Ischaemia, Aneurysm , Varicose Veins Flashcards
What is intermittent claudification?
Lack of O2 on exercise to muscle leading to cramp like pain
Clinical Signs of intermittent claudification?
Pain upon walking further steeper faster, but pain is quickly relived upon rest
Ankle brachial pressure under between 0.4-0.85
Treatment of intermittent claudification?
No cure for peripheral arterial disease
Slow progression on prevention
Stop smoking, more exercise, lipid lowering
Bypass need healthy inflow and outflow
Endovascular Stent treats only the symptoms
Why does walking more despite the pain improve intermittent claudification?
Because more pain means more anastomoses form increasing blood flow to the area
What is critical limb ischaemia
Pain occurs in the foot even at rest, particularly bad lying down and sleeping
Signs of severe ischaemia?
Cool to touch, absence of peripheral pulses, hairless, thick nails, shiny skin, venous guttering
How does critical limb ischaemia lead to limb loss?
Injury, ulcer gangrene amputation
Life or Limb
What is Varicose Veins
Dilated tortuous superficial veins due to abnormal transmission of pressure within deep veins
What three thing result in VV?
Increased venous pressure, damaged valves, deep vein obstruction
Causes of VV
Pregnancy , old age , obesity, females,
Risks related to VV
Bleeding- significant and recurrent elevation and pressure
thrombophlebitis - inflammation due to clot sore bruising scaring
Haemosidium deposits- Black dots under the skin red cell leakage out of vessel iron broken down
Liperdermatosclerosis- intense inflammatory response leads to scaring fibrosis- like cellulitis
Venous ulceration
Management of VV
Compression bandages, low APBI no bandages as blood completely prevented from getting to foot
Foam Sclerotherapay
Chemical treatment of VV fuses veins together
Endogenous ablation
Physical thermal radiowaves all damage endothelium of vein closing it off
Why is surgery not really used for VV
Are risks to patient and was more for cosmetic reasons , higher success rate endovenous
What is an Abdominal Aortic Aneurysm
Aorta has been dilated by more than 50%
Two types of Aneurysm?
True- vessel walls are intact
False- Blood contained by the surrounding soft tissue
Three shapes of aneurysm
Sacular- simple sack on aorta
Fusiform- bulges out on both sides
Mycotic- due to infection
What causes an AAA
Medial degeneration- elastin collagen decrease, increased pressure, increased wall stress
Risk factors for an AAA
Old male Smoker Hypertension
Are most AAA symptomatic
No 75% are asymptomatic
Symptoms of an AAA
Pain can mimic renal colic, trashing
What symptoms follow a rupture
tearing sudden epigastric pain radiating to the back, sudden collapse
Is an free intraperitoneal worse than a retroeritoneal rupture
Yes as its not contained by anything rapidly bleed out and die
When is an aneurysm deemed serious enough to deal with
If over 5.5cm or rapidly growing
Two options for treating an AAA
Open surgery- more risky iliac dacron graft used as stent
Endovascular- required good seal before and after AAA
Acute limb ischaemia
Sudden loss of blood to the foot
Causes of Acute limb ischaemia
Trauma embolism arterial dissection, compression
Signs of acute limb ischaemia
6 P's Pallor Pulsless Perishingly cold Paraesthesia- pins and needle Pain Paralysis
0-4 hours in ALI
White foot painful sesorimotor effect- reversible
4-12 hours in ALI
White with mottled blanches on pressure- partly reversible
12h+ hours in ALI
Fixed mottling non blanching, improving perfusion is dangerous non reversible could lead to harmful systemic effects due to chemical released by necrosis
Management of ALI
ABCDE, Blood tests, ECG CXR
Anticoagulants, prevent thrombus formation, increase perfusion
Diabetic Foot Sepsis
Pressure as a result of infection results in lack of perfusion to the foot
Three things required for diabetic foot sepsis to occur?
Diabetic neuropathy, peripheral vascular disease, infection
Common sources that lead to DFS
Pressure ulcers- don’t feel them forming due to neuropathy
Ingrown toe nail
puncture wound
Why does pressure build due to infection?
Muscles are confined by fascia and bones into rigid compartments, inflammation due to infection results in obstruction of blood vessels
Clinical signs of DFS
Pyrexia, tachypnoea , tachycardia, confused , kussmauls breathing- laboured
Swollen and Boggy, tender to touch, ulcers with puss, erythema tracking up leg, woody necrosis patches, crepitus from microbes releasing gas, pedal pulse is lacking
Is the infection usually mononclonal?
No its usually multicultural gram -ve and +ve
Treatment for DFS
Remove all infected tissue leave open to encourage drainage
