Peripheral Vascular Disease II Flashcards
What is an anuerysm?
Dilatation of a vessel by more than 50% of its usual
What is a true/false aneurysm?
True- vessel walls (3 layers maintained
False- vessel wall breached. surrounding structures keep it in check
What are the types of aneurysm?
Saccular- Sac formed off the wall of artery
Fusiform- spindle shaped
Mycotic- secondary to an infectious process. infection weakens the wall
All types prone to rupture
What is the pathogenesis of an aortic aneurysm?
Due to degeneration of the tunica media
- Unbalance between elastin/collagen in the aortic wall
- Causes weakening of the wall and dilatation
- Increases aortic wall stress
- Progressive dilatation
Age, males, smoking and hypertension are risk factors
What is the main effect of an aneurysm?
Ruptures
What is the common presentation of an AAA?
- Asymptomatic (75% of the time)
- Symptomatic: Pain (may mimic renal colic), Trashing- thrombus in the distal circulation, Rupture
How does a ruptured aneurysm present?
- Sudden Epigastric and central chest pain
- May radiate to the back
- Mimic renal colic
- collapse
What happens on examination?
- May look fine
- Hype/hypotensive
- Pulsatile, expansile mass +/- tender
- Transmitted pulse
- Peripheral pulse
What is the outcome of an AAA rupture?
- 75% Don’t make it
- those who do:
1. Mostly retro-pertioneal contained rupture
free intra-peritoneal rupture= rapidly fatal
50% operative mortality
What does duplex ultrasound offer in AAA?
non invasive.
Allows one to see aneurysm and measure its AP diameter
What is a CT used for in AAA?
aneurysm shape, size, iliac involvement
ONLY scan that can show a rupture.
What does endovascular aneurysm repair (EVAR) do?
Places a stent into the aneurysm to push the plaque distally, allowing better blood flow
Two big modifiable risk factors of AAA?
- Smoking 2. Hypertension
What are the three main types of acute limb threat?
- Acute limb ischaemia
- Acute on chronic limb ischaemia
- Diabetic foot sepsis
What happens in acute limb ischaemia? why?
Sudden onset of pain due to loss of blood supply in the leg, caused by an occlusion of an artery
What can be some causes for a sudden occlusion?
- Embolism
- Atheroembolism
- Arterial dissection
- trauma
- extrinsic compression
What are the clinical features of acute limb ischaemia?
- Pain: severe, sudden, resistant to analgesia
- Pale: limb white empty veins.
- Pulseless
- perishingly cold
- parasthesia
- paralysis
muscle/ calf tenderness with “woody compartements” or non blanching mottline= irreversible ischaemia
What are the signs of ALI in these 3 stages:
- salvageable
- partly reversible
- irreversible
- Salvagable- white foot, painful
- Partly reversible- mottled, blanches on pressure
- Irreversible- fixed mottling, non blanching, paralysis, tender/red compartments
What investigations would you do for Acute LI?
- FBC, coagulant +/- troponin
- ECG: MI, disrhhythmias
- CXR- any malignancy
What main dug type is used in acute li?
anticoagulants
How would you manage salvageable vs non salvageable Acute LI?
Salvageable- embolectomy, thrombolysis
non “ - palliative, amputation
What are the three focal points of diabetic foot sepsis (DFS)
- Diabetic neuropathy
- peripheral vascular disease
- infection
DFS is vascular surgical emergency
Effects of DFS?
Can cause foot necrosis, ulceration, gangrene
may lead to amputation
What is the source of infection in DFS?
- Simple puncture wound
- From a neuro-ischaemic ulcer
- from a nail plate/ inter-digital space
Why does infection in the foot lead to sepsis and ischaemia?
Intrinsic muscles in the foot have small spaces
Infection takes over theses spaces–> pus build up
Increased pressure in the spaces–> restricts capillary blood flow–> ischaemia
What are the clinical findings in DFS?
- Systemic:
- Pyrexic
- tachycardia
- tachypnoea
- confused
- kussmauls breathing (deep, laboured) - Local:
- Swollen digits + forefoot
- Tenderness
- Ulcer, pus extending
- Erythema
- patches of necrosis
How should DFS be treated?
Vascular surgical emergency
- Appropriate antibiotic based on infection (gram +/-)
- surgical debridement of infected tissue
What can be some after-measures for DFS?
- Adequate education
- foot assessment
- pressure offloading footwear.
