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Vascular Surgery > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

what are the two types of PVD?

A

organic and functional

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2
Q

what is organic PVD?

A

where a blockage has occurred

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3
Q

what is functional PVD?

A

blood vessels change diameter

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4
Q

what are the causes of organic PVD?

A

atherosclerosis
embolus
stenosis/occlusion
disruption/ulceration

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5
Q

what is the cause of functional PVD?

A

vasospasms

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6
Q

what is PVD?

A

narrowing or arteries, usually affecting the limbs

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7
Q

what are the risk factors for PVD?

A

SMOKING
Also: diabetes, dyslipidaemia, hypertension, obesity, age, male, hypocholestrolemia, hyperhomocysteinaemia, geography, family history

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8
Q

what is claudication?

A

pain during exercise, occurs in calf, may also involve thigh or buttock, frequently 2 or 3 muscle groups become symptomatic, cramp like,

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9
Q

what are the exacerbating causes of claudication?

A

walking quickly, climbing hills, cold weather, medications (e.g. beta blockers)

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10
Q

what is a symptom of mild PVD?

A

claudication

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11
Q

what are the symptoms of severe PVD?

A 
o	Claudication at rest
o	Pain at night when legs are raised on bed, relieved by lowering legs/sitting up
o	Ulcers - punched out
o	Gangrene 
o	Reduced/absent peripheral pulses
o	Skin atrophy
o	Hair loss
o	Colour changes or cyanosis
o	Excessive sweating 
o	Erectile dysfunction
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12
Q

what is beugers angle test?

A

highlights if Lower limb arterial pressure is insufficient to perform the additional work against gravity

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13
Q

what are the investigations for PVD?

A 
Palpation of femoral and distal pulses 
Auscultation of iliac artery – bruit
Doppler ultrasound 
ABI = BP ankle/BP arm
CT angiogram
Bloods
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14
Q

what are different ABI measurements in PVD?

A

o Normal >1
o PVD diagnosis <0.9
o Pain at rest <0.6
o High risk of gangrene <0.3

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15
Q

what blood tests should be carried out in PVD?

A

HbA1c, lipids, U&Es, ESR/CRP, platelets and clotting

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16
Q

what classification system is used for PVD?

A

Fontaine

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17
Q

what is the definition of Fontaine I (PVD)?

A

asymptomatic lower limb arterial disease

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18
Q

what is the definition of Fontaine IIa (PVD)?

A

claudication > 200m

19
Q

what is the definition of Fontaine IIb (PVD)?

A

claudication < 200m

20
Q

what is the definition of Fontaine III (PVD)?

A

rest pain

21
Q

what is the definition of Fontaine IV (PVD)?

A

ulceration and/or gangrene

22
Q

what are the different categories of management of PVD?

A

Lifestyle
Medical
Surgical

23
Q

what is the medical management of PVD?

A 
o	Statin (atorvastatin 40mg)
o	Control hypertension – ACE or calcium channel blocker
o	Antiplatelet
24
Q

what is the surgical management of PVD?

A

o Percutaneous transluminal Angioplasty – guided wire balloon
o Infra-inguinal Bypass
o Aorta-femoral/iliac bypass

25
Q

what is the definition of critical limb ischaemia?

A

limb with rest pain of at least 2 weeks duration or tissue loss caused by arterial disease

26
Q

what are the limbs systolic pressures in critical limb ischaemia?

A

ankle systolic >50mmHg

toe pressure >30mmHg

27
Q

what are the symptoms of critical limb ischaemia?

A

rest pain, gangrene, ulceration

28
Q

what are the two types of gangrene?

A

dry and wet

29
Q

what is wet gangrene?

A

gangrene with infection

spreads rapidly, severe compromised limb, systemic sepsis

30
Q

what are the causes of acute limb ischaemia?

A
  • Thrombus in situ
  • Emboli
  • Graft/angioplasty occlusion
  • Trauma
  • IV drug users
  • Compartment syndrome
  • Can be acute on chronic
31
Q

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

A
  • Pulseless
  • Paraesthesia
  • Pain – muscles also become tender to palpation after about 6-8hours
  • Paralysis
  • Pallor
  • Perishing cold
32
Q

how is acute limb ischaemia diagnosed?

A

clinically

33
Q

what is the 1st line management of acute limb ischaemia?

A

o Analegesia (parenteral)
o Full anticoagulation with heparin or LMWH if immediate treatment is not planned
o Optimise CVD status

34
Q

what is the 2nd line management of acute limb ischaemia>

A

Find source of emboli - arteriography

35
Q

if possible, how can revascularisation be achieved in acute limb ischaemia?

A

o Thrombolysis - tissue plasminogen factor most effective when given via local arterial catheter (Fogarty Catheter), streptokinase
o Embolectomy/bypass/PTA
o A combination

36
Q

when should revascularisation not be attempted in PVD management?

A

o In bedridden patients
o In a functionally useless limb
o In patients with life-threatening sepsis
o Where revascualarisation is technically impossivle
o Where there is extensive muscle necrosis

37
Q

what is a reperfusion injury?

A

Release of toxic metabolites and oxygen free radicals into the systemic circulation from the ischaemic limb. This can cause a profound cardiovascular collapse with renal and sometimes respiratory failure.

38
Q

when is amputation considered in limb ischaemia?

A

when revascularisation is inappropriate
If revascularisation fails
Also: calf tenderness, a raised CK and prolonged, profound paralysis or sensory loss

39
Q

what are the two types of amputation?

A

major and minor

40
Q

what are the two types of major amputation?

A

Above the knee (AKA)

Below the knee (BKA)

41
Q

what are the features of BKA?

A

can become independently mobile because knee joint is preserved and a lighter prosthesis is used

42
Q

what are the features of AKA?

A

o Above knee amputation (AKA) or transferomal amputation has poorer outcome
o Although more likely to heal rehab is less successful
o Patients are often more unwell than below knee amputation

43
Q

what are the features of post amputation management?

A

Antibiotic prophylaxis
analgesia
early fitting of prosthesis and mobilisation

Vascular Surgery (2 decks)

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