Vascular Flashcards
How long do you keep the legs in the air during Buerger’s test?
2 minutes
What signs are suggestive of peripheral vascular disease during Buerger’s test?
Pallor
Reactive hyperaemia
Why do venous ulcers form?
Chronic venous insufficiency leading to capillary fibrin cuff or leucocyte sequestration
What are the features of venous ulceration?
Ankle/Gaiter region
Painless
Bleed
Oedema
Brown pigmentation
Venous eczema
Lipodermatosclerosis (panniculitis with hardening and discolouration)
Where do arterial ulcers form?
Dorsal surface of foot, toes and heel
Where do neuropathic ulcers tend to form?
Over bony prominces of volar surface of the foot
What is a Marjolin’s ulcer?
SCC occurring at areas of chronic inflammation e.g. burns, osteomyelitis
What are the treatments for peripheral arterial disease?
Medical: Statins + Antiplatelets
;
Naftidrofuryl oxalate (vasodilator)
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Surgery: Bypass or angioplasty
What are the features of critical limb ischaemia?
Painful
Pale
Poikilothermia
Pulseless
Paralysed
Paraesthesia
What are the features of arterial ulcers?
Painful
Well-defined border
Punched out appearance
Worse when horizontal, better when lowering leg (think Buerger’s test)
What investigations may you consider in a patient presenting with an ulcer?
Urinalysis
Glucose
Bloods: FBC; U+Es; TFTs; LFTs; CRP; HbA1c
ABPI
Doppler US
Charcoal swaps
Skin biopsy
How may you manage venous ulcers?
Conservative: Compression therapy; Physiotherapy
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Infection: ABX
±
Pentoxyfiline
When a patient has an AAA of 3.9cm, when should they have surveillance?
Yearly if
3.4-4.4cm
When a patient has an AAA of 4.9cm, when should they have surveillance?
3 monthly if
4.5-5.4cm
When should a AAA be operated on?
Symptoms
>5.5cm
Growth of >1cm per year
