Vascular Flashcards
What med can be used to treat claudication in pts with peripheral artery disease
Pentoxifylline
What is the initial treatment for acute limb ischaemiaas an fy1
analgesia
heparin
on call vascular team
first line ix for acute limb ischaemia
doppler US
Aaa screening.
Who
What cm get referred to vascular
How often get re screened if dilated
How much growth in a year would need EVAR
Males >65
>3 cm refer to vascular
If 3-4.4 screen every year
If 4.5-5.4 screen every 3 months
If >5.5, URGENT vascular referral for probable intervention.
If >1cm per year, refer to vascular.
2 surgical options for AAA
Possible complication
EVAR or open repair
EVAR - anastomotic leak
Signs and sx of a ruptured AAA
Signs of shock
severe abdo pain that may radiate to groin or back
central guarding
pulsatile mass
collapse
LOC
Rx of ruptured AAA
Vascular on call now!
Permissive hypotension
Fluid resus
Get to theatres
Crossmatch 6 units of blood
imaging ix of choice for venous insufficiency/varicose veins
venous duplex ultrasound as will show retrograde flow
complications of varicose veins
superficial thrombophlebitis
DVT
prolonged heavy bleeding after trauma
all its with peripheral arterial disease should take what 2 medications …
statin and clopidogrel
big risk factor for embolic acute limb ischaemia
Afib
embolic vs thrombus acute limb ischaemia
embolic - AF, no hx of leg pain until it suddenly comes on, no evidence of peripheral vascular disease, no previous hx of claudication
thrombus - hx of chronic venous insufficiency, reduced or absent pulses in contralateral limb
how is abpi calculated
(highest bp of either posterior tibial artery or dorsals pedis) divided by (highest systolic bp of brachial artery r or l)
rx of uncomplicated superficial thrombophlebitis
compression stockings
analgesia - NSAIDs
pathophys of atherosclerosis
endothelial injury (eg by htn, increased lipids) causes chronic inflammation and deposition of lipids. Proliferation causes fatty streak to become atherosclerotic plaque
how to differentiate between femoral claudication and iliac claudication (ie location of pain)
femoral - calf pain
iliac - buttock pain
criteria for critical limb ischaemia
ankle pressure <50mmHg and either:
- ulceration or gangrene
- rest pain requiring analgesia for >2 weeks
why does hanging foot out bed alleviate pain in PAD
use gravity to help increase perfusion
how is burgers test performed and what is it a sign of
lift leg straight to 20 degrees.
Then hang over bed.
If goes pale when lifted and goes red after putting down this is a positive test for peripheral arterial disease
what would you do to complete a vascular examination
cardiovascular exam
review duplex uss or ct angiograms
cap glucose
fundoscopy
ABPI
presentation of acute limb ischaemia
pain
parasthesia
perishing with cold
pallor
paralysis
pulseless
May have concurrent AF on examination
presentation of chronic limb ischaemia
intermittent claudication, hang foot out of bed at night, metabolic syndrome pts
rf of limb ischaemia
smoking
obesity
htn
ABPI results
> 0.8 vascular so compression bandaging
0.5-0.8 more likely to be arterial. light compression may be okay
<0.5 critical ischaemia
1.2 diabetes calcification
spinal claudication vs PAD claudication
PAD gets worse uphill spinal gets better because flexion
what levels do these branch off the aorta
- coeliac
- sma
- ima
- iliac
T12
L1
L3
L5
Aortic dissection presentation
tearing pain
intra scapular
radial radial delay (also seen in coarctation)
BP differs in each arms
may have st ecg and trop changes
ix of aortic dissection
ct aortogram
compare ulcers - presentation, ix and rx
arterial - on pressure sites, dry irregular margins with necrotic centre. ix - abpi. Rx - statins, clopidogrel, lifestyle.
venous - gaiter distribution, wet exudative shallow with irregular borders. other signs of CVI. ix - duplex us. Rx compression bandaging
neuropathic - pressure sites - punched out, painless, callous. Rx - control BM
