Vascular Flashcards
Normal aorta size
<3cm
Small aortic aneurysm
3-4.4cm
Medium aortic aneurysm
4.5-5.4cm
Large aortic aneurysm
> 5.5cm
What are the modifiable risk factors for an aortic aneurym?
*Smoking
*Diet
*Exercise level
*Hypertension
*Diabetes
*Hyperlipidaemia
What is the screening programme for aortic aneurysm?
Abdominal USS for males aged 65+
Screening outcome: small aneurysm
Rescan every 12 months
Screening outcome: medium aneurysm
rescan every 3 months
Screening outcome: large aneurysm
Refer within 2 weeks to vascular surgery for probable intervention
Management of asymptomatic aneurysm, less than 5.5 cm
Abdominal USS surveillance and optimise cardiovascular risk factors
Management of ≥5.5cm, or rapidly growing , or symptomatic aneurysm
Refer within 2 weeks with elective endovascular repair (EVAR) or open repair
What counts as a rapidly growing aneurysm?
> 1cm a year
What is EVAR?
Stenting via the common femoral artery
What are the three patterns of peripheral arterial disease?
- intermittent claudication
- critical limb ischaemia
- Acute limb threatening ischaemia
Presentation of critical limb ischaemia
- Rest pain in foot for >2 weeks
- Ulceration
- Gangrene
- ABPI of <0.5
Management of critical limb ischaemia
- refer to vascualr specialist
- aspirin
- risk factor modification: stop smoking, increase exercise, decrease salt
What is the presentation of acute limb ischaemia
- 6Ps: pallor, pulselessness, paraesthesia, paralysis, pain, paralysis
- onset of symptoms rapidly over 2 weeks
What points towards an embolic cause of acute limb ischaemia?
- sudden onset
- less severe than thrombotic
- cardiac history of AF or recent MI
- unlikely to have history of PAD
- cold; soft tender artery
What points towards a thrombotic cause of acute limb ischaemia?
- gradual/vague onset
- severe
- no cardiac history
- history of PAD
- hard artery; less cold than embolic; cyanotic
What is the management of acute limb ischaemia?
- endovascular thrombolysis
- endovascular thrombectomy or surgical embolectomy
- bypass surgery
- amputation if unable to restore the blood flow
- ABCDE, IV opioids, vascular review
What are the complications of peripheral arterial disease?
- leg/foot ulcers
- gangrene
- permanent limb weakness/numbness/pain
What is the presentation of a ruptured abdominal aortic aneurysm?
- Severe abdominal pain radiating to the back or groin
- HAemodynamic instability
- pulsatile and expansile mass in the abdomen
- collapse
- loss of consciousness
What is the management of ruptured abdominal aortic aneurysm?
- surgical embolectomy
- if they are haemodynamically stable you can use CT angiography to diagnose/exclude
What is carotid artery disease?
Narrowing of the carotid arteries in the neck secondary to atherosclerosis
What is the presentation of carotid artery disease?
- asymptomatic
- cervical bruit
- focal neurological deficit - stroke or TIA
What is the investigation for carotid artery disease?
- duplex ultrasonography
- CT angiography of the head, neck, and chest
Classification of carotid artery disease
- mild <50% reduction in diameter
- moderate 50-69% reduction in diameter
- severe 70%+ reduction in diameter
Conservative management of carotid artery disease
- diet and exercise
- stop smoking
- anti-platelet
- lipid lowering medication
Surgical management of carotid artery disease
carotid endartectomy or angioplasty and stenting
What are the main complications of carotid artery disease?
Thromboembolism -> ischaemic stroke or TIA
Medical management of intermittent claudication
- Atorvastatin 80mg
- Clopidogrel 75mg once daily (aspirin if clopidogrel is unsuitable)
- Naftidrofuryl oxalate (5-HT2 receptor antagonist that acts as a peripheral vasodilator)
What is ABPI?
ratio of systolic blood pressure (SBP) in the ankle (around the lower calf) compared with the systolic blood pressure in the arm
Explain the results of ABPI
- 0.9 – 1.3 is normal
- 0.6 – 0.9 indicates mild peripheral arterial disease
- 0.3 – 0.6 indicates moderate to severe peripheral arterial disease
- Less than 0.3 indicates severe disease to critical ischaemic
What are the signs in a history of a venous ulcer?
- DVT or venous disease previously
- obesity
- pregnancy
- immobility
- pro-thrombotic tendency
What are the signs on examination of a venous ulcer?
- gaiter area
- shallow
- palpable pulses
- normal CRT
- varicosities
- haemosiderin deposition
- venous eczema
