Vascular Flashcards
Acute limb ischaemia:
- Definition + pathophysiology
- Causes
- Symptoms
- Investigations
- Management
- Complications
Acute limb ischaemia:
- Definition + pathophysiology: sudden decrease <2 weeks in arterial supply
- Causes: thrombus, embolism (AF), aaa, trauma (compartment syndrome)
- Symptoms: pulseless, pain, perishing with cold, parasthesia, paralysis (this is worst one), pallor
- Investigations: ecg, fbc/crp/lactate/u+es, arterial doppler uss, ct angiography
- Management: analgesia, unfractionated heparin, oxygen, then revascularisation (thrombolysis, embolectomy, bypass surgery, angioplasty)
- Complications: compartment syndrome, hyperkalaemia, acidosis, aki (myoglobin)
Chronic limb ischaemia: (peripheral arterial disease)
- Definition
- Causes
- Symptoms
- Signs
- Risk factors
- Investigations
- Management
- Complications
Chronic limb ischaemia: (peripheral arterial disease):
- Definition: >2 weeks of peripheral artery narrowing. Rutherford or fontaine classification
- Causes: atherosclerosis
- Symptoms: intermittent claudication
- Signs: reduced pulses, reactive hyperaemia
- Risk factors: SMOKING, obesity, htn, diab, hyperlipidaemia
- Investigations: abpi (mild 0.8-0.9, mod 0.5-0.8, sev <0.5), duplex arterial uss, ct angiogram diagnostic
- Management: statin + clopidogrel, mx cormorbidities, supervised exercise programme, endovascular revascularisation (angioplasty with stenting) or surgical bypass if >10cm, naftidrofuryl oxalate vasodilator if not suitable for surgery
- Complications: critical limb ischaemia when claudication at rest >2 weeks with gangrene/ulcers/hair loss/skin changes/thick nails. ABPI <0.5
classifications: fontaine
Abdominal aortic aneurysm:
- Definition + pathophysiology
- Causes
- Risk factors
- Symptoms
- Signs
- Investigations
- Management
- Complications
Ruptured:
- Symptoms
- Signs
- Investigations
- Management
Abdominal aortic aneurysm:
- Definition + pathophysiology: >30% diameter (>3cm diameter) - IMA + renal veins
- Causes: atherosclerosis, marfans, syphilis, trauma, infection
- Risk factors: male, obese, smoking, htn, age, hyperlipidaemia, fx
- Symptoms: assymp, back pain
- Signs: pulsatile and expansile abdo mass
- Investigations: screening uss male 65 yrs. Needs uss, if 5.5cm then ct angiogram in prep for surgery. If 3-4.4 uss yearly, if 4.5-5.4 3 monthly
- Management: statin/smoking/aspirin etc. Then surgery within 2 weeks if >5.5cm/ growing over 1cm yr/ symptomatic - EVAR endovasc aortic repair or open repair
- Complications: ruptures, embolises, aortoduodenal fistula, retroperitoneal leak (in EVAR need yearly uss)
Ruptured:
- Symptoms: hypotension, severe abdo + back pain, pulsatile abdo mass, syncope
- Signs: tachycardia
- Investigations: ct angiogram if stable
- Management: oxygen, iv, fbc/u+es/clotting, keep bp under <100mg, open repair if young/evar if older
Superficial venous insufficiency: (varicose veins)
- Definition + pathophysiology
- Risk factors
- Causes
- Symptoms
- Investigations
- Management
- Complications
Superficial venous insufficiency:
- Definition + pathophysiology: tortuous dilated superficial vein >3mm esp great and small saphenous veins due to incompetent valves hence backflow of blood
- Risk factors: prolonged standing, preg, obese, fem, age
- Causes: idiopathic, dvt, preg, fibroids
- Symptoms: itching, aching visible veins, thrombophlebitis, venous skin changes
- Investigations: venous duplex uss (shows retrograde venous flow)
- Management: compression stockings, elevation, ex/weight loss. Refer to secondary care if signif symptoms/thrombophlebitis/ skin changes/ulcer for endothermal ablation, foam sclerotherapy or
surgery (vein ligation, vein strippling)
- Complications: chronic, bleeding
CEAP - classification
Deep venous insufficiency:
- Definition + pathophysiology
- Risk factors
- Causes
- Symptoms
- Signs
- Management
- Complications
Deep venous insufficiency:
- Definition + pathophysiology: superficial and deep insufficiency due to reflux, htn and obstruction causing failure
- Risk factors: previous dvt, smoking, obese, preg, f, age
- Causes: connective tissue disease, dvt, trauma
- Symptoms: leg ache relieved by elevation, swollen limbs, itching, ulcers
- Signs: haemosiderin staining, venous eczema, atrophie blanche, lipodermatosclerosis, peripheral oedema
- Management: compression stockings, analgesia, topical steroids, stenting
- Complications: cellulitis, ulcers, marjohn ulcer (Scc when chronic inflammation)
Deep vein thrombosis:
- Definition
- Risk factors
- Symptoms
- Investigations
- Management
Venous ulcers:
- Definition + pathophysiology
- Risk factors
- Symptoms
- Signs
- Investigations
- Management
Venous ulcers:
- Definition + pathophysiology: pooling of blood traps wbcs hence inflammatory mediator release injuring tissue
- Risk factors: venous insuff, preg, obese, immobile, trauma
- Symptoms: shallow irregular with granulating base common on med malleolus, pain relieved by elevating, venous insuff symptoms
- Investigations: apbi, duplex uss, swab cultures, fbc/crp/hba1c
- Management: elevation, exercise, weight, abx, oral pentoxifylline vasodilator, multicomponent compression bandaging if apbi >0.6, surgical decompression, skin grafting
Arterial ulcers:
- Defintion
- Symptoms
- Investigations
- Management
Arterial ulcers:
- Definition: due to PAD = dec perfusion + healing
- Symptoms: v painful deep well defined lesion with necrotic base on pressure sites e.g. heel worse when elevating, dec pulses
- Investigations: abpi, doppler uss, ct angiogram
- Management: smoking/weight/ex, statin + clop, angioplasty with stenting or bypass grafting, cushioned shoes
Neuropathic ulcers:
- Definition
- Risk factors
- Symptoms
- Signs
- Investigations
- Management
Neuropathic ulcers:
- Definition: peripheral neuropathy decreases sensation so unoticed when injury
- Risk factors: uncontrolled diabetes, pad, b12def, foot deformities
- Symptoms: burning/tingling, amotrophic neuropathy
- Signs: variable size/depth, pressure points
- Investigations: hba1c, b12, apbi, duplex uss, swab, xray
- Management: glucose control, abx, debridement
Charcots
- rocker bottom due to destruction of tarsal bones
Carotid artery disease:
- definition
- signs
- complications
- ix
- mx
- Definition: ath plaque in common or internal carotid arteries resulting in occlusion
Mild: <50%
Mod: 50-70%
Sev: >70% - Signs: carotid bruit
- Complic: TIA, stroke
- Ix: carotid duplex uss or ct angiography
- Mx- dual antiplatelet therapy - clopidogrel + aspirin, carotid endarterectomy if stenosis >50% + SYMPTOMS
if one carotid artery is stenosed circle willis still allows blood flow all over brain so surgery done to prevent embolism and no surgery if occluded artery
Carotid artery dissection:
- most common cause of stroke in young people because causes ischaemia due to lumen obstruction.
- mr angiogram (cresecenf) ct angiogram
Superficial thrombophlebitis:
- definition
- ix
- mx
Superficial thrombophlebitis:
- definition: nflamm assoc with thrombosis of one of the superficial veins. 20% have underlying dvt
- ix: uss to exclude dvt
- mx: antiembolism stockings, nsaids
Leriche syndrome
stenosis at the aortic bifurcation (iliac vessels)
ED, buttock pain, absent femoral pulses/atrophy of legs
Needs endovasc angioplasty + stent
Buerger’s diseases:
- definition
- symptoms
Berger’s diseases:
- definition: thromboangiitis obliterans), small and medium vessel vasculitis, strongly associated with smoking.
- symptoms: 25-35 year old man smoker, claudication of fingers, ulcers, thrombophlebitis, raynauds
- mx: stop smoking, iv iloprost
