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Finals > Vascular > Flashcards

Vascular Flashcards

1
Q

Define intermittent claudication

A

-> Symptom of ischaemia in a limb, occurring during exertion and relieved by rest.
-> Crampy, achy pain in the calf, thigh or buttock muscles associated with muscle fatigue when walking beyond a certain intensity.

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2
Q

Define acute limb ischaemia

A
  • Rapid onset of ischaemia in a limb.
  • Either due to thrombus or embolus (secondary to AF)
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3
Q

Define critical limb ischaemia and 3 features

A
  • End-stage of peripheral arterial disease
  • Features include 1 or more of :
  1. Rest pain in foot for >2 wks (pain worse at night, hang it out of bed to ease)
  2. Ulceration
  3. Gangrene
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4
Q

Presentation of acute limb ischaemia

A

6 P’s

  • Pain
  • Pallor
  • Pulseless
  • Paralysis
  • Paraesthesia (abnormal sensation or “pins and needles”)
  • Perishing with cold
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5
Q

What is Leriche syndrome

A
  • Occurs with occlusion in the distal aorta or proximal common iliac artery
  • Triad of : Thigh/buttock claudication, absent femoral pulses
    and male impotence
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6
Q

Signs of arterial disease on examination

A
  • Skin pallor
  • Cyanosis
  • Dependent rubor (a deep red colour when the limb is lower than the rest of the body)
  • Muscle wasting
  • Hair loss
  • Ulcers
  • Poor wound healing
  • Gangrene
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7
Q

what test can be done to assess for peripheral arterial disease

A

-> Buerger’s Test

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8
Q

Investigations for peripheral arterial disease

A

-> Ankle-brachial pressure index (ABPI)
-> Duplex ultrasound – 1st line
-> Angiography (CT or MRI) – using contrast to highlight the arterial circulation

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9
Q

Stepwise management of intermittent claudication

A
  1. Lifestyle changes - stop smoking
  2. Exercise training
  3. Medical treatments : atorvostatin, clopidogrel, naftidofuryl oxalate
  4. Surgical options
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10
Q

what should all patients with PAD be started on ?

A
  • Atorvastatin 80mg
  • Clopidogrel
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11
Q

Initial management of acute limb-threatening ischaemia

A
  • Analgesia
  • IV unfractionated heparin
  • Vascular review
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12
Q

Management of critical limb ischaemia

A

Urgent revascularisation with :

  • Endovascular angioplasty and stenting
  • Endarterectomy
  • Bypass surgery
  • Amputation of the limb if it is not possible to restore the blood supply
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13
Q

Management of acute limb ischaemia

A
  • Endovascular thrombolysis
  • Endovascular thrombectomy
  • Surgical thrombectomy
  • Bypass surgery
  • Endarterectomy
  • Amputation
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14
Q

Stepwise diagnosis of DVT

A
  • D dimer
  • Doppler USS
  • CTPA (if PE concerns)
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15
Q

How long is anticoagulation continued for in a DVT

A
  • 3mnths if provoked
  • 6 mnths in unprovoked
  • 3-6 months in active cancer
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16
Q

Define varicose veins, reticular veins and telangiectasia

A
  1. Varicose veins : distended superficial veins >3mm.
  2. Reticukar veins : dilated blood vessels in skin 1-3mm.
  3. Telangiectasia : dilated blood vessels in the skin <1mm.
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17
Q

Signs of chronic venous insufficiency

A
  • Brown discolouration to lower legs (haemosiderin)
  • Venous eczema
  • Lipodermatosclerosis (champagne bottle legs)
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18
Q

Special tests for varicose veins

A
  • Tap test : pressure on SFJ and tap vein, feel trill at SFJ
  • Cough test : trill when applying to pressure on SFJ and pt coughs
  • Trendelenberg’s test
  • Perthes test
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19
Q

Management of varicose veines

A
  1. Weight loss, staying active, elevating leg and graduated compression stockings
  2. Surgical : endothermal ablation, foam sclerotherapy, surgical stripping
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20
Q

RF for varicose veins

A
  • Increasing age
  • Female
  • Pregnancy
  • Obesity
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21
Q

what is chronic venous insufffiency ?

A
  • When blood does not efficiently drain from the legs back to the heart
  • Blood pools in the vein causing venous hypertension
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22
Q

what does chronic venous insufficiency result in ?

A
  • Haemosiderin staining (red/brown discolouration of the skin)
  • Venous eczema
  • Lipodermatosclerosis : hardening and tightening of skin and rissue beneat the skin
  • Atrophie blanche : patches of smooth, porcelain-white scar tissue
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23
Q

4 common types of skin ulcers

A

Venous ulcers
Arterial ulcers
Diabetic foot ulcers
Pressure ulcers

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24
Q

Causes of aterial and venous ulcers

A
  1. Arterial ulcers : insufficient blood supply to the skin due to peripheral arterial disease.
  2. Venous ulcers : due to the pooling of blood and waste products in the skin secondary to venous insufficiency.
25
Q

Features of arterial ulcers

A
  • Occur distally (toes and heels)
  • Associated with PAD : absent pulses, pallor and intermittent claudication
  • Smaller and deeper than venous ulcers
  • Well defined borders
  • Have a “punched-out” appearance
  • Pale colour due to poor blood supply
    Are less likely to bleed
  • Painful !
  • Pain worse at night (when lying horizontally)
  • Pain is worse on elevating and improved by lowering the leg (gravity helps the circulation)-
26
Q

