Vascular Flashcards
What are risk factors for varicose veins
Standing for prolonged period of time without use
F>M
Giving birth
What are the symptoms of varicose veins
Asymptomatic in early disease
Cramping, heaviness, burning along the affected vein
Varicose eczema and haemorrhage
What is the management of varicose veins
Ligation or vein stripping
Typically only done if experiencing symptoms, ulceration or causing distress
What is the progression of peripheral venous disease called
Chronic venous insufficiency
Can develop from superficial vein incompetence as it ‘overflows’ or arise in those who are unable to use their calf muscles
Leads to more reflux and obstruction and can cause venous hypertension
What is the presentation of chronic venous insufficiency
Venous ulceration
Lipodermatosclerosis
Hemosiderin staining
Swelling
Pain of exertion
Varicose veins
Restless leg syndrome
What is the management for chronic venous insufficiency
Keep legs raised when possible
Compression stockings
Anti-platelets
Prophylaxis for DVT
Ligation and vein ablation
What is atherosclerosis
Atheroma - fatty deposits within the arterial wall
Sclerosis - hardening or stiffening of the blood vessel walls
Caused by chronic inflammation and immune response
what are risk factors for peripheral arterial diseases
Smoking, alcohol, sedentary lifestyle, diet, age, M>F, obesity, stress, FHx, diabetes, HTN, dialysis, inflammatory conditions, familial hypercholesterolaemia.
How does chronic limb ischaemia present
Intermittent Claudication
Pain in toes
Changes to colour of the feet/ peripheries
Long healing time
Symptoms for >2wks
What is the management of chronic limb ischaemia
Statin and anti-platelet
Life style modification
If severe and long healing time ulceration then angioplasty may be considered
What is critical limb ischaemia
Progression of chronic limb ischaemia
Triad of rest pain, tissue loss and pain at night
What is the management of critical limb ischaemia
Antiplatlet, statin and lifestyle modification
Angioplasty may aid healing of tissue but long term management bypass is a better option
Measuring creatinine kinase could give estimate of muscle loss and how urgent intervention needs to be
What is acute limb ischaemia
Near to total occlusion of an artery, may be from ruptured plaque, emboli or trauma
What is the management of acute limb ischaemia
Ensure analgesia and patient is NMB
Ensure the patient is heparinised
Bypass would be most suitable option
If there is muscle loss then amputation may be required
What is leriche syndrome
Generally affects the aortic bifurcation leading to occlusion in the distal aorta or proximal illiac artery
Buttock claudication, absent femoral pulse and male impotence
Why is carotid stenosis often asymptomatic
As there are two of them and the cranium has many blood supplies
It tends to be asymptomatic until lumen is occluded by at least 50%
What is the management of carotid stenosis
If asymptomatic: antiplatlet, statin and lifestyle modification
If symptomatic carotid endarterectomy or stenting of the artery
Risk factors for AAA
Age
M>F
Genetic predisposition
Smoking
Connective tissue disorder
COPD
Hyperlipidaemia
HTN
Central obesity
Presentation of AAA
Abdominal, flank and back pain
Pulsatile abdominal mass
Hypotension
Loss of consciousness
Pallour
Distension
Fever
Define AAA
Permanent pathological dilation of the aorta >1.5 times the expected size for an individual
Most common below the renal arteries
How do you manage AAA
If >5.5cm or >4cm and rapidly growing then endovascular abdominal aortic repair is generally the best line of treatment.
If ruptured will require emergency surgery, can consider doing cross match/ group and save and a clotting screen
What should you do before elective AAA repair
CVS risk reduction
ABX
Analgesia
VTE prophylaxis
