4. Vascular Disease Flashcards

1
Q
  1. What does claudication mean?

2. Describe the 3 types of claudication, with specific clinical features distinctive to each type.

A
  1. impairment in walking or pain/discomfort/numbness/tiredness in the legs
  2. VASCULAR - intermittent cramping pain in the calves; predictable, reproducible and relieved by rest. Starts distally and progresses proximally

NEUROGENIC - caused by nerve root compression/stenosis of spinal canal. dermatomal pain. shooting/tingling. relieved by leaning forwards. unpredictable, positional

ORTHOPAEDIC - early morning stiffness; located at the joint

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2
Q

Describe the Rutherford Classification of Chronic Limb Ischaemia

A
  1. asymptomatic
  2. mild intermittent claudication
  3. severe claudication
  4. rest pain/nocturnal pain
  5. minor tissue loss (non-healing ulcer, focal gangrene, diffuse pedal ischaemia)
  6. major tissue loss - gangrene extending above trans-metatarsal level
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3
Q

4 investigations for chronic limb ischaemia

A
  1. ABPI - ratio of BP at the ankle to BP in upper arm. Ratio of <0.9 indicates need for risk factor modification; <0.5 indicates critical limb ischaemia
  2. Doppler/duplex ultrasound
  3. MRI angiogram (non invasive)
  4. catheter angiography (offers opportunity for therapeutic intervention)
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4
Q

Describe the pharmacological management of chronic limb ischaemia

A
  • Statin
  • Clopidogrel
  • cilostazol - phosphodiesterase II inhibitor; promotes vasodilation
  • Niftidrofuryl - 5HT2 antagonist; vasodilator
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5
Q

What is acute limb ischaemia?

A

sudden decrease in perfusion to the limb

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6
Q

Name the 6Ps of acute limb ischaemia

A
Pain
Pallor
Parasthesia
Paralysis
Pulseless
Perishingly cold sensation
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7
Q
  1. What is Rutherford’s classification used to assess?

2. Which 2 parameters does it use to do this?

A
  1. assess prognosis of acute limb ischaemia

2. sensory loss and muscle weakness

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8
Q

Name the 2 main causes of acute limb ischaemia

A
  1. Embolic event - commonly secondary to cardiac thrombus

2. thrombotic disease - acute on chronic ischaemia

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9
Q

Within what time limits does revascularation need to be performed within?

A

at least 12 hours

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10
Q

What is the major complication of revascularisation?

A

reperfusion injury

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11
Q

Describe the pathophysiology of reperfusion injury

A
  • capillaries more permeable - increase in diffusion and fluid filtration into tissues - can result in compartment syndrome
  • activated endothelial cells produce more ROS but less NO following reperfusion leading to inflammation
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12
Q

What is an ulcer?

A

a chronic sore (abnormal break in the skin) that takes >2 weeks to heal

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13
Q
  1. What are venous ulcers caused by?
  2. Describe the appearance of a venous ulcer
  3. Name other features of venous ulcers
A
  1. venous insufficiency (blood unable to return to heart)
  2. shallow; irregular borders; typically found over medial malleolus
  3. Painful. associated symptoms of chronic venous disease (aching, itching, varicosities)
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14
Q
  1. What are arterial ulcers caused by?
  2. Describe the appearance of arterial ulcers
  3. Name other features of venous ulcers
A
  1. reduction in arterial blood flow
  2. small, deep lesions; well defined borders; necrotic base
  3. cold limbs, absent pulses
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15
Q

How are venous ulcers managed?

A
  1. leg elevation
  2. increased exercise
  3. multicomponent compression bandaging
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16
Q

Why do varicose veins form?

A

incompetent venous valves permit blood flow from the deep venous system to the superficial venous system, leading to venous hypertension and dilatation

17
Q

Name 4 risk factors for the development of varicose veins

A
  1. prolonged standing
  2. obesity
  3. pregnancy
  4. fam hx
18
Q

When is surgical intervention indicated for varicose veins (4)

A
  1. symptomatic primary or recurrent varicose veins
  2. lower limb skin changes
  3. superficial vein thrombosis
  4. venous leg ulcer
19
Q

Name 5 indications for limb amputation

A
  1. PVD with ABPI <0.5 or unrelenting rest pain
  2. trauma
  3. malignant bone tumours
  4. infection
  5. congenital limn deficiency