriptions:
Signup and view all the answers
What is the clinical sign associated with Class 4 in Boyd's Classification?
What is the clinical sign associated with Class 4 in Boyd's Classification?
Signup and view all the answers
Bruit over the iliac region is a clinical finding in femoropopliteal obstruction.
Bruit over the iliac region is a clinical finding in femoropopliteal obstruction.
Signup and view all the answers
What does a duplex scan help to assess in vascular surgery?
What does a duplex scan help to assess in vascular surgery?
Signup and view all the answers
The Ankle Brachial Pressure Index (ABPI) for intermittent claudication is __________.
The Ankle Brachial Pressure Index (ABPI) for intermittent claudication is __________.
Signup and view all the answers
Match the site of disease with its clinical findings:
Match the site of disease with its clinical findings:
Signup and view all the answers
What is the primary cause of dry gangrene?
What is the primary cause of dry gangrene?
Signup and view all the answers
Wet gangrene has a well-defined line of demarcation between living and dead tissue.
Wet gangrene has a well-defined line of demarcation between living and dead tissue.
Signup and view all the answers
List one indication for amputation as per the mnemonic 'Dead, deadly, damn nuisance.'
List one indication for amputation as per the mnemonic 'Dead, deadly, damn nuisance.'
Signup and view all the answers
The line of demarcation in dry gangrene is described as ______ if the bone is involved.
The line of demarcation in dry gangrene is described as ______ if the bone is involved.
Signup and view all the answers
Match the types of gangrene with their characteristics:
Match the types of gangrene with their characteristics:
Signup and view all the answers
What is the first step in managing atherosclerosis?
What is the first step in managing atherosclerosis?
Signup and view all the answers
Buerger's disease can be managed effectively with angioplasty due to the presence of distal target blood vessels.
Buerger's disease can be managed effectively with angioplasty due to the presence of distal target blood vessels.
Signup and view all the answers
Name one medication used to manage Buerger's disease.
Name one medication used to manage Buerger's disease.
Signup and view all the answers
Aorto-bifemoral graft is commonly used for treating __________ syndrome.
Aorto-bifemoral graft is commonly used for treating __________ syndrome.
Signup and view all the answers
Match the following graft types with their descriptions:
Match the following graft types with their descriptions:
Signup and view all the answers
Study Notes
Amputation Techniques
- Below Knee: Transmetatarsal amputation is used when several toes are affected.
- Below Knee Amputation: The preferred method is the long posterior flap, where the anterior mark is 10 cm below the tibial tuberosity.
- Above Knee Amputation: Should not be less than 20 cm below the knee.
- Complications: Early complications include hemorrhage, infection, flap necrosis, and DVT. Late complications include pain and phantom limb.
Raynaud's Phenomenon
- A condition characterized by episodic vasospasm of digital vessels.
-
Phases of Raynaud's Phenomenon:
- Phase 1: Arterial and venous spasm, resulting in white hands.
- Phase 2: Arterial relaxation with continued venous spasm, leading to blue and painful hands.
- Phase 3: Arterial and venous relaxation, resulting in red hands.
Abdominal & Thoraco-Abdominal Aneurysm
- Aneurysm: Dilatation of a vessel.
- Types of Aneurysms: Fusiform.
- Vessels Involved: Circle of Willis, infrarenal abdominal aorta, popliteal artery, splenic artery.
- Mycotic Aneurysm: Most commonly associated with S.aureus infection in the aorta.
Abdominal Aortic Aneurysm
- Location: Most commonly found in the infrarenal abdominal aorta.
- Risk Factor: Atherosclerosis.
Critical Diameter
- (Less by 0.5 cm in females)
- Abdominal aortic aneurysm: 5.5 cm
- Ascending thoracic aortic aneurysm: 5.5 cm or 0.5 cm increase in size per year.
- Descending thoracic aortic aneurysm: 6 cm.
