Vascular

Question 1

What features on H/E distinguish embolic phenomena from pre-existing vascular disease for ischaemic limb?

Answer 1

• No history of claudication
• Acute onset with no prodrome
• AF or pAF
• Normal contralateral limb (no evidence of PVD)
• Known proximal vascular issue such as AAA
• No collateral vessels on imaging (would occur with chronic PVD)

Question 2

What features on H/E distinguish thrombotic phenomena from acute embolism for ischaemic limb?

Answer 2

• Known PVD/claudication
• Acute on chronic/gradual onset
• collateral circulation on imaging
• Signs of PVD bilaterally (ulcers, hair loss, shiny skin, hyperpigmentation)

Question 3

What is the significance of an ankle-brachial index (ABI)?

Answer 3

Ratio of the ankle to the brachial systolic BP’s, lower limb usually higher so normal ABI is 1.0 to 1..3

An ABI =/<0.4 is highly suggestive of acute ischaemic limb

Question 4

What are the 6 P’s of the acute ischaemic limb?

Answer 4

Pain (severe, out of proportion)
Pulselessness
Pallor
Poikilothermia (cold)
Paraesthesia
Paralysis (in advanced ischaemia, not initially)

Question 5

What is the general management of an acute ischaemic limb?

Answer 5

• Analgesia
• IV fluids
• Heparin infusion
• Vascular urgent referral

Question 6

What are the treatments for carotid artery dissection?

Answer 6

Anti-platelets
- Small area of thrombus and no flap

Heparin/DOAC
- Moderate to large thrombus +/- flap

Surgery
- Persistent ischaemia despite medical management

Question 7

What factors favour surgery over BP control for type B aortic dissection?

Answer 7