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1. Cardiovascular > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

What is an aneurysm?

A

Dilatation of a vessel by more than 50% of its normal diameter - (around 3cm)

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2
Q

What is the normal aortic diameter?

A

1.2 – 2.0 cm

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3
Q

What is a false aneurysm?

A

There is a breach in vessel wall (surrounding structures act as vessel wall)

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4
Q

What is a true aneurysm?

A

The vessel wall is intact (i.e. all 3 layers)

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5
Q

What is the pathenogenesis of an aneurysm?

A
  • Regulation of elastin/collagen in aortic wall
  • Aneurysmal dilatation
  • Increase in aortic wall stress
  • Progressive dilatation
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6
Q

How do aneurysms present?

A 
Asymptomatic (75% of AAA)
–Identified on imaging for other pathology
–Surveillance
Symptomatic
–Pain
May mimic renal colic
–“Trashing”
–Rupture
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7
Q

How does an Abdominal Aortic Aneurysm rupture present?

A
  • Sudden onset epigastric/central pain
  • May radiate through to back
  • May mimic renal colic
  • Collapse
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8
Q

When would you intervene in a AAA?

A

if it grows over 0.5cm in 6 months or >1cm in a year

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9
Q

What is the only way to identify a ruptured AAA?

A

CT Scan

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10
Q

What are the two types of AAA imaging?

A

CT scan and Duplex Ultrasound

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11
Q

What are the two management options for an AAA?

A

Open Repair – open the body up
–Laparotomy
–Clamp aorta + iliacs

Endovascular Aneurysm Repair (EVAR) – requires a lot of follow up appointments
–Exclude AAA from ‘inside’ the vessel
–Inserted via peripheral artery
–X-ray guided

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12
Q

What has a lower mortality? EVAR or Open Repair?

A

EVAR

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13
Q

What can cause aneurysms?

A 
Smoking
Hypertension
High Cholesterol
CVD
Diabetes
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14
Q

What is acute limb ischaemia?

A

Sudden loss of blood supply to a limb due to occlusion of native artery or bypass graft

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15
Q

What are the causes of Acute Limb Ischaemia?

A 
Embolism
Atheroembolism – atherosclerosis plaque can break off and travel down the limb
Arterial dissection
Trauma
Extrinsic compression
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16
Q

What are the 6 Ps of acute limb ischaemia? (clinical features)

A 
Pain 
Pallor 
Pulseless
Perishingly cold
Paraesthesia
Paralysis
17
Q

What does non blanching mottling mean?

A

Irrevesible ischaemia

18
Q

Describe acute limb ischaemia pain?

A

Severe, sudden onset, resistant to analgesia

Calf/muscle tenderness with tight (‘woody’) compartment indicates muscle necrosis - Often irreversible ischaemia

19
Q

Describe acute limb ischaemia pallor?

A

Limb initially white with empty veins

Later, capillaries fill with stagnated de-oxygenated blood giving a mottled appearance

20
Q

What is salvageable acute limb ischaemia?

A

0-4hrs

  • white foot
  • painful
  • sensorimotor deficit
21
Q

What is partially reversible acute limb ischaemia?

A

4-12hrs

  • mottled
  • blanches on pressure
22
Q

What is non salvageable acute limb ischaemia?

A

12+hrs

  • fixed mottling
  • non blanching
  • paralysis
  • compartments red
23
Q

What is the management of acute limb ischaemia?

A 
ABC – resuscitate and investigate
FBC, U/Es, CK, Coag +/- Troponin
ECG – MI, dysrhythmia 
CXR – underlying malignancy
Anticoagulate –Stops propagation of thrombus
Arterial Imaging
Urgent CT angiogram/ Catheter angiogram
24
Q

What do diabetic foot problems encompass?

A

Diabetic neuropathy
Peripheral vascular disease
Infection

25
Q

Where could diabetic foot sepsis come from?

A

simple puncture wound
infection from the nail plate or inter-digital space
from a neuro-ischaemic ulcer

26
Q

What is the biggest risk factor for loss of a leg?

A

Diabetes

27
Q

How does diabetic infection spread?

A

Within the foot the intrinsic muscles of the digits are confined within rigid compartments
Infection tracks in the soft tissues into this rigid compartment.
If the build up of pus cannot escape – the pressure builds up in this rigid compartment rapidly leading to impairment of capillary blood flow and further ischaemia and further tissue damage.
–can rapidly progress to sepsis

28
Q

What are the systemic clinical findings of diabetic foot sepsis?

A 
Pyrexia
Tachycardic
Tachypnoeic
Confused
Kussmauls breathing
29
Q

What are the local findings of diabetic foot sepsis?

A 
Swollen affected digit (‘sausage’ like)
Swollen forefoot (‘boggy’ feeling to swelling)
Tenderness
Ulcer with pus extruding
Erythema, may track up the limb
Patches of rapidly developing necrosis
Crepitus in the soft tissues of the foot
30
Q

What is the management of diabetic foot sepsis?

A

Vascular Surgical Emergency
Appropriate antibiotics -
Gram +ve cocci (S. aureus + Streptococcus sp.)
Gram –ve bacilli (E. coli, Klebsiella sp, Enterobacter, Proteus sp and Pseuodomonas sp.)
Anaerobes (Bacteroides)

31
Q

How do you prevent diabetic foot sepsis?

A

adequate education
foot assessment (diabetic foot clinic, podiatrist)
pressure offloading footwear

32
Q

What is intermittent claudication?

A

muscle ischaemia on exercise

33
Q

What are the ranges for Ankle-Brachial Pressure?

A

Normal 0.9 - 1.2
Claudication0.4 - 0.85 (– 1.0)
Severe 0 - 4.5

34
Q

What are the non invasive and invasive investigations of lower limb ischaemia?

A 
Non invasive
-	Measurement of ABPI
-	Duplex ultrasound scanning
Invasive 
-	Magnetic resonance angiography (good cause no radiation, but need to lie for long)
-	CT angiography - quick
-	Catheter angiography
35
Q

What is the treatment of lower limb ischaemia?

A 
Slowing progression 
 -  Stop Smoking
 - Lipid Lowering
 - Antiplatelets
 - Hypertension Rx
 - Diabetes Rx
 - Life Style Issues
Symptom improvement:
- Angioplasty
- Surgery
- Exercise training
36
Q

What is critical limb ischaemia?

A

Pain at rest = toe / foot ischaemia (nerve ending pain)

Ulcers/gangrene = severe ischaemia + damage

37
Q

What are the amputation levels?

A
  • transfemoral
  • hip disarticulation
  • through knee
  • transtibial

1. Cardiovascular (30 decks)

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