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Cardiovascular > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

What is the predominant cause of PVD?

A

Atheroma

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2
Q

What are extra risk factors for PVD?

A

Increased homocysteine or free radicals

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3
Q

What are PVD patients also likely to have?

A

Coronary artery disease or cerebro-vascular disease

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4
Q

What is chronic leg ischaemia?

A

Not enough blood getting to the leg

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5
Q

What is claudication?

A

Muscle ischaemia on exercise

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6
Q

What is the brief cause of claudication?

A

The vessel is narrowed or blocked so not enough oxygen can get to the muscles when the demand increases upon exercise

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7
Q

When will the pain of claudication occur?

A

Always at the same point of exercise

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8
Q

What is the most commonly occluded artery in PVD?

A

Superficial femoral artery

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9
Q

What is the most common test to do for claudication?

A

Ankle brachial pressure index

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10
Q

What do the scores from the ABPI test mean?

A

0.9-1.2= normal
0.4-0.85= claudication
0-0.4= severe

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11
Q

What stops the ABPI test from working?

A

Having a calcified vessel e.g. from diabetes or renal failure

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12
Q

What test is used instead of ABPI when it cannot be?

A

Doppler leg scan

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13
Q

What are some other investigations could be of use for claudication?

A

US, magnetic resonance angiography (MRA), CT or catheter angiography

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14
Q

What is the best way to treat claudication?

A

Lifestyle advice, stop smoking, decrease lipids etc. May give anti-platelet. Exercise can also be used.

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15
Q

Why is exercise used as a treatment for claudication and what is the downside to this?

A

To get the muscle used to working with low oxygen- causes patients pain

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16
Q

What procedures could be used for claudication?

A

Angioplasty with stent, or inflow/outflow bypass

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17
Q

What is the downside of a stent for claudication?

A

Gets riskier the further down the leg you go

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18
Q

What is critical leg ischaemia?

A

Pain in the foot or toe which comes on at rest, particularly when lying or sleeping

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19
Q

What can critical leg ischaemia lead to?

A

Ulcers, gangrene and amputation

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20
Q

What are clinical signs of critical leg ischaemia?

A

Loss of peripheral pulses, shiny legs, hair loss, redness, thick nails

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21
Q

What different types of amputation can you get?

A

Trans-femoral, trans-tibial or through the knee

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22
Q

What are the two most common causes of varicose veins?

A

Failure of a valve, or DVT

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23
Q

What are risk factors for varicose veins?

A

Age, pregnancy, obesity

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24
Q

What is the only reason to operate on someone for varicose veins?

A

If they can’t wear compression stockings

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25
Q

What are the complications of varicose veins?

A

Thrombophlebitis, bleeding, chronic venous insufficiency

26
Q

What is thrombophlebitis?

A

Inflammation of a vein caused by a blood clot which is sore and can cause scarring

27
Q

What is chronic venous insufficiency?

A

Red cell leakage and breakdown

28
Q

What is the final stage of varicose veins and how do you investigate for this?

A

Ulceration- Duplex scan

29
Q

What is the non-interventional management for varicose veins?

A

Compression stockings

30
Q

What is the contra-indication to compression stockings?

A

Peripheral arterial disease

31
Q

What is interventional management for varicose veins?

A

Foam scleropathy or endovascular ablation

32
Q

What is an aneurysm?

A

Abnormal dilatation of a blood vessel by > 50% of its normal diameter

33
Q

What is the normal diameter of the aorta?

A

2-2.2cm

34
Q

What is a true aneurysm?

A

All three layers of the vessel wall are intact

35
Q

What is a false aneurysm?

A

A breach in the vessel wall involving all three layers- surrounding structures keep the aneurysm in tact

36
Q

What is a saccular aneurysm?

A

Sacs coming off the vessel

37
Q

What is a fusiform aneurysm?

A

Inside the vessel

38
Q

What is a ruptured/mycotic aneurysm?

A

Arise secondary to infection- weakens the vessel wall, all three layers involved

39
Q

Can any type of aneurysm rupture?

A

Yes

40
Q

Which layer of the vessel wall does the pathogenesis of aneurysms attack?

A

Middle

41
Q

What is the rough pathogenesis behind an aneurysm?

A

Involves regulation of collagen and elastin. There is an imbalance of build up and break down proteins which causes dilatation and increases vessel wall stress

42
Q

What are risk factors for AAA?

A

Male, increased age, smoking, hypertension

43
Q

What are some symptoms of an AAA?

A

Pain, trashing, rupture

44
Q

What is trashing?

A

Turbulent blood flow as bits of thrombus break off

45
Q

how will an AAA present?

A

Sudden onset of epigastric pain which may radiate to the back and the patient may collapse

46
Q

What are the two different types of AAA rupture and what are their outcomes?

A

Retroperitoneal- contained

Intraperitoneal- rapidly fatal

47
Q

When should you intervene to treat an AAA?

A

If symptomatic, greater than 5.5cm or has grown more than 0.5cm in 6 months

48
Q

What test is used to keep checks on an AAA?

A

Duplex ultrasound

49
Q

What test is used to assess a management plan for AAA?

A

Arterial phase CT

50
Q

How can you surgically manage AAA?

A

Open repair or endovascular aneurysm repair

51
Q

What is acute limb ischaemia?

A

Sudden loss of blood supply to a limb from the occlusion of a vessel or bypass graft

52
Q

What are some causes of acute limb ischaemia?

A

Embolism, atheroembolism, arterial dissection, trauma or extrinsic compression

53
Q

What are clinical features of acute limb ischaemia?

A

Pain, pallor, pulseless, paralysis, paraesthesia, perishingly cold

54
Q

When is an acute limb ischaemia non-salvageable?

A

After 12 hours

55
Q

What tests are done for acute limb ischaemia?

A

FBC, U+E, CK, coagulation, ECG, CXR

56
Q

Why is creatinine kinase looked for in acute limb ischaemia?

A

To look for muscle damage

57
Q

What are the treatment options for acute limb ischaemia?

A

Anticoagulation
If salvageable- surgery
If non-salvageable- palliation or amputation

58
Q

What is the triad leading to diabetic foot sepsis?

A

Diabetic neuropathy, PVD, infection

59
Q

What does diabetic foot sepsis cause?

A

Necrosis, gangrene, amputation

60
Q

What are clinical findings of diabetic food sepsis?

A

Pyrexia, tachycardia, tachypnoea, confusion, Kausmall’s breathing (ketoacidosis)

61
Q

How do you treat diabetic foot sepsis?

A

Antibiotics

Surgery with open wound to encourage drainage

62
Q

What causes the problem of diabetic foot sepsis?

A

Pressure

Cardiovascular (23 decks)

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