peripheral vascular Flashcards
what is the ABPI
leg BP : arm BP
what ABPI would indicate calcification
> 1,2
what ABPI is normal
1-1.2
what ABPI indicated PAD
<0.9
how does intermittent claudication present
aching/ burning walking which is relieved by rest
1st line invx intermittent claudication
USS
what invx required before intervention in intermittent claudication
MRA
what ABPI indicated critical limb ischaemia
<0.5 (severe disease)
symptoms critical limb ischaemia
1 of: rest pain for 2+ weeks // ulcers // gangrene
features of acute limb-threatening ischaemia
pale, pulseness, pallor, pain, paraesthesia, cold
1st line invx acute limb threatening ischaemia
USS doppler
difference in history between thrombus and emboli acute critical limb ischaemia
thrombus - plaque rupture (pre-existing PAD) // emboli eg A fi =b
initial mx acute critical limb ischaemia
ABCDE // IV opioids // IV heparin
definitive mx acute critical limb ischaemia
thrombolysis // embolectomy // angioplasty // bypass // amuptation
lifestyle mx for PAD
lose weight + stop smoking + exercose
1st line mx PAD
clopidogrel (+ statin)
when are endovascular revascularization procedures done for PAD
short segment stenosis (<10cm) or aortic iliac disease in high risk patients
when are surgical revascularization procedures done for PAD
long segments, multifocal segments, common femoral and infrapopliteal
how do most venous leg ulcers form
due to venous insufficiency
features of venous insufficiency
oedema, brown pigmentation, lipodermatosclerosis, eczema
where do venous ulcers form
usually above the ankle + painless
invx venous ulcer
USS
mx venous ulcer
4 layer compression bandage (if no PAD)
what can be done for non-healing venous ulcers
skin graft
where do arterial ulcers form
toes and heels
presentation arterial ulcer
painful, cold, may be gangrene
where do neuropathic (diabetic) ulcers form
plantar surface of metatarsal head or hallux (base of toes)
what vein do varicose veins usually form
great and small saphenous vein
RF varicose veins
age, female, pregnant, obesity
invx varicose veins
USS doppler (retrograde)
conservative mx varicose veins
leg elevation, weight loss, exercise, compression stockings
reasons for referral varicose veins
pain, swelling // bleeding // skin changes from venous insufficiency // superficial thrombophlebitis // leg ulcer
mx varicose veins (3)
endothermal ablation // foam sclerotherapy // surgical ligation
what is superficial thrombophlebitis + where does it usually occur
thrombosis of a superficial vein - saphenous
acute cause of superficial thrombophelbitis
DVT
mx superficial thrombophlebitis
oral NSAIDS + compression stockings +/- topical NSAIDS or heparinoids
what invx should all patients with superficial thrombophlebitis recieve
USS
what is reynauds
hands become white and blue in cold - affects females
mx reynauds
CCB
where are emboli in the upper limb likely to lodge
50% brachial, 30% axillary
what is buergers disease
small and medium vessel vaculitis assoc with smoking –> claudication, superficial thrombophlebitis + reynauds