- Thoracic aortic aneurysm in Marfan patients: 4.5-5 cm.
Clinical Features
- Often Asymptomatic
- Abdominal pain
- Pulsatile mass
- Blue Toe Syndrome: Gangrene due to emboli blocking toe vessels.
Rupture
- Most commonly occurs in the left retroperitoneum.
- Presents with shock.
- 50% mortality rate.
Investigations
- Screening: Ultrasound (USG)
- Diagnostic: CT Angiography
Management
- Conservative Management:
- Blood pressure control
- Lipid-lowering agents
- Smoking cessation.
Chronic Arterial Occlusion
- Caused by swelling of muscles.
- Compartment Syndrome: Presents with pain, specifically pain on passive flexion. Management involves fasciotomy.
- Distal Runoff: Structures distal to the blockage are nourished by collaterals.
-
Clinical Features:
- Intermittent Claudication: Cramping pain after walking a certain distance, known as the claudication distance.
- Rest Pain: Relieved by hanging the leg down from the bed at night.
- Gangrene:
- Walking/Exercise: Increased demand for blood cannot be met due to arterial blockage.
Differential Diagnosis
- Intermittent Claudication: Cramping pain after walking, usually in one muscle group lower than the blockage. Progresses to rest pain.
- Osteoarthritis: Maximum pain on the first step, primarily affecting the affected joint.
- Neurogenic Claudication: Pain varies with posture and is relieved when the patient bends forward.
Open Graft Surgery
- Mattox Maneuver: Rotation of the left colon medially to expose the aorta.
- Cattell-Braasch Maneuver: Right medial visceral rotation (ascending colon medially) to expose the IVC.
- Kocherization: Mobilization of the duodenum.
Complications of Aneurysm Surgeries
- Cardiovascular: Most common cause of death.
- Renal Failure:
- Aorto-duodenal Fistula: Rare cause of upper GI bleeding usually detected with CT angiography.
- Colonic Ischemia: Mostly affects the left side of the colon. Symptoms include bloody diarrhea.
- Paraparesis: Damage to the anterior spinal artery (supplied by the artery of Adamkiewicz).
- Mortality: Elective repair: 2-3%. Ruptured aneurysm: 50%.
Overview of Instruments
-
ABPI (Ankle Brachial Pressure Index):
- Decreases > 20% after exercise: Indicates arterial disease.
- < 0.5: Twice more likely to deteriorate than those with > 0.5.
- Gradually decreasing ABPI: Sign of imminent limb loss.
- Every 0.1 decrease in ABPI: Increases the risk of cardiac mortality by 10%.
-
1.4: Associated with diabetic mellitus, calcified vessels, and chronic renal failure.
-
TBI (Toe Brachial Pressure Index):
- Digital arteries are more resistant to sclerosis.
- TBI + ABPI: Reliable for large vessel occlusions in diabetic patients.
- < 0.6: Significant arterial lesion.
-
DSA (Digital Subtraction Angiography):
- Provides dynamic arterial flow information.
- Potential complications: Bleeding, thrombosis, aneurysm, dissection, renal dysfunction.
- Indication: Intervention is planned.
Causes of Chronic Arterial Occlusion
- Buerger's disease
- Atherosclerosis
Buerger's disease vs Raynaud's Disease
- Buerger's Disease (Thromboangitis obliterans): Primarily affects men in their 3rd-4th decade. Risk factors include smoking. Affects small to medium arteries.
- Atherosclerosis: Affects both men and women, typically in the 5th decade. Risk factors include stress, smoking, alcohol, and dyslipidemia. Affects medium to large arteries.
Boyd's Classification
- Class 1: Pain upon starting to walk but decreases as the individual keeps walking (due to washout of substance P)
- Class 2: Pain on walking but the patient continues to walk despite the pain.
- Class 3: Pain necessitates stopping walking.
- Class 4: Pain at rest.
