lower limb disease and DVT Flashcards
what is intermittent claudication
insufficient blood reaching the muscle while exercising.
muscle ischaemia
risk factors for intermittent claudication
smoking age diabetes hypertension high cholesterol
what are the investigations for intermittent claudication
ABPI measurement
ultrasound
angiography (CT, Catheter, MRI)
what is ABPI?
ankle BP/ Brachial pressure
what is normal ABPI
0.9-1.2
what is an ABPI of claudication
0.4-0.85
what is the gold standard investigation for intermittent claudication
catheter angiography
what are the treatment options for intermittent claudication
angioplasty +/- stent
endarterectomy
bypass
what is critical intermittent claudication
insufficient blood reaching the muscle while at rest
what is a DVT
formation of thrombi within the lumen of the vessels that make up the deep venous system
where do DVT form
predominantly in venous valve pockets and other sites of stasis
what is a distal DVT
DVT of the calves
what is a proximal DVT
DVT of the popliteal vein or the femoral vein
what are the risk factors for DVT
(virchow's triad) LV dysfunction immobility/paralysis obesity smoking High BP and cholesterol surgery
what is a “provoked DVT”
a VT with cause, these causes can be transient (e.g surgery or hospitalisation) or continuing (e.g cancer)
what is a “unprovoked DVT”
DVT with no identifiable cause. high recurrence rate
complications of DVT
PE
recurrent DVT
chronic thromboembolic pulmonary hypertension (CTEPH)
post-thrombotic syndrome
what is post-thrombotic syndrome
A complication of DVT experienced by 1/3 or patients
what is post-thrombotic syndrome characterised by
pain oedema hyperpigmentation varicose collateral veins venous ulceration
what is chronic thromboembolic pulmonary hypertension (CTEPH)
serious complication of DVT experienced by 5% of patients. it is a progressive condition
the original material is replaced by fibrous tissue that is incorporated into the intimate and media of the pulmonary arteries
what are the symptoms of chronic thromboembolic pulmonary hypertension (CTEPH)
initally asymptomatic followed by progressive SOB and low O2 in the blood
what can chronic thromboembolic pulmonary hypertension (CTEPH) lead to
RH failure
what are the investigations of DVT
D-dimer test
well’s score
Ultrasound
CTPA
what is the gold standard for DVT
CTPA
what is the first line test for DVT
D-dimer test
what would a moderate or high D-dimer test result in
further imaging (CTPA)
what would a low/negative D-dimer test suggest
patient is not suffering from PE or DVT
what are the pharmacological treatments for DVT
anticoagulants
thrombolysis
what are the mechanical interventions for DVT
compression stockings
IVC filters
what should you check a patient presenting with a DVT for
thrombophila
cancer
if the patient has a DVT due to drug use what drugs should be prescribed
rivaroxaban or fragmin
when should thrombolysis be considered in patients with DVT
symptomatic ileofemoral DVT symptoms LEES than 14 days
low risk of bleeding
life expectancy above 1 year
which patients should be given an IVC filter
PROXIMAL DVT
what is the treatment for an provoked DVT
LMWH for 5 days
Vit K antagonist within 24hrs and continued for 3 months
what is the treatment for unprovoked DVT
LMWH for 5 days
Vit K antagonist within 24hrs and continued for minimum 3 months
anticoagulation can be continued after 3 months to prevent recurrence
