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MBChB Surgery > Peripheral vascular disease > Flashcards

Peripheral vascular disease Flashcards

1
Q

Define peripheral vascular disease

A

Circulatory condition involving reduced blood flow to the limbs due to narrowed blood vessels

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2
Q

What is peripheral vascular disease also known as?

A

Chronic limb arterial insufficiency/ischemia

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3
Q

Give the etiology of peripheral vascular disease

A 
Atherosclerosis 
HIV vasculopathy
Popliteal aa entrapment
Mucinous cystic degeneration
Buerger's disease
Abdominal aortic co-arctation
Peripheral emboli
Fibrodysplasia
Pseudoxanthoma elasticum
Persistent sciatic aa
Iliac aa syndrome
Primary arterial tumours
Hypercoaguability
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4
Q

Name risk factors for atherosclerosis

A 
Smoking
DM
Hypertension
Hyperlipidemia
Obesity
Elevated homocystein/fibrinogen
Male
>55yo
Family history
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5
Q

What is Leriche syndrome?

A

Clinical syndrome involving

  1. Buttock claudication
  2. Impotence
  3. Decr/absent femoral pulses
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6
Q

Name clinical features of peripheral vascular disease

A 
Silent
Intermittent claudication
Absent pulses
Trophic changes
Rest pain
Critical limb ischemia
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7
Q

Name the features of ischemic rest pain

A

> 2w duration
Worse at night
Relieved by leg dependency

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8
Q

Name causes of intermittent claudication

A

PVD
Venous claudication
Neurogenic claudication

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9
Q

Define intermittent claudication

A
  1. Pain, cramps or paresthesia distal to arterial occlusion
  2. Worsens upon exertion completely relieved by rest
  3. Reproducible
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10
Q

How do you differentiate between intermittent claudication, venous claudication and neurogenic claudication?

A 
Quality of pain
Onset
Relieved by
Location
Legs affected
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11
Q

Give the characteristics of intermittent claudication

A 
Cramping pain
Gradual onset
Relieved by rest
Located at muscle groups
Usually one leg affected
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12
Q

Give the characteristics of venous claudication

A 
Aching, heavy pain
Gradual/immediate onset
Relieved by activity
Whole leg
Usually one leg affected
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13
Q

Give the characteristics of neurogenic claudication

A 
Pins and needles
Immediate onset
Relieved by sitting down, flexion
Poorly localized
Often both legs affected
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14
Q

Differentiate between ischemic, venous and neuropathic ulcers

A

Pain
Location
Pulses
Appearance

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15
Q

Name the characteristics of ischemic ulcers

A

Painful
Distal foot
Absent foot pulses
Punch out w/ gangrenous base

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16
Q

Name the characteristics of venous ulcers

A

Mild pain unless septic
Medial malleolus
Pulses present
Shallow with granulation tissue at base

17
Q

Name the characteristics of neuropathic ulcers

A

Painless
Located at pressure points
Pulses present
Granulation tissue

18
Q

Define critical limb ischemia

A
  1. Persistent, recurring ischemic rest pain requiring opiate analgesia >2w
  2. Ulceration/gangrene of foot/toes
  3. Ankle systolic <50
  4. Toe systolic <30
19
Q

What do absent femoral pulses indicate?

A

Aorto-iliac disease

20
Q

What do absent popliteal pulses with present femoral pulses indicate?

A

Femoral-popliteal disease

21
Q

What do absent foot pulses with palpable popliteal pulses indicate?

A

Tibio-peroneal disease

22
Q

How can you asses severity of PVD using a measurement?

A

Ankle-to-brachial index

23
Q

Discuss the grading of severity of PVD using ankle-to-brachial index

A

> 0.9 normal
0.8 - 0.9 mild
0.5 - 0.79 moderate
<0.5 severe

24
Q

Name special investigations in PVD

A

Duplex ultrasound
Angiography
Convnitonal angiogram

25
Q

What do duplex ultrasound findings indicate in PVD?

A

Triphasic flow - normal
Biphasic flow - proximal occlusion
Monophasic flow - proximal stenosis

26
Q

Which classification is used to assess PVD severity?

A

Fontaine classification

27
Q

Discuss the Fontaine classification of peripheral vascular disease

A

Stage 1 asymptomatic
Stage 2a intermittent claudication after >200m pain free walking
Stage 2b intermittent claudication after <200m pain free walking
Stage 3 ischemic rest pain
Stage 4 ischemic ulceration/gangrene

28
Q

Name the objectives of management in peripheral vascular disease

A 
Pain relief
Ulcer healing
Limb loss prevention
Improve patient function and QOL
Prolong survival
29
Q

Discuss the management of peripheral vascular disease

A

Best medical therapy

  1. Pharmacology
    - statins (dyslipidemia)
    - ACE-Is (hypertension)
    - metformin (diabetes)
    - aspirin (all)
    - PDE inhibitors
  2. Lifestyle modification
    - smoking cessation
    - exercise

Surgery

30
Q

Name indications for surgery in peripheral vascular disease

A

Disabling claudication

Critical limb ischemia

31
Q

Name types of surgical intervention

A

Endovascular
- PTA and stenting

Open

  • endartectomy
  • surgical bypass
32
Q

Name types of bypass grafts

A

Autogenous

  • vein (long saphenous, short saphenous, superficial femoral)
  • artery (internal mammary, radial)

Biological

  • human umbilical vein
  • bovine pericardial
  • porcine

Synthetic

  • ePTFE (goretex)
  • dacron
33
Q

Which trial compared open to endovascular surgery and what were the findings

A

BASIL trial
Endovascular = less invasive
Open = better long term patency

34
Q

Name complications of surgical revascularisation

A

Early

  • hemorrhage
  • limb ischemia
  • renal failure
  • intestinal ischemia

Late

  • graft occlusion
  • infection
  • aorto-enteric fistula
35
Q

Which organism is most common in surgical revascularization infection?

A

Staph epidermidis

36
Q

Discuss PDE inhibitors

A

Can be given after 3months graded exercise therapy in lifestyle-limiting intermittent claudication
Reduces platelet aggregation
Causes arterial vasodilation

MBChB Surgery (38 decks)

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