Peripheral Vascular Disease Flashcards
What is intermittent claudication?
Pain in the back of the calves after exertion, relieved after a while by rest
What causes intermittent claudication?
Insufficient blood reaching the exercising muscle (via collaterals), i.e. muscle is starved of oxygen
What classification/staging is used to grade claudication?
Fontaine staging
Name two non-invasive investigations for lower limb ischaemia
Ankle brachial pressure index (ABPI)
Duplex ultrasound scan
Name three invasive investigations for lower limb ischaema
Magnetic resonance angiography
CT angiography
Catheter angiography
How is ABPI measured?
Ankle pressure / Brachial pressure (mm Hg) using systolic pressures
What range for ABPI would indicate claudication?
0.4-0.85
Name some non-invasive therapy for limb ischaemia
Stop smoking Increase exercise (EXERCISE THROUGH PAIN) Antiplatelet drugs Statins Antihypertensives
Is angioplasty + stenting indicated for lower limb ischaemia?
Yep
What is endarterectomy?
Cutting out the inside of an artery (remove plaque and fibrous tissue)
Describe critical limb ischaemia
Pain in toes/foot/leg at rest, worse at night (lying down), relieved by walking about for a bit
Can cause ulcers/gangrene
What is the general pathogenesis behind AAA?
Defect in collagen-elastin regulation, causing excessive dilation + increase in aortic wall stress
What are some typical features of AAA? What can it mimic?
Abdo pain/ Back pain
Collapse
Pulsatile mass
May be asymptomatic unless ruptured
Renal colic
What does expansile mean? How does it differ from pulsatile?
Expansile mass pushes hands in opposite directions; pulsatile mass pushes hands up and down
What 2 non-invasive investigations are done for AAA?
Duples US scan
CT scan
What is the investigation of choice for AAA?
Ultrasound - tells us whether there is an AAA or not
What can a CT scan tell us about an AAA?
Whether it is ruptured or not
At what size would an AAA be considered/referred for elective repair?
5.5 cm
What is involved in endovascular aneurysm repair (EVAR)?
Stent inserted via groin and passed up until the weakened part of the artery aneurysm is reached, where it seals off the aneurysm from inside the artery
What are the benefits of EVAR over open surgery?
Less mortality
Faster recovery
What are the benefits of open surgery over EVAR?
Possible in almost everyone
Rare further interventions
Which veins in the leg make up the deep venous system?
Tibials, popliteals, femorals
Which veins in the leg make up the superficial venous system?
Saphenous, perforators
How do varicose veins arise?
Back pressure due to incompetent valves causes blood to pool in superficial veins
What are secondary varicose veins?
Arise due to DVT
What is thrombophlebitis?
Inflammation of veins caused by a clot, causing scarring/fibrosis
Name a non-interventional management of varicose veins
Compression stockings
N.B. contraindicated in those with low ABPI
Name interventional management of venous insufficiency
Foam sclerotherapy (chemical thrombophlebitis) Endovenous ablation
What are some risk factors for intermittent claudication or AAA?
Smoking High BP DM High cholesterol Male Age (>55) Alcohol
What is the treatment for critical limb ischaemia?
Analgesia
Angioplasty/stenting
Surgical reconstruction
Amputation
The risk of limb loss is increased by…
Smoking
What is acute limb ischaemia? What are the two types?
Sudden loss of blood supply to limb
Acute or acute on chronic
What is the cause of acute limb ischaemia?
Embolism Atheroembolism Arterial dissection Trauma Extrinsic compression
What are the signs of acute limb ischaemia?
6Ps: pain, pallor, perishingly cold, pulseless, paraesthesia, paralysis
If a limb is blanching it is reversible. True/False?
True. Non-blanching is irreversible.
What is the management for acute limb ischaemia if the limb is salvageable or not?
SALVAGEABLE: embolectomy, thrombolysis, fasciotomy
NOT: amputation, palliation
What post-op complication is associated with acute limb ischaemia? How is it managed?
Compartment syndrome due to re-perfusion injury
Fasciotomy
What are the three types of aneurysm?
Saccular
Fusiform
Myocytic (all 3 layers of artery)
What are some likely causes of aneurysms?
Atheroma Trauma Endocarditis Syphilis CT disorder - Marfans Inflammatory
What veins are involved in varicose veins?
Long saphenous
Short saphenous
What are some risk factors for varicose veins?
Prolonged standing Age Obesity Contraceptive pill Pregnancy Family history
What are some signs/symptoms of varicose veins?
Pain, cramps, tingling, heavy or restless legs
Signs of chronic venous insufficiency - oedema, ulcers, thrombophlebitis, lipodermatosclerosis (hardening of skin)
What is the first line investigation for varicose veins?
Duplex US scan
What are some complications of varicose veins?
Thrombophlebitis Skin staining Local ulceration Wound infection Nerve damage
