Vascular Flashcards
Mx of AAA
< 3 cm Normal =
3 - 4.4 cm- Rescan every 12 months
4.5 - 5.4 cm- Rescan every 3 months
>= 5.5cm- Refer within 2 weeks to vascular surgery for probable intervention
Takayasu Arteritis Sx
Malaise, headache
Unequal blood pressure in the upper limbs
Absent or weak peripheral pulses
Upper and lower limb claudication on exertion
Intermittent claudication defintion
Cramping after walking certain distance
Critical limb ischaemia
Pain at rest
Hang foot out of bed
ABPI <0.5
Require urgent vascular referral
Burgers disease sx and RF
Heavy smoker
Inflammation in medium arteries
Peripheries- gangrene
Burgers sign
Reactive hyperaemia due to deoxygenated blood in dilated capillaries
Chronic limb ishcaemia Ix
Doppler
ABPI
Bloods- lipids
Walk test
Mx of chronic limb ischaemia
Conservatively- stop smoking
Surgical if- short walking distance, affecting QoL, pain at rest develops
Medical- clopidogrel, statin 80mg
Mx of ALI
Embolus- embolectomy
With forgarty catheter
Anticoagulate
Tx cause- AF
Thrombosis- angiography and plasty
Or thrombylysis
or Amputation - if dead gangrenous
Critical limb Ischaemia
1 or more of
Pain at rest >2w
Ulcers
Gangrene
Investigations for peripheral vascular disease
Handheld doppler 1st
ABPI
Anatomy of arteries in lower limb
External Iliac to common femoral after inguinal ligament
CFA to superficial and profunda
Becomes popliteal
Tibio-Peroneal trunk- Anterior tibialis branch off
Split into posterior tibialis and peroneal
Anatomy of lower limb veins
External iliac to femoral
Great saphernous branch off- medially
Popliteal with small saphenous branch off on lateral side
Anterior tibial branch off
Peroneal branch off
Continue as posterior tibial
Tx of superficial thrombophlebitis
NSAIDs
Compression stockings
Medication that increase VTE prevalence
COCP
Tamoxifen
Antipsychotics
Oestrogen therapy
Changes seen in venous ulcers
Brown piigmentation- haemosiderin
Lipodermatosclerosis
Eczema
Initial management of acute limb ischaemia
IV heparin
analgesia
Vascular review
When is ABPI >1
Calcification in DM
Leriche syndrome
Iliac atherosclerosis
Causing, buttock claudication, impotence, decrease distal pulses
When to start DOAC for DVT before Ix
If >4 hours before d dimer or scan can be done
Tx of aortic dissection
A- ascending- surgery
B- beta blockers IV
Arterial vs neuropathic ulcers
Arterial- heel and toes- painful and cold- reduced ABPI
Neuropathic- plantar surface
Mx of popliteal aneurysm
Stable- femoral distal bypass- if symp, thrombus, >2cm
Acute- embolectomy +/- bypass
Ix for venous ulcer
Venous duplex US
Tx of severe PAD or critical ischaemia
Endovascular- angioplasty +/- stent
used for short segment stenosis (e.g. < 10 cm)
Surgical- endarectomy/bypasss-
open surgical techniques are typically used for long segment lesions (> 10 cm),