surgery - vascular presentaitons Flashcards
what are ulcers?
abnormal breaks in the skin or mucous membranes
what are types of ulcers?
80% venous
arterial insufficiency
diabetic-related neuropathy
infection, trauma, vasculitis, malignancy (SCC)
what may cause ulcers in less mobile people?
PRESSURE ULCERS = prolonged or excessive pressure over bony prominence
leads to skin breakdown + encores
HOW ARE PRESSURE ULCERS MANAGED/
adequate mattresses + good wound management
what are venous ulcers?
shallow ulcers with granulated base
how do venous ulcers present?
shallow
irregular borders
granulating base
over medial malleolus
pathophysiology of venous ulcers
impaired venous return
“trapping” of white blood cells
formation of a fibrin cuff
impaired oxygen transport
release of inflammatory mediators
resultant tissue injury, poor healing, and necrosis
main components of venous ulcers?
superficial venous incompetence, deep venous incompetence, poor mobility causing gravitational leg swelling, and cardiac failure
RF for venous ulcers
Increasing age
Pre-existing venous incompetence or history of venous thromboembolism, Including varicose veins
Pregnancy
Obesity or physical inactivity
Severe leg injury or trauma
features of venous ulcers
painful
gaiter region
aching, itching, burning sensation
varicose eczema/thrombophelbitis
haemosiderin staining
lipodermatosclerosis
atrophie blanche
ix for venous ulcers
duplex USS
ABPI
if infection - swab cultures
mx of venous ulcers
leg elevation and increased exercise
weight reduction and improved nutrition
compression bandaging
v
how do you manage venous ulcers with concurrent varicose veins?
endovenous techniques or open surgery
what are arterial ulcers?
an ulcer caused by a reduction in arterial blood flow, leading to decreased perfusion of the tissues and subsequent poor healing.
small deep lesions with well-defined borders and a necrotic base
where do arterial ulcers form
distally at sites of trauma and in pressure areas (e.g. the heel).
RF for arterial ulcers?
peripheral arterial disease
smoking
diabetes mellitus
hypertension
hyperlipidaemia
increasing age
positive family history
obesity and physical inactivity
features of arterial ulcer
intermittent claudication
critical limb ischaemia
develops over a long period of time
no healing
limbs will be cold
absent pulses
sensation maintained
ix for arterial ulcers
ABPI
duplex ultrasound, CT Angiography, and / or Magnetic Resonance Angiogram (MRA).
what are severity of PAD rated through ABPI?
> 0.9 = normal
0.9-0.8 = mild
0.8-0.5 = moderate
<0.5 = severe
conservative mx of arterial ulcer
lifestyle changes, including smoking cessation, weight loss, and increased exercise (specific supervised exercise programmes are available).
1st step mx of arterial ulcer
urgently referred for a vascular review
medical mx of arterial ulcer
statin therapy, an antiplatelet agent (aspirin or clopidogrel), and optimisation of blood pressure and glucose.
surgical mx of arterial ulcer
Angioplasty (with or without stenting) or bypass grafting (usually for more extensive disease)
what are neuropathic ulcers?
occurs as a result of peripheral neuropathy
a loss of protective sensation. which leads to repetitive stress and unnoticed injuries forming, resulting in painless ulcers forming on the pressure points on the limb.