Symptoms based on Location
- Aortoiliac Obstruction: Claudication in the buttocks, thighs, and calves. Femoral and distal pulses absent in both limbs. Bruit over the aortoiliac region. Impotence (Leriche syndrome)
- Iliac Obstruction: Unilateral claudication in the thigh and calf, sometimes the buttock. Bruit over the iliac region. Unilateral absence of femoral and distal pulses.
- Femoropopliteal Obstruction: Unilateral claudication in the calf. Femoral pulse palpable with absent unilateral distal pulses. Femoral & popliteal pulses palpable.
- Distal Obstruction: Ankle pulses absent. Claudication in calf and foot.
Complications
- Arterial Ulcer: Punched-out ulcer, loss of pulsation, loss of muscle mass.
- Shiny skin/loss of hair
- Sensations intact
Investigations
- Duplex scan (IOC):
-
ABPI (Ankle brachial pressure index):
- 0.9-1.4: Normal
- < 0.9: Intermittent claudication
- < 0.4 : Chronic limb threatening ischemia (CTLI) - Ischemic rest pain +/- ulceration/gangrene. Requires urgent revascularization
Primary v/s secondary Raynaud's
- Primary Raynaud's: Common, not associated with autoimmune disease, no antinuclear antibodies, no microangiopathy in periungueal capillaroscopy, no family history of Raynaud's, no pharmacological treatment needed (rarely). No complications (rarely)
- Secondary Raynaud's: Rare, associated with autoimmune rheumatic diseases (Aird), presence of antinuclear antibodies (ANA), microangiopathy in periungueal capillaroscopy (PUC), no family history of Raynaud's (occasionally), frequently requires pharmacological treatment. Complications are possible.
Triggers for Primary Raynaud's
- Cold
- Vibrating tools
- Heavy machinery
Management
- DOC: CCBS (Calcium channel blockers)
Differential Diagnosis
- Acrocyanosis: Seen in females, painless, not episodic, mottled cyanosis followed by paraesthesia.
Subclavian Steal Syndrome
- Stenosis: In the first part of the subclavian artery.
- Etiology: Thrombus or thoracic outlet obstruction.
- Pathophysiology (during exercise): Retrograde blood flow from the basilar/vertebral artery leading to decreased perfusion to the brain, resulting in syncopal attacks.
Management
- Angioplasty
Gangrene
- Macroscopic and microscopic death of tissue.
Types of Gangrene
- Dry Gangrene: Tissue desiccation due to gradual slowing of blood.
- Wet Gangrene: Venous blockade or super-added infection.
Amputation
-
Indications:
- Gangrene
- Gas gangrene
- Soft tissue sarcoma
- Contractures
-
Key Points:
- Local digit amputation: Used in diabetic patients.
- Ray excision: Indicated when the MTP joint is involved.
Buerger's Disease Management
- Cessation of smoking:
- Pentoxyphylline: Reduces viscosity
- Conservative Amputations:
- Lumbar Sympathectomy: Reduces rest pain
Atherosclerosis Management
- Angioplasty (endovascular stenting): First-line treatment
- Bypass Graft: Used if stenting fails.
Angioplasty
- Procedure: Balloon inflated for 30 seconds, then deflated.
- Success: More likely to be successful in above knee vessels than below knee vessels.
-
Complications:
- Failure
- Hematoma
- Bleeding
- Thrombosis
Grafting
- Aorto-bifemoral graft: Indicated for Leriche syndrome (blockage at aortic bifurcation)
-
Types
- Site: Iliac block, femoral block, ilio-popliteal grafting.
-
Materials:
- Natural: Reversed saphenous vein graft
- Synthetic: PTFE graft
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers critical topics related to amputation techniques such as below knee and above knee procedures, as well as complications associated with these surgeries. It also addresses Raynaud's phenomenon and abdominal aneurysms, highlighting their phases and characteristics. Test your knowledge on these important medical subjects!