Features of venous ulcers

A
  • Proximal to medial malleolus
  • Associated with chronic venous changes : hyperpigmentation, venous eczema and lipodermatosclerosis
  • Occur after a minor injury to the leg
  • Larger and more superficial than arterial ulcers
  • Irregular, gently sloping border
  • More likely to bleed
  • Less painful than arterial ulcers
  • Have pain relieved by elevation and worse on lowering the leg
27
Q

Management of arterial ulcers

A
  • Same as PAD : urgent vascular referral
28
Q

Management of venous ulcers

A
  • Cleaning the wound
  • Debridement
  • Dressing the wound
  • Compression therapy
29
Q

Defintion and types of lymphoedema

A
  • Impaired lymphatic drainage
  • Primary : rare genetic condition, presents befpre 30
  • Secondary : a separate condition affects lymphatic drainage (e.g. after breast cancer surgery due to removal of axillary lymph nodes)
30
Q

Important differential of lymphoedema

A
  • Lipoedema
  • This is abnormal build-up of fat
  • Spares the feet, ulike in lymphoedema
31
Q

In what ways can lymphoedema be assessed

A
  1. Negative Stemmer’s sign
  2. Assessing limb volume
  3. Bioelectric impedance spectrometry to measure volume of fluid in the limb
  4. Lymphoscintigraphy : to assess structure of lymphatic system
32
Q

Non surgical management of lymphoedema

A

-> Massage techniques to manually drain the lymphatic system
-> Compression bandages
-> Specific lymphoedema exercises to improve lymph drainage
-> Weight loss if overweight
-> Good skin care

33
Q

Surgical management of lymphoedema

A

Lymphaticovenular anastomosis

34
Q

what is lymphatic filariasis

A
  • Disease caused by parasitic worms spread by mosquitos causing severe lymphoedema
35
Q

How is the severity of carotid artery stenosis classified

A
  1. Mild – less than 50% reduction in diameter
  2. Moderate – 50 to 69% reduction in diameter
  3. Severe – 70% or more reduction in diameter
36
Q

What may be heard on examination in carotid artery stenosis

A

Carotid bruit

37
Q

Diagnosis of carotid artery stenosis

A

Carotid Ultrasound

38
Q

Surgical interventions for carotid artery stenosis

A
  • Carotid endarterectomy
  • Angioplasty and stenting
39
Q

Injuries caused by carotid endarterectomy

A

-> Facial nerve injury causes facial weakness (often the marginal mandibular branch causing drooping of the lower lip)
-> Glossopharyngeal nerve injury causes swallowing difficulties
-> Recurrent laryngeal nerve (a branch of the vagus nerve) injury causes a hoarse voice
- Hypoglossal nerve injury causes unilateral tongue paralysis

40
Q

What is Buerger disease (thromboangiitis obliterans)

A
  • Inflammatory condition causing thrombus formation in distal arterial system (hands and feet)
41
Q

What are the notable features of buerger disease

A
  • <50 (usually men 25-35)
  • NOT having RF for atherosclerosis (other than smoking = strong association)
42
Q

How does Buerger disease present

A
  • Painful, blue discolouration to the fingertips or tips of toes
  • Pain is worse at night
43
Q

Typical finding on angiograms in buerger’s disease

A

Corkscrew collaterals = new collateral vessels form to bypass affected arteries

44
Q

Management of buergers disease

A
  • Stop smoking
  • IV iloprost (prostacyclin analogue to dilate blood vessels)
45
Q

Age of screening for AAA

A

Males aged 65

46
Q

AAA screening outcomes

A
  • <3cm = normal
  • 3-4.4 = small = rescan 12mnths
  • 4.5 - 5.4 = rescan every 3 mnths
  • > 5cm = 2wk vascular referral
47
Q

When will AAA be referred 2wk

A
  • > =5.5cm
  • Symptomatic
  • Growth of >1cm a year
48
Q

Management of AAA

A

Elective endovascular repair (EVAR)

49
Q

Diagnosis of varicose veins

A

Venous duplex USS = retrograde venous flow.

50
Q

First line investigation for PAD

A

DUplex USS

51
Q

Interpretation of ABPI in PAD

A

Looks at SBP in ankle compared to that in arm

> 1.3 - calcification of artery (e.g. DM)
1 : normal
0.6-0.9 : claudication (mild PAD)
0.3-0.6 : rest pain (mod-severe)
<0.3 : impending (critical)

52
Q

Define superficial thrombophelbitis

A

Inflammation of a superficial vein associated with a thrombus. Usually long saphenous vein of the leg

53
Q

when should be measure when suspected superficial thrombophelbitis ?

A

ABPI to exclude PAD
USS to exlcude DVT

54
Q

Management of superficial thrombophebitis

A
  • Topical NSAIDS if mild, oral if more severe
  • Compression stockings.
55
Q

Presentation of neuropathic ulcers

A
  • Over plantar surface of metarsal head and plantar surface of hallux
  • Common in diabetics
56
Q

Intermittent claudication affecting the buttock, what vessel

A

Iliac stenosis

57
Q

Surgical options for intermittent claudication

A
  • Endovascular angioplasty anfd stenting
  • Endarterectomy
  • Bypass surgery
58
Q
A

Finals (92 decks)

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