Peripheral Vascular Disease Flashcards
In chronic lower limb ischaemia how might the legs present?
Legs are cold with dry skin and lack of hair. Pulses may be diminished or absent. Ulceration may occur in association with dark discolouration of toes and gangrene.
Describe the ankle brachial pressure index and what it is used for
Indicates the severity of lower limb ischaemia. Intermittent claudication= 0.5-0.9 and values of less than 0.5 are associated with critical limb ischaemia. Remember it is important to listen to wave forms particularly in diabetic patients.
Treatment of chronic lower limb ischaemia
Prevent more atherosclerosis (ie encourage patient to stop smoking, lower lipids etc.)
Encourage patient to exercise more- continue walking beyond the pain.
Surgery may be required in patients with severe symptoms- angioplasty or bypass.
Drugs- cilostazol and naftidrofuryl
What is acute lower limb ischaemia?
Sudden loss of blood supply to a limb as a result of occlusion of native artery or bypass graft
6Ps patients will complain of in acute lower limb ischaemia?
Pain (usually unbearable) , pallor (skin will change from white to mottled as the deoxygenated blood starts to stagnate), pulseless, perishingly cold, paraesthesia and paralysis.
Acute lower limb ischaemia…
From 0-4 hrs ___________
From 4-12 hours ______
From 12 hours onwards____
The foot is white and salvageable
The foot is mottled and damage is partly reversible
There is fixed mottling on the foot and it is paralysed. The foot is not salvageable.
In acute lower limb ischaemia if the foot is salvageable you could treat with ___1__
If the limb is unsalvageable the two options are ___2____
1 embolectomy, fasciotomies 2 palliation (if patient too frail for amputation) or amputation
Diabetics are particularly prone to foot infections because…
Neuropathy (damage to peripheral nerves) and presence of peripheral vascular disease means that they may not notice infection until there are systemic symptoms.
Diabetic foot infections are usually ______so a ________ spectrum antibiotic is required
polymicrobial
broad spectrum
Presentation of diabetic foot sepsis?
Patient is pyrexic, tachycardia, tachypnoeic, confused and has very laboured breathing. Swollen forefoot and digit Ulcer with pus Erythema which may track up the limb Patches of necrosis Crepitus in soft tissues of the foot
Symptoms of abdominal aortic aneurysm?
Pain mimicking renal colic (kidney stones), trashing (occurs when tiny bits of the aneurysm break off causing small spots of discolouration on the feet) or rupture.
Symptoms of AAA rupture?
Sudden onset epigastric/ central pain, pain radiation to the back, collapse, hypo/hypertensive, pulsatile expansile abdominal mass, transmitted pulses and changes to peripheral pulses.
What other type of aneurysm should you check for in those with AAA?
Popliteal aneurysms.
Intervene with AAA if…
They are fixed with…
Patient is symptomatic- has pain, trashing or rupture.
If more than or equal to 5.5 cm in diameter or expanding at a rate of more than 1cm a year.
Fixed with open repair or endovascular repair.
Distal vein thrombosis refers to DVT of the ____1______ and there is no evidence that you have to _____2______ Proximal vein thrombosis refers to DVT of __3__ or __4____ and these are ___5____
1 Calves 2 treat these 3 popliteal vein 4 femoral vein 5 treated
The ______ will be high in DVT as this is a break down product of cross linked fibrin
D-dimer
A patient with suspected DVT needs a scan if …
Their D dimer is high or they have a moderate or high probability DVT or PE score
The scans for DVT/PE
For PE mainly CTPA but also V/Q if CTPA not possible.
For DVT can use ultrasound
A complication of DVT other than PE?
Post thrombotic syndrome (chronic symptoms)
DVT can usually be treated as an in or out patient?
Out patient
In DVT what treatment are patients given?
Oral anticoagulation
2 first line oral anticoagulants for DVT and PE
Apixaban and Rivaroxaban
When are low molecular weight heparin injections PE?
In patients with active cancer and PE
Men with unprovoked VTE events are given ….
Long term anticoagulation unless bleeding issue
Women with unprovoked events are only given long term anticoagulation if …
HERDOO score is 2 or more
Varicose veins are ….
dilated, torturous, elongated superficial veins due to abnormal transmission of deep vein pressure.
Varicose veins are more common in ….
Women and pregnancy
Bleeding is a complication of varicose veins, to treat this…
Elevate the legs above the heart
Thrombophlebitis is a complication of… and is …. It should be treated with …. You are only worried about a superficial clot if …
Varicose veins and is inflammation of vein due to a clot
Anti-inflammatory drugs
Risk of it reaching the deep veins
For varicose veins do a __1___ scan if the deep veins are working then __2___
1 duplex
2 no treatment
Can give patients with varicose veins compression stockings but these are contraindicated in patients with a low ____
ABPI
Treatment of varicose vein can either be
Endovenous foam sclerotherapy (chemical) or endogenous ablation (mechanical laser of radiofrequency)
Do you offer treatment of varicose veins for cosmetic reasons? Why?
No
Not worth surgery especially as they might come back after anyway
Biggest risk for peripheral vascular disease?
Smoking
