Peripheral Vascular Disease Flashcards
What is the predominant cause of PVD?
Atheroma
What are extra risk factors for PVD?
Increased homocysteine or free radicals
What are PVD patients also likely to have?
Coronary artery disease or cerebro-vascular disease
What is chronic leg ischaemia?
Not enough blood getting to the leg
What is claudication?
Muscle ischaemia on exercise
What is the brief cause of claudication?
The vessel is narrowed or blocked so not enough oxygen can get to the muscles when the demand increases upon exercise
When will the pain of claudication occur?
Always at the same point of exercise
What is the most commonly occluded artery in PVD?
Superficial femoral artery
What is the most common test to do for claudication?
Ankle brachial pressure index
What do the scores from the ABPI test mean?
0.9-1.2= normal
0.4-0.85= claudication
0-0.4= severe
What stops the ABPI test from working?
Having a calcified vessel e.g. from diabetes or renal failure
What test is used instead of ABPI when it cannot be?
Doppler leg scan
What are some other investigations could be of use for claudication?
US, magnetic resonance angiography (MRA), CT or catheter angiography
What is the best way to treat claudication?
Lifestyle advice, stop smoking, decrease lipids etc. May give anti-platelet. Exercise can also be used.
Why is exercise used as a treatment for claudication and what is the downside to this?
To get the muscle used to working with low oxygen- causes patients pain
What procedures could be used for claudication?
Angioplasty with stent, or inflow/outflow bypass
What is the downside of a stent for claudication?
Gets riskier the further down the leg you go
What is critical leg ischaemia?
Pain in the foot or toe which comes on at rest, particularly when lying or sleeping
What can critical leg ischaemia lead to?
Ulcers, gangrene and amputation
What are clinical signs of critical leg ischaemia?
Loss of peripheral pulses, shiny legs, hair loss, redness, thick nails
What different types of amputation can you get?
Trans-femoral, trans-tibial or through the knee
What are the two most common causes of varicose veins?
Failure of a valve, or DVT
What are risk factors for varicose veins?
Age, pregnancy, obesity
What is the only reason to operate on someone for varicose veins?
If they can’t wear compression stockings
What are the complications of varicose veins?
Thrombophlebitis, bleeding, chronic venous insufficiency
What is thrombophlebitis?
Inflammation of a vein caused by a blood clot which is sore and can cause scarring
What is chronic venous insufficiency?
Red cell leakage and breakdown
What is the final stage of varicose veins and how do you investigate for this?
Ulceration- Duplex scan
What is the non-interventional management for varicose veins?
Compression stockings
What is the contra-indication to compression stockings?
Peripheral arterial disease
What is interventional management for varicose veins?
Foam scleropathy or endovascular ablation
What is an aneurysm?
Abnormal dilatation of a blood vessel by > 50% of its normal diameter
What is the normal diameter of the aorta?
2-2.2cm
What is a true aneurysm?
All three layers of the vessel wall are intact
What is a false aneurysm?
A breach in the vessel wall involving all three layers- surrounding structures keep the aneurysm in tact
What is a saccular aneurysm?
Sacs coming off the vessel
What is a fusiform aneurysm?
Inside the vessel
What is a ruptured/mycotic aneurysm?
Arise secondary to infection- weakens the vessel wall, all three layers involved
Can any type of aneurysm rupture?
Yes
Which layer of the vessel wall does the pathogenesis of aneurysms attack?
Middle
What is the rough pathogenesis behind an aneurysm?
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
What are risk factors for AAA?
Male, increased age, smoking, hypertension
What are some symptoms of an AAA?
Pain, trashing, rupture
What is trashing?
Turbulent blood flow as bits of thrombus break off
how will an AAA present?
Sudden onset of epigastric pain which may radiate to the back and the patient may collapse
What are the two different types of AAA rupture and what are their outcomes?
Retroperitoneal- contained
Intraperitoneal- rapidly fatal
When should you intervene to treat an AAA?
If symptomatic, greater than 5.5cm or has grown more than 0.5cm in 6 months
What test is used to keep checks on an AAA?
Duplex ultrasound
What test is used to assess a management plan for AAA?
Arterial phase CT
How can you surgically manage AAA?
Open repair or endovascular aneurysm repair
What is acute limb ischaemia?
Sudden loss of blood supply to a limb from the occlusion of a vessel or bypass graft
What are some causes of acute limb ischaemia?
Embolism, atheroembolism, arterial dissection, trauma or extrinsic compression
What are clinical features of acute limb ischaemia?
Pain, pallor, pulseless, paralysis, paraesthesia, perishingly cold
When is an acute limb ischaemia non-salvageable?
After 12 hours
What tests are done for acute limb ischaemia?
FBC, U+E, CK, coagulation, ECG, CXR
Why is creatinine kinase looked for in acute limb ischaemia?
To look for muscle damage
What are the treatment options for acute limb ischaemia?
Anticoagulation
If salvageable- surgery
If non-salvageable- palliation or amputation
What is the triad leading to diabetic foot sepsis?
Diabetic neuropathy, PVD, infection
What does diabetic foot sepsis cause?
Necrosis, gangrene, amputation
What are clinical findings of diabetic food sepsis?
Pyrexia, tachycardia, tachypnoea, confusion, Kausmall’s breathing (ketoacidosis)
How do you treat diabetic foot sepsis?
Antibiotics
Surgery with open wound to encourage drainage
What causes the problem of diabetic foot sepsis?
Pressure
