1000. Vascular 18/01/2021 Flashcards
What are the three main presentations of peripheral artery disease?
Intermittent claudication
Critical limb ischaemia
Acute limb threatening ischaemia
How do you assess someone with intermittent claudication?
Check the pulses of the lower limb
Check ankle brachial pressure index
Duplex ultrasound is the first line investigation
Magnetic reasonable angiography before any intervention
How is screening for AAA done?
Single abdominal ultrasound aged 65
If<3cm no more scans
3-4.4cm re-scan every 12 months
4.5-5.4 - rescan every 3 months
> 5.5cm refer within 2 weeks to vascular surgery for probable intervention
How do vascular treat a large aneurysm (>5.5cm)
Refer within 2 weeks for elective endoscopic endovascular repair
What are the 6P’s of acute limb ischeamia?
Pale, pulse less, pain, paralysis, perishingly cold
What drug is given first line in both ischaemic strokes and peripheral artery disease
Clopidogrel
How do cholesterol levels impact the amount of statin taken in cardiovascular disease?
Statins are given in all cardiovascular disease regardless of baseline cholesterol
What are some risk factors for peripheral artery disease?
Smoking Hypertension Diabetes mellitus Obesity Sedentary lifestyle (as exercise plan is shown to help)
How is severe Peripheral artery disease or certificate limb ischaemia treated?
Angioplasty
Stents
Bypass surgery
What is critical limb ischaemia?
Progression of claudication
What drugs are liscenced for those with peripheral arterial disease
Naftidrofruyl oxalate- vasodilator
Cilostazol- antiplatelelet and vasodilator
What are the doses of clopidogrel and aspirin?
Maintenance- 75mg
Loading- 300mg
How do AAA arise?
Failure of elastic proteins within the extra cellular matrix
Dilation of the layers of the arterial wall
Potentiated by proteolytic activities and lymphocytic infiltration
What are the risk factors for AAA?
Major- Smoking and hypertension
Minor- syphillis and connective tissue disease (Ehlers Danlos type 1, Marfans’s syndrome)
What is marjolins ulcer?
Squamous cell carcinoma occurring at sites of chronic inflammation or previous injury
What causes venous leg ulcers?
Venous hypertension due to chronic venous insufficiency
What are the features of venous insufficiency
Oedema,
brown pigmentation,
lipodermatosclerosis,
eczema
How do you assess venous leg ulcers?
Doppler ultrasound- prescience of reflux
Duplex ultrasound- anatomy/flow of vein
How do you manage venous leg ulcers?
4 layers of compression banding
If fail to heal after 12 weeks or greater than 10cm squared then skin grafting needed
Describe the typical presentation of an arterial ulcer?
Occur at the toes and heel
Painful
Area of gangrene
Cold with no palpable pulses
Low ABPI measurements
What is the velocity of growth of a AAA that would be considered dangerous?
> 1cm increase over 1 year
What does ABPI scoring indicate regarding bandaging for peripheral artery disease
Compression bandaging if ABPI >/= 0.8
What sort of vessel stenosis cause buttock pain?
Iliac stenosis
What sort of vessel stenosis causes calf pain?
Femoral stenosis
What is Adsons test?
Lateral flex ion of the next away from sympathetic side and traction of symptomatic arm leads to obliteration of radial pulse
What is subclavian steal syndrome?
Proximal stenosis lesion of the subclavian artery
Causes syncope
Discuss takayasus arthritis with regard to:
Presentation
Treatment
Large vessel graulomatous arterititis
Most common in young Asian females
Mild systemic illness, pulse less phase with vascular insufficiency
What genetic condition is most commonly associated with co-arctation of the aorta
What is the classic presenting sign
Turners
Radio femoral delay
