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Peripheral Vascular Disease Flashcards

1
Q

In relation to the blockage where will pain be felt?

A

Distal

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2
Q

A patient comes into the GP with calf pain whilst playing golf, it is usually around the 5th hole but now nearer the 4th it is relieved when she stops. What is the diagnosis?

A

intermittent claudication

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3
Q

Describe intermittent claudication

A

muscle ischaemia on exercise, usually comes on at a steady distance & relieved at rest

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4
Q

Describe the progression of intermittent claudication

A

As symptoms worsen so does the blood supply until continuous pain at rest occurs leading to tissue loss

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5
Q

How can intermittent claudication be assessed?

A

Ankle brachial pressure index

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6
Q

What values indicate claudication from the ABPI?

A

Normal 0.9 -1.2
Claudication 0.4 - 0.85
Severe 0 - 0.4

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7
Q

What is a duplex ultrasound?

A

combination of doppler - looks at flow and ultrasound - sees a 3D image

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8
Q

Name three invasive tests for arterial disease

A
  • Magnetic resonance angiography
  • CT
  • Catheter angiography
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9
Q

How can arterial disease be slowed down?

A 
stop smoking 
lipid lowering 
anti platelet (aspirin & clopidogrel) 
hypertension treatment 
diabetes treatment 
lifestyle
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10
Q

What can be offered for intermittent claudication?

A

Supervised exercise programmes the more you walk the better it will be, however this only treats symptoms

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11
Q

What treatment is available for arterial disease?

A
  • Angioplasty with batons & stents

- Bypass

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12
Q

Name three things required to complete bypass surgery

A
  1. inflow
  2. outflow
  3. graft
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13
Q

Why is it better to use a patients own vein as opposed to a prosthetic one?

A

Microorganisms love prosthetic veins whereas a patients own veins are resistant to infection

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14
Q

How can critical limb ischaemia be described?

A

Toe/foot pain usually at night when flat in bed, then progresses to all the time

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15
Q

What can critical limb ischaemia lead to?

A

Ulcers & gangrene as a result of minor trauma

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16
Q

State five clinical features of critical limb ischaemia

A
  • cold
  • absence of pulses
  • poor tissue nutrition
  • venous guttering
  • ulcers/gangrene
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17
Q

What is venous guttering?

A

When you lift the leg up the vein will empty rapidly

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18
Q

If an artery cannot be treated what is required?

A

Amputation

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19
Q

What does amputation depend on?

A

Damage to leg & blood supply

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20
Q

Name the structure that connects the deep venous system to the superficial system

A

Perforators

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21
Q

What is required in order to get blood out of the legs?

A
  1. Vessel
  2. Valves (one-way system)
  3. Pump (muscles)
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22
Q

Define varicose vein

A

dilated, tortuous superficial elongated vein due to abnormal transmission of deep vein pressure

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23
Q

What are the two types of varicose vein?

A

Primary - occurs out of the blue

Secondary - due to DVT

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24
Q

Name risk factors for Varicose veins

A
  • Age (old)
  • Gender (female)
  • Pregnancy
  • Obesity
  • Family history
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25
State five clinical features of Varicose Veins
- bleeding - thrombophlebitis - venous hypertension - lipodermatosclerosis - ulceration
26
What do you do if a varicose vein starts bleeding?
Elevate and apply pressure
27
Define thrombophlebitis
inflammation of a vein caused by a clot
28
What does venous hypertension lead to?
Haemosiderin deposits
29
State the characteristics of lipodermatosclerosis
white cells, inflammation & fibrosis
30
Why must you be careful of ulceration?
There may be an underlying cause especially if it has rolled edges
31
What investigation is done for varicose veins?
Duplex scan to check if; - occlusion or incompetence - which vein/valve is affected
32
How can a varicose vein be managed?
Educate the patient, bandaging & graduated compression
33
When are compression stockings contraindicated?
Patients with a low ABPI
34
What procedures can be done on a patient with varicose veins?
Endogenous - foam or ablation - x-ray guided | Surgery - high tie distal from ablation (50% risk of wound infection)
35
What are the three types of ablation?
- mechanical - laser (heat) - radiofrequency (waves)
36
Define abdominal aortic aneurysm
dilatation of a vessel by more than 50% of its diameter
37
In terms of vessel wall what are the two types of aneurysm
true - vessel wall is intact | false - breach in the vessel wall
38
Name three types of aneurysm
1. saccular 2. fusiform 3. mycotic - due to infection
39
Describe the pathogenesis of AAA
Medial degeneration leads to an imbalance between elastin/collagen. This causes aneurysmal dilatation and increase in vessel wall stress
40
Name four risk factors for AAA
- age - gender - smoking - hypertension
41
What are the symptoms of an AAA?
75% asymptomatic | Symptoms ; pain, trashing, rupture
42
Define trashing
Parts of the thrombus break off & clot
43
How are asymptomatic patients diagnosed?
Imaging
44
How will an AAA rupture present?
Sudden onset epigastric pain, the patient may look well but will be hypo/hypertensive, pulsatile, have transmitted & peripheral pulses
45
What types of AA are treatable?
Contained retroperitoneal but 50% operative mortality
46
When are AAA dealt with?
If symptomatic, >5.5cm, grows >1cm/year
47
How are AAA detected?
Duplex ultrasound - allows you to see front - back diameter
48
Name the investigation used to assess the complexity of the aneurysm
CT scan using IV contrast, only method in detecting a ruptured AAA
49
What is the management for an AAA?
``` Open repair (laparotomy, clamp aorta & iliac, graft new aorta) Endovascular (EVAR, x-ray guided insertion of a stent with a seal) ```
50
Define acute leg ischaemia
sudden loss of blood supply to a limb
51
What are the causes of acute leg ischaemia?
- embolism - atheroembolism - arterial dissection - trauma - extrinsic compression (cancer & limb disease)
52
State the six P's of acute leg ischaemia
``` Pain Pallor Pulseless Persistently cold Paraethesia Paralysis ```
53
After how many hours of no blood supply can a leg be saved?
0-4 hours salvageable 4-12 hours partly reversible >12 irreversible (not blanching/ turning white from purple when pressed)
54
Describe the test for a patient with acute limb ischamia
ABC FBC U/E, CK, Coag, Troponin ECG
55
If the limb is salvageable what is done?
Embolectomy Fasciotomies Thrombolysis (rare)
56
If it is not salvageable what is done
Palliation or amputation
57
What does the ageing population mean?
Not just one emboli may be present
58
What is the triad for a diabetic foot sepsis?
- neuropathy - PVD - Infection
59
What does diabetic foot sepsis lead to?
Ulceration, necrosis & gangrene strongest risk factor for
60
State the causes for diabetic foot sepsis
- simple puncture wound - infection from the nail plate/inter-digital space - neuro-ischaemic ulcer Build up of puss cannot escape, pressure builds up leading to rapid sepsis & necrosis
61
What are the features of diabetic foot sepsis?
- swollen affected digit/forefoot - tenderness - ulcer - erythema - patches of necrosis
62
Describe the management of diabetic foot sepsis
Polymicrobial needs broad spectrum antibiotics & rapid surgery of infected tissue - open wound to encourage drainage
63
How can diabetic foot problems be prevented?
Education &assessment

Cardiovascular (19 decks)

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