Vascular Flashcards
What is the end stage of peripheral arterial disease?
Critical limb ischaemia
What does PAD present with?
intermittent claudication
What are the features of critical limb ischaemia?
6 Ps Pain Pallor Pulseless Paralysis Paraethesia Perishing cold
What is the triad of symptoms in leriche syndrome?
Thigh/buttock claudication
Absent femoral pulses
Male impotence
Which test is performed in examination to test for PAD?
Buerger’s test (holding the limb at 45 degrees for 2 mins)
Will go pale and then when you hang them over the side of the bed, would go blue then red when reperfusing
What are the differences between the appearance of arterial and venous ulcers?
Arterial- smaller, deeper, “punched out lesions”, painful, peripheral
Venous- larger, superficial, less painful, occur alongside signs of chronic venous insufficiency
What investigations could be done for PAD?
Ankle-brachial pressure index
Duplex ultrasound
Angiography
What do the results of ABPI suggest?
09.-1.3= normal
0.6-0.9= mild
0.3-0.6= moderate to severe
less than 0.3= critical
How can intermittent claudication be managed?
Lifestyle changes
Exercise training
Atorvastatin 80mg
Clopidogrel 75mg OD
Surgery:
Endovascular angioplasty and stenting
Endarterectomy
Bypass surgery
How is acute limb ischaemia managed?
Endovascular thrombolysis
Endovascular thrombectomy
Bypass surgery
Amputation
What are varicose veins?
Superficial veins which measure more than 3mm in diameter
Why does venous eczema occur?
Blood pools in distal veins, pressure causes veins to leak in small amounts into the nearby tissues. The pooling of blood leads to inflammation, the skin becomes dry and inflamed which is referred to as venous eczema
What is the management of varicose veins?
Weight loss
Staying physically active
Keeping leg elevated
Compression stockings
Stripping
Sclerotherapy
Endothermal ablation
What are the complications of chronic venous insufficiency?
Lipodermatosclerosis (causes inverted champagne bottle legs) Cellulitis Poor healing after injury Skin ulcers Pain
What is the management of chronic venous insufficiency?
Regular use of emollients
Potent topical steroids
What are the 4 types of skin ulcers?
Arterial
Venous
Pressure
Diabetic foot
What is an important complication of diabetic foot ulcers?
Oestomyelitis
Which scoring system is used to measure an individual’s risk of pressure ulcers?
The waterlow score
Where do venous ulcers usually occur?
In the gaiter area. This is between the top of the foot and the bottom of the calf muscle
Which investigations should be done for skin ulcers?
ABPI
Bloods (FBC, CRP, HbA1c)
Charcoal swabs if infected
Skin biopsy
What is the management of venous ulcers?
Compression therapy
Pentoxifylline
Antibiotics
Analgesia
Which sign elicited on examination can suggest lymphoedema?
Stemmer’s sign- pinch skin at toe or finger and let go, if a tent is left then +ve suggesting lymphoedema
What is the management of lymphoedema?
Massage techniques
compression bandages
Weight loss
What must the diameter of the abdominal aorta be to classed as a AAA?
> 3cm
Who is eligible for AAA screening in the UK?
All men are offered ultrasound screening at age 65
How is AAA diagnosed
Usually by ultrasound, CT can be used to get a better picture
When should elective repair of AAA be offered?
If symptomatic
Diameter growing by >1cm a year
Diameter >5.5 cm
How can an AAA be repaired?
Open repair
Laparoscopically
Endovascular aneurysm repair
How should ruptured AAA be managed?
Surgical emergency
Permissive hypotension should be maintained
Haemodynamically unstable patients should be taken straight to theatre
CT angiogram can exclude or confirm the diagnosis in stable patients
What is aortic dissection?
A break or tear occurs in the intima causing blood to enter between the intima and media layers of the aorta
What are the risk factors for aortic dissection?
Hypertension
Events which cause a big increase in BP (heavy weightlifting and cocaine use)
Connective tissue disease (ehlers-danlos, marfans)
Aortic conditions (bicuspid valve, coarctation, aortic valve replacement, CABG)
What is the presentation of aortic dissection?
Ripping or tearing chest pain HTN initially, hypotension as it progresses Differences in BP between arms Radial pulse deficit in one arm Chest and abdo pain
How is aortic dissection diagnosed?
ECG and CXR
CT angiogram can confirm
what are the 2 types of aortic dissection?
Type A= ascending aorta (before brachiocephalic artery)
Type B= descending aorta (after left subclavian artery)
How is aortic dissection managed?
Surgical emergency
Analgesia
Blood pressure and heart rate must be controlled, usually by beta blockers
Which group of patients are often investigated for carotid artery stenosis?
Patients who have had TIAs
How is carotid artery stenosis diagnosed?
Carotid ultrasound
How is carotid artery stenosis managed?
Modify RFs
Endarterectomy
Angioplasty and stenting
What is buerger’s disease?
Also known as thrombangiitis obliterans. Usually affects men aged 25-35 who smoke. Presents with blue, painful discolouration to the fingertips and tips of the toes
