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), doppler arterial uss, ct angiogram diagnostic
- Management: statin + clopidogrel, mx cormorbidities, supervised exercise programme, endovascular angioplasty with stenting or surgical bypass, 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%
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 , lmwh prophylactic dose 30 days (if can’t have lmwh then 8-12 days oral nsaids)
Leriche syndrome
stenosis at the aortic bifurcation
ED, buttock pain, absent femoral pulses
