MedED - vascular disease Flashcards
cardiovascular risk factors
male obese elderly smoking PMH of CVD
PVD (peripheral vasc dusease)
atherosclerosis –> stenosis of arteries
types of PVD
acute - acute limb ischaemia - 4-6hrs hours to save limb
chronic - intermittent claudication(pain at exercise) and clitical limb ischaemia (pain at rest)
arterial ulcers
gangrene
Fontaine stages of severity of PVD
Grade 0, Category 0: asymptomatic
Grade I, Category 1: mild claudication
Grade I, Category 2: moderate claudication
Grade I, Category 3: severe claudication
Grade II, Category 4: rest pain
Grade III, Category 5: minor tissue loss; ischemic ulceration not exceeding ulcer of the digits of the foot
Grade IV, Category 6: major tissue loss; severe ischemic ulcers or frank gangrene
leriche sydrome
aortoiliac occluisve disease
absent weak distant pulses
and other
Buerger’s angle
leg should remain pink even at 90 degrees when lying down
severe limb ischaemia if pain becomes ischaemic at 20 degrees
Something about dangling leg
acute limb ischaemia - 6 Ps
pain pale pulseless perishingly cold paralysis paraesthesia
ABPI
ankle brachial pressure index - systolic ankle pressure divided by brachial systolic. If less than 0.5 then severe ischaemia of limb
colour duplex US
duplex shows colour of vessels
ulcers
loss of continuity of epithelium/endothelium
types of ulcers
arterial - inadequate supply
venous - incompetent valves, obstruction
neuropathic - peripheral neuropathy typically in diabetic pts
which are more common - arterial or venous?
venous
arterial are only 10-30%
arterial ulcers symptoms
punched out appearance distal well defined deep night pain pale base - grey granulation tissue
venous ulcers symptoms
large shallow more proximal medial gaiter region (halfway down calf) painless
lipodermatosclerosis AKA? (venous)
inverted champagne bottle sign
investigations for arterial vs venous ulcers?
both - duplex USS
ABPI
arterial - bloods and ECG
venous - measure surface area and take swabs
venous ulcer management
graded compression stockings - debridement and cleaning, moisturing, antibiotics if infected
AAA
> 3cm or >50% larger than normal diameter of abdominal aorta
where do most AAA occur?
below renal arteries 90%
what is a characteristic sign of ruptured AAA?
grey-turner’s sign
pulsatile and laterally expansile abdominal mass on palpation
aortic dissection
tear in tunica intima
layers of vessel wall
tunica intima, media and adventitia
classification of aortic dissection
Type A: Dissection involves the ascending aorta with or without involvement of the arch and descending aorta.
Type B: Dissection does not involve the ascending aorta. Predominantly involves only the descending thoracic (distal to the left subclavian artery) and/or abdominal aorta.
why is BP useful in aortic dissection?
interarm BP difference >20mmHg
varicose veins?
subcut, permanently dilated veins >3mm in diameter when measured in standing position
causes of varicose veins
venous valce incompetence
can be primary (idiopathic) or secondary (e.g. pregnancy)
where are varicose veins most common?
saphenofemoral junction
saphenopopliteal junction
risk factors for varicose veins
females
pregnancy - esp multiple, hormones of preg also cause dilatation and relaxation of the veins
when
phlebitis - tender
tap test - VV distally and feel transmitted impulse over saphenofemoral junction
trendelenburg test for varicose veins
tourniquet is used to test for incompetent valves
management of varicose veins
conservative - compression stockiing
endovascular treatments
surgical managemnt
avulsion
ligation
stripping of long saphenous veins
what is a risk of varicose vein surgery?
peroneal nerve injury –> foot drop
