Vascular Flashcards
Vessel used in CABG
Long “great” saphenous vein
Incompetent venous valves allowing reflux of blood
Varicose veins
Common varicose veins vessels
Long saphenous vein
Small saphenous vein
Risk factors for varicose veins
Age
Female
Obesity
Pregnancy (compression of pelvic veins)
Complications of varicose veins
Varicose eczema
Haemosiderin deposition (hyperpigmentation)
Lipodermatosclerosis
Atrophie blanche (hypo pigmentation)
Management of mild-moderate varicose veins
Compression stockings
Weight loss
Leg elevation
Management of severe varicose veins
Endothelial ablation
Foam sclerotherapy
Aortic dissection = anterior chest pain
Anterior AD (Type A) - 66%
Aortic dissection = back pain
Descending AD (Type B) - 33%
Management of Anterior aortic dissection
Surgery + BP control
Management of Posterior aortic dissection
IV Labetalol
Investigations for aortic dissection
CT Angiography: false lumen
CXR: widening of aorta
Transoesophageal echo
Aortic dissection with lucid period before death
Temporary haematoma
Aortic dissections occur distal to
ligamentum arteriosum
Classification index for Aortic dissection
Debakey classification
Abdo pain
Pulsatile + expansile abdo mass
Back pain
Haemodynamic instability
Abdominal Aortic Anneurysm (AAA)
Risk factors for AAA
Smoking HTN Syphilis Marfans Ehler Danlos Connective tissue diseases
AAA screening
Single US scan at 65
Normal AAA at screening
< 3cm
No need to re-scan
Small AAA at screening
3 - 4.4cm
Re-scan every 12 months
Medium AAA at screening
4.5 - 5.4 cm
Re-scan every 3 months
Large AAA at screening
> 5.5 cm
Re-scan every 2 weeks
Increased AAA rupture risk if
> 1cm enlargement in a year
Management of AAA
Elective endovascular repair (EVAR)
- via femoral artery
ABPI < 0.5
Severe peripheral arterial disease
ABPI < 1
Peripheral arterial disease
ABPI 1 - 1.2
Normal
ABPI > 1.2
Calcification of vessels
- common in diabetes
Deposition of RBC + WBC into tissue due to back-log of venous pressure from:
- venous HTN
- chronic venous insufficiency
Venous ulcers
Oedematous leg (due to WBC)
Brown pigmentation (due to RBC)
Lipodermatosclerosis
Eczema
Venous ulcers
Location of venous ulcers
Above ankle = painless
superficial
Management for venous ulcers
Compression banding (4 x layer) Skin grafting
Cold leg
No pulses
Painful lesion
Arterial ulcers
Location of arterial ulcers
Toes + heel = painful
Investigations for venous ulcer
Doppler US to look for reflux and veins
Investigations for arterial ulcer
Doppler US
MR Angiography
Complications of arterial ulcers
Gangrene
Intermittent claudication (pain in posterior legs when walking) is an indicator of
Peripheral arterial disease
Risk factors of peripheral arterial disease
Smoking
HTN
Diabetes
Obesity
Management of peripheral arterial disease
Exercise
Statins
Clopidogrel
Surgery
- angioplasty
- stenting
- bypass
- amputation
Complications of peripheral arterial disease
Arterial ulcers
Acute limb-threatening ischaemia
6Ps of Acute limb threatening ischaemia
Pale Perishingly cold Pulseless Painful Paralysed Paraesthetic
Inflammation + thrombosis of superficial veins
Superficial thrombophlebitis
Risk of superficial thrombophlebitis
20% have underlying DVT
4% will progress to DVT
The longer the vein the increased risk of DVT
Management of superficial thrombophlebitis
NSAIDs
Topical heparinoids
Compression stockings
LMWH
Ulcers formed due to pressure and/or diabetes
Neuropathic ulcers (plantar surface)
Management of neuropathic ulcers
Cushioned shoes
Amputation
Ulcers that appear at sites of chronic inflammation in the lower limb (burns, osteomyelitis)
Associated with SCC
Marjolin’s ulcer
mixed atriovenous ulcers
