Peripheral Vascular Disease Flashcards

1
Q

What is intermittent claudication?

A

Pain in the back of the calves after exertion, relieved after a while by rest

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2
Q

What causes intermittent claudication?

A

Insufficient blood reaching the exercising muscle, i.e. muscle is starved of oxygen

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3
Q

What classification/staging is used to grade claudication?

A

Fontaine staging

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4
Q

Name two non-invasive investigations for lower limb ischaemia

A

Ankle brachial pressure index (ABPI)
Duplex ultrasound scan

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5
Q

How is ABPI measured?

A

Ankle pressure / Brachial pressure (mm Hg)
using systolic pressures

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6
Q

What range for ABPI would indicate claudication?

A

0.4-0.85

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7
Q

Name some non-invasive therapy for limb ischaemia

A

Stop smoking
Increase exercise
Antiplatelet drugs
Statins

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8
Q

Is angioplasty + stenting indicated for lower limb ischaemia?

A

Yep

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9
Q

What is endarterectomy?

A

Cutting out the inside of an artery (remove plaque and fibrous tissue)

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10
Q

Describe critical limb ischaemia

A

Pain in toes/foot/leg at rest, worse at night (lying down), relieved by walking about for a bit
Can cause ulcers/gangrene

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11
Q

What is the general pathogenesis behind AAA?

A

Defect in collagen-elastin regulation, causing excessive dilation + increase in aortic wall stress

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12
Q

What are some typical features of AAA?

A

Abdo pain
Pulsatile mass
May be asymptomatic unless ruptured

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13
Q

What does expansile mean? How does it differ from pulsatile?

A

Expansile mass pushes hands in opposite directions; pulsatile mass pushes hands up and down

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14
Q

What 2 non-invasive investigations are done for AAA?

A

Ultrasound
CT scan

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15
Q

What is the investigation of choice for AAA?

A

Ultrasound - tells us whether there is an AAA or not

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16
Q

What can a CT scan tell us about an AAA?

A

Whether it is ruptured or not

17
Q

At what size would an AAA be considered/referred for elective repair?

A

5.5 cm

18
Q

What is involved in endovascular aneurysm repair (EVAR)?

A

Stent inserted via groin and passed up until the weakened part of the artery aneurysm is reached, where it seals off the aneurysm from inside the artery

19
Q

What are the benefits of EVAR over open surgery?

A

Less mortality
Faster recovery

20
Q

What are the benefits of open surgery over EVAR?

A

Possible in almost everyone
Rare further interventions

21
Q

Which veins in the leg make up the deep venous system?

A

Tibials, popliteals, femorals

22
Q

Which veins in the leg make up the superficial venous system?

A

Saphenous, perforators

23
Q

How do varicose veins arise?

A

Back pressure due to incompetent valves causes blood to pool in superficial veins

24
Q

What are secondary varicose veins?

A

Arise due to DVT

25
Q

What is thrombophlebitis?

A

Inflammation of veins caused by a clot, causing scarring/fibrosis

26
Q

Name a non-interventional management of varicose veins

A

Compression stockings
N.B. contraindicated in those with low ABPI

27
Q

Name interventional management of venous insufficiency

A

Foam sclerotherapy (chemical thrombophlebitis/injecting the vein with an irritant foam that causes closure of the vein)

Endovenous ablation- inserting a catheter into the vein to apply radiofrequency ablation