vascular Flashcards
stages of chronic venous insufficency?
CEAP system;
class1/earliest stage - no signs
class 2 - varicose vein class 3 - oedema class 4 - skin changes / pigmentation / venous eczema class 4b - lipodermatosclerosis "champagne bottle leg"
class 5 - closed wound/ healed venous ulcer class 6 - open wound / venous ulcer
how might chronic venous insufficency present?
Swelling in the lower legs and ankles, especially after extended periods of standing
Aching or tiredness in the legs
New varicose veins
Leathery-looking skin on the legs
Flaking or itching skin on the legs or feet
Stasis ulcers (or venous stasis ulcers)
cause of CVI?
risk factors?
causes: venous valvular insufficiency
risk factors:
- history of deep vein thrombosis, cellulitis, or venous leg ulcers.
- advancing age, being overweight or obese, immobility, varicose veins
what questions to ask in a hx for symptoms of venous insufficiency?
pain, heaviness, aching, swelling, and itching of the affected leg.
management of skin changes of CVI?
Management of a person with venous skin changes includes:
Advising on regular application of an emollient.
Treating flares with a topical steroid (flares of lipodermatosclerosis may require application of a very potent topical steroid).
Giving appropriate self-care advice eg elevate the legs when resting, keep physically active, lose weight (if overweight or obese)
Considering referral to a VASCULAR service
Offering compression stockings (after excluding arterial insufficiency).
Consider referring to a dermatologist
complications of skin conditions associated with CVI?
pain, infection, secondary eczema, contact dermatitis
permanent skin discolouration, and skin ulceration.
mx of CVI?
Exercisie
Weight loss
Compression stockings if ABPI >0.8 (see scotts)
treat underlying cause accordingly eg VV
chronic limb ischaemia
see scotts notes
how is chronic limb ischaemia mx?
Claudication - not life limiting:
- Clopi 75mg (if not then Aspirin 75)
- Lifestyle; exercise, weight loss +atorvastatin
- rx risk factors eg BP, DM
Claudication - life limiting:
- Above
- Cilostazol; sx relief
- Revascularisation
Critical limb ischaemia;
- Urgent consideration for revascularisation (surgical or endovasc)
- all of above
- consider amputation
arterial ulcers have what ABPI normally?
low eg 0.4
see passmerd vascular section
rx for superficial thrombophlebitis?
- Compression stockings
2. Considered for treatment with prophylactic doses of LMWH for up to 30 days or fondaparinux for 45 days.
ivx for claudication ?
Exercise treadmilll ABPI
Duplex USS
Angiography
difference between deep and superficial venous insufficiency?
??
what is beurgers disease?
AKA Thromboangiitis obliterans
a small/ medium vessel vasculitis affecting the ARTERIES and VEINS
results in blood stasis => clot formation -> gangrene and necrosis of digits and limbs
RFs; Smoking - present in young men mainly 20-40s
what are the deep and superficial veins in the lower limbs?
Deep; anterior + posterior tibial femoral external iliac common iliac IVC
Superficial;
Great saphenous - most anterior areas
Small saphenous - posterior to tibia
Dorsal arches and networks of foot
