Aorta and PAD clinical Flashcards
What is an aneurysm?
ii. what is the difference between a true and a false aneurysm
An artery with a dilation >50% of its original diameter
an aorta >1.5 times expected size, which is generally defined as aorta >3cm
ii. true aneurysm involves all layers of arterial wall a false one doesn’t
What are the causes of an abdominal aorta aneurysm?
Atheroma
trauma
hypertension
smoking
genetics (marfans)
What are the signs and symptoms of ruptured AAA?
Intermittent or continuos abdominal pain (radiates to back,illiac fossae or groin)
collapse and shock
pulsatile
may be tachycardic/hypotensive
How do you diagnose ruptured AAA?
Abdominal US
CT
How do you manage ruptured AAA?
Surgical repair: open or endovascular.
Infra renal: EVAR (enter from femoral artery). Endovascular aortic repair
Supra renal: TVAR (enter from thoracic aorta). thoracic endovascular aortic repair
screening programme:
Should be offered to all men > 65.
Thought to be safe to monitor all aneurysms <5.5cm in size.
In aneurysms >5.5cm, surgical repair should be offered but mortality can be up to 50%.
What are the signs and symptoms of unruptured AAA?
often asymptomatic
May be picked up incidentally on abdominal exam.
On examination: pulsatile abdominal mass.
How do you diagnose unruptured AAA?
abdominal US
CT
How do you manage unruptured AAA
screening programme
elective surgery : if >5.5cm
what is aortic dissection?
It is the splitting within the tunica media . This creates a false lumen where blood now travels through - very dangerous.
What are the risk factors of aortic dissection?
Hypertension.
Trauma including surgery.
Connective tissue disease: Marfans. associated with aortic root dilation. causes aortic regurgitation
Inherited diseases: Turners syndrome. associated with coarcation of aorta
What are the signs and symptoms of aortic dissection?
sudden chest pain (+/-) radiation to back
Radial – radial pulse delay.
Unequal BP between both arms
How do you diagnose and manage aortic dissection?
Diagnostic investigation: CT or MRI or TOE (transeophageal echocardiogram)
Management:
Analgesia.
B blockers – reduce cardiac output and amount of blood being forced into the dissection. or CCB if B blockers are contraindicated
Open or endovascular repair.
What are the categories for the symptoms of Peripheral artery disease?
ii. which stages suggest critical limb ischaemia
Stage I – asymptomatic
Stage II – intermittent claudication
Stage III – rest pain/nocturnal pain
Stage IV – necrosis/gangrene.
ii. stage 3/4
What do people complain of if they have intermitten claudication?
Cramping pain in the calf, thigh or buttock after walking for a given distance and is relieved by rest
What are the symptoms of critical limb ischaemia? (severe form of PAD)
Ulceration, gangrene and foot pain at rest
burning pain at night relieved by hanging legs over side of bed
What are arterial ulcers?
Punched out ulcer that are usually small and circular.
Found on the lateral surface of the ankle.
Intensely painful.
What are the signs of peripheral arterial disease (PAD)
absent femoral, popliteal or foot pulses
cold white legs
atrophic skin
punched out (arterial ulcers)
buerger’s angle (angle that leg goes pale when raised off the couch)
How do you diagnose PAD?
Ankle brachial pressure index: To calculate it divide ankle pressure/brachial pressure
- 0.9-1.2 - normal
- 0.4-0.85 - claudication
- 0.-0.4 - severe
Duplex ultrasound scanning. (first line)
Invasive- MR angiography, CT angiography
What can effect the ABPI ratio?
calcified vessels due to diabetes and chronic renal failure
doppler signal.
How do you manage PAD?
- Slowing down progression
e. g. stop smoking, lipid lowering, antiplatelets treating hypertension diabetes - exercise: 30 mins three times a week
- surgical:
Stenting.
Bypass graft.- inflow and outflow bypass
Sympathectomy.
Amputation.
What are the causes of acute limb ischaemia?
Thrombosis - more likely from vasculopaths causing emboli and thrombosis to complete occlusion
What are the signs and symptoms of acute limb ischaemia?
6 P’s
Pale
pulseless
painful
paralysed
paraesthetic
perishingly cold
How do you mange acute limb ischaemia?
urgent open surgery or angioplasty
anticoagulate with heparin and look for source of emboli
What conditions can increase the deep vein pressure?
- deep valve incompetence
2. deep vein obstruction.
What are the signs and symptoms of chronic venous disease?
Varicose veins
pain
cramps
tingling
heaviness
restless
oedema
venous eczema
ulcers
chronic venous insuffiency:
haemosiderin: iron deposits which give legs red brown colour
lipodermatoscerosis: causes skin to swell and harden
What are varicose veins?
Dilated, tortuous superficial veins, due to the abnormal transmission of deep vein pressure
What are the risk factors of varicose veins?
prolonged standing
obesity
pregnancy
family history
contraceptive pill
What investigations can be used for chronic venous disease?
Duplex scan
State of the deep veins (occlusions or incompetence)
Saphenofemoral or saphenopopliteal incompetence
How do you manage chronic venous disease?
education - exercise don’t stand on legs to long and weight loss
treat underlying cause
- Endovenous (Duplex guided)
Foam sclerotherapy - chemical - Endovenous (Duplex guided)
Endovenous ablation- mechanical-physical
surgical- removal of vein
