4.01 Vascular Surgery - Presentations Flashcards
What are the two common presentations of vascular disease?
- lower limb ulcers
- acutely painful limb
An acutely painful limb that is cold and pale should be treated as what?
Acute limb ischaemia until proven otherwise, and is a surgical emergency.
What are the associated signs of acute limb ischaemia?
Hint: 6 Ps
- pain
- pallor
- perishingly cold
- paraesthesia
- paralysis
- pulselessness
Give some risk factors for acute limb ischaemia.
- atrial fibrillation
- hypertension
- smoking
- diabetes mellitus
- recent myocardial infarction
What investigations are warranted if acute limb ischaemia is suspected?
CT angiogram for confirmation and anatomical delineation, along with urgent vascular review.
In acute limb ischaemia, how long does it take for irreversible tissue damage to occur?
Approximately 6 hours - patients should be sufficiency resuscitated and started on IV heparin whilst decisions for definitive versus conservative treatments are made.
An acutely painful limb that is hot and swollen should be treated as what?
Deep vein thrombosis (DVT) until proven otherwise.
NB pain is often localised to the calf, associated with calf tenderness of firmness.
Give some risk factors for deep vein thrombosis.
- PMHx or FHx of pro-thombotic diseases (e.g. CVA, MI)
- recent immobility
- recent surgery
- COCP
- pregnancy
What score should be calculated in a patient you are suspecting a DVT in?
Comment upon the significance of the score and the subsequent management.
Well’s score should be calculated (see image).
Score ≥1 arrange ultrasound Doppler scan
Score =0 use D-Dimer to exclude DVT.
Outline the management of DVT.
If confirmed by ultrasound Doppler, DVT can be initially treated with therapeutic doses of Low-Molecular Weight Heparin (LMWH), before being swapped to a DOAC for 3-6 months.
NB those with an iliofemoral DVT with severe symptoms require urgent vascular review. Usually presents with complete leg swelling, with a blue or white discolouration.
Give some differentials for an acutely painful limb that is hot and swollen.
- cellulitis
- septic arthritis
- gout
Give some differentials for an acutely painful limb.
- acute limb ischaemia
- DVT
- cellulitis
- septic arthritis
- gout
- radiculopathy
- trauma
Which examinations are imperative when assessing the acutely painful limb?
- cardiovascular
- peripheral vascular
- neurological
- musculoskeletal
What is an ulcer?
An abnormal break in the skin or mucous membrane
Give some causes of ulcers.
- venous insufficiency (most common, 80%)
- arterial insufficiency
- diabetic-related neuropathy
- infection
- trauma
- vasculitis
- malignancy (SCC)
- pressure ulcers