Vascular Flashcards
Abdominal aortic aneurysm
What are the RFs for it?
- When is screening conducted?
- What action is taken if the aorta width is
a) <3cm
b) 3-4.4cm
c) 4.5-5.4cm
d) >5.5cm
3
a) when should an urgent referral to vascular surgery be conducted?
b) if suitable, what is their management likely to be?
smoking
hypertension
syphilis
Connective tissue diseases: Ehlers-Danlos and Marfans
- once in 65 year old males
2
a) no action
b) rescan every 12 months
c) rescan every 3 months
d) urgent referral to vascular surgery
3
a)
- AA >5.5cm
- AAA symptoms
- rapid growth >1cm in one year
b) elective end-vascular repair (EVAR)
-> this is where stent inserted via the femoral artery
(need surveillance following procedure because stent can cause end-vascular leak)
Ankle Brachial Pressure Index
- For what disease is this a useful test?
- How should you interpret the following ABPI results:
a) >1.2
b) 1-1.2
c) 0.9-1
d) <0.9
e) <0.5
3.
What treatment for another disease is contraindicated if ABPI <0.8 or >1.3 (arteriosclerosis)
- peripheral vascular disease (PAD)
e. g. smoker comes in with intermittent leg pain
2 a) stiff, calcified arteries (could indicate T2DM, old age or PAD) b) normal c) acceptable d) PAD NOTE: this is 90% sensitive and 98% specific for PAD e) severe PAD requiring urgent referral to vascular surgery
3
compression bandaging in venous ulcers as this will worsen circulation
Venous Ulcers
- What clinical features are seen?
- What is related to
a) deep venous insufficiency
b) superficial insufficiency - What investigations can be done?
- How is it managed?
- oedema
- brown legs
- lipodermatosclerosis (hardened + tight skin)
- eczema
- painless
mnemonic: think about this happening chronologically)
location: above ankle
2
a) previous DVT
b) varicose veins
- doppler US: looks for reflux
duplex US: looks at blood flow - compression stalkings
BUT if >10cm2 or 12 weeks without healing refer to surgery for possible skingraft
Marjolins ulcer
- What is it?
- Where does it occur?
- Squamous cell carcinoma
- sites of chronic inflammation
e. g. burns or osteomyelitis 10-20 years later
Arterial ulcers
- What clinical features are seen?
- What is seen on investigation?
- painful
- cold
- no palpable pulses
- possibly areas of gangrene
menumonic: just think about if you didnt get blood supply to something
location: toes or heel
2. low ABPI
Neuropathic ulcers
- What causes them?
- Where do they occur?
- How are they managed?
- pressure
- plantar surface of metatarsal head or hallux
- cushioned shoes to prevent callous formation
pyoderma gangrenosum
what clinical features are seen?
- associated with IBD + RA
- begin as erythematous nodules/pustules which then ulcerate
- can occur at stoma sites
Acute limb threatening ischaemia
- What clinical features indicate acute limb-threatening ischaemia?
(remember this would be for both upper and lower limbs) - Thrombus
a) What causes the blockage of an artery in this case
b) What factors suggest it is likely to have been caused by a thrombus? - Embolus
a) What can cause an embolus?
b) What factors suggest it is likely to have been caused by an embolus? - How is it treated?
- 6Ps!
- pale
- painful
- pulseless
- parathesiae
- paralysed
- perishingly cold
2
a) rupture of atherosclerotic plaque
b)
- previous intermittent claudication
- history of previous vascular disease
- weak/absent pulses in contralateral limb
3
a)
- AF
- Clot moved on e.g. recent MI or history of aneurysm e.g. abdominal or popliteal
b)
- no history of intermittent claudication or vascular disease
- explanation for embolus (3a)
- analgesia
- IV heparin
- vascular review for surgery
Intermittent claudication
- What clinical features are seen?
- What investigations can be done?
- What is the ABPI likely to be if there is:
a) intermittent claudication
b) pain at rest
c) impending leg loss - What differential is it important to consider in these types of symptoms?
- pain in the legs induced by walking stopping within minutes of rest
2
- check leg pulses
- ABPI
- duplex US
- MR angiography required before any surgical intervention
3
a) 0.6-0.9
b) 0.3-0.6
c) <0.3
How is peripheral vascular disease managed?
- quit smoking (huge link)
- treat comorbidities (DM, Hypertension, obesity)
- statin
- clopidogrel
- exercise
if having large effect on quality of life: natidrofuryl oxalate
if still symptomatic after all these have tried refer for surgery
Ruptured abdominal aortic aneurysm
- What is the mortality rate?
- What clinical features are seen?
- What investigation is done?
- 80%
- sudden severe central abdominal pain radiating to the back
- pulsatile expanding mass in the abdomen
- signs of shock (tachycardia, hypotension) or even collapse
- haemodynamically stable: CT angiogram
haemodynamically unstable: clinical diagnosis
Superficial thrombophlebitis
- What vein is most commonly effected?
- How many patients will also have a DVT at presentation?
- What clinical features are seen?
- How is it treated?
- long saphenous vein
- 20%
- tender, inflamed worm like mass under the skin with some mild overlying erythema
4.
- compression stalkings
- LMWH or fondaparinux
Varicose veins
- They are often asymptomatic. What symptoms can sometimes be seen?
- What complications can happen?
- How can they be managed conservatively?
- How can they be managed surgically?
- ache / throbbing
- itch
- venous ulceration
- hyperpigmentation
- lipodermatosclerosis
- eczema
- DVT
- superficial thrombophlebitis
NOTE: any of these complications indicate for referral to secondary care
mnemonic: venous ulceration, the symptoms of it, DVT and then what it can cause
- exercise
- weight loss
- elevation
- compression stalkings
4. minimally invasive: - Ultrasound Guided Foam - Sclerotherapy - Endovenous Laser Therapy (EVLT) - Clarivein - Radiofrequency (RF) Ablation
OR open surgery to disconnect effected area from deep venous system
Cervical rib
- What is this?
- a) What can this cause?
b) What clinical features are seen in this disease? - How is it treated?
- fibrous band arising from 7th cervical vertebrae
2
a) thoracic outlet syndrome
b)
- shoulder + neck pain
- numbness in the fingers
(could also lead to absent radial pulse)
(this is because vessels + nerves get compressed between the clavicle + first ribs)
- surgical division of rib
Subclavian Steal syndrome
- What is it?
- What clinical feature is seen?
- What investigations can be done?
- stenosis of the subclavian artery
- > can result in reversal of flow through vertebral artery - dizziness / vertigo / syncope during exertion of the arm
this is because backlog can cause reduced cerebral blood flow
NOTE: backlog causes retrograde blood flow through internal thoracic + vertebral arteries
- duplex US and/or angiogram to plan for surgery
