Peripheral Vascular Disease Flashcards
What is the tunica intima?
The inner epithelial lining of the vessels
What is the tunica media?
The middle smooth muscle of the vessels
What is the tunica adventitia?
The outer fibrous layer of the vessel
What is a thrombus?
A blood clot
What is an embolus?
Any mass carried within circulation, for example:
- atherosclerotic plaque
- thromboembolus
- tumour
- vegetations from heart valves
What is Virckows triad?
The 3 factors that lead to thrombosis:
- Stasis
- Endothelial damage
- Hypercoagubility
What is chronic arterial disease?
Intermittent claudication due to mild ischaemia, relieved by rest
What is critical limb ischaemia?
Severe ischaemia, at night and whilst resting, due to tissue loss
This can be partly relieved by hanging leg out of bed
What is the main risk factor for PVD?
Smoking
When looking at ulcer what must you assess (BEDS)?
Base - granulation tissue
Edge - regular/irregular
Discharge - pus/blood/fluid
Structures visible - muscle/tendon/tissue
Describe a typical arterial ulcer, including its treatment
Severe pain in pressure areas B - deep, green or black E - regular, punched out, deep D - very little S - bone/tendon
Often skin is not swollen, but there are features of limb ischaemia
TREAT: surgical revascularisation and treat underlying cause
Describe a typical venous ulcer
Non-severe pain in legs B - pink and granulating E - irregular, neo-epithelium, very shallow D - yellow-green slough S - none visible
Often skin is swollen and surrounded by lipdermatosclerosis or venous eczema
TREAT: compression, dressing, antibiotics and steroids
What is gangrene?
Decay of body tissues, can be:
Wet - liquefactive necrosis following infection. Swollen, painful foul smelling
Dry - coagulative necrosis due to ischaemia. Cold, numb, begins distally
What is acute limb ischaemia?
A medical emergency, usually caused by an embolus, thombosis, trauma or raynauds
What are the 6Ps when assessing acute limb ischaemia?
Pale Perishingly cold Pulseless Pain Parastehsia Paralysis
What is an aneurysm?
Abnormal dilation of an endothelial lined vessel, which is greater than 1.5x its normal diameter
What is an AAA?
Increase in diameter of abdominal aorta by 50% or more (≥3cm). This is MUCH more common in males.
What is carotid artery stenosis?
Narrowing of the carotid artery due to atherosclerosis - this is a common cause of stroke
What is a varicose vein?
Dilated veins due to abnormal communication between the deep and superficial venous systems - this is often asymptomatic but can cause night cramps
What are some signs of venous disease?
Varicose veins, venous eczema, atrope blanche (white spots), ankle flare, pitting oedema, lipodermatosclerosis
What is stasis dermatitis?
AKA venous eczema
The skin changes in the leg that result from insufficient venous return. RBCs break down and hemosiderin is deposited in the legs
What is Burgers test?
Put foot off the bed and then lift the foot up, before putting down.
It should go pale and revascularise quickly.
How do you take an ABPI?
Measure BP manually at both brachial arteries and take the highest reading.
Using doppler, measure BP of one ankle at both arteries, and take the highest reading
ABPI = ankle BP/arm BP
Repeat for the other leg
What is a normal ABPI reading - or one for venous disease?
0.9-1.3
What would the ABPI reading be in calcified vessels?
> 1.3
This might be in diabetic or elderly patients
What would the ABPI reading be in intermittent claudication?
0.4-0.9
What would the ABPI reading be in critical limb ischaemia?
<0.4
What imaging can be used to assess vascular damage?
- USS - to assess patency of individual vessels
- CT angiography
- Magnetic resonance angiography
- Digital subtraction angiography
What is embolectomy?
Surgical removal of an embolus, by inserting a catheter with an inflatable balloon
What is an endartectomy?
Surgical removal of plaque from an artery that has become narrowed
What is a bypass graft?
Surgical creation of a new pathway for blood to flow, using a graft (from a vein or synthetic)
