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Vascular Flashcards

1
Q

Acute limb ischaemia: define

A

sudden decrease in limb perfusion that causes a potential threat to viability

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2
Q

Acute limb ischaemia: causes

A

atherosclerosis (60%)
- dehydration, low BP, cancer, polycythaemia
emboli (40%)
rare: trauma, aortic dissection, iatrogenic injury, peripheral aneurysm (popliteal)

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3
Q

ABPI limits for critical limb ischaemia, peripheral arterial disease and artierial stifferning

A

Critical limb ischaemia <0.5
peripheral arterial disease < 0.9 (intermittent claudication)
artierial stifferning >1.3

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4
Q

Acute limb ischaemia signs

A 
Pain 
Pallor
Pulselessness
Parasthesia
Paralysis 
Parshingly cold
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5
Q

Ischaemia colour changes and explanaitons

A

Marble white- arterial spasm
Blue blanching moltting limb -deoxygenated blood fills vessels as they begin to relax -> salvagable
Purple non-blanching- blood coagulation -> blistering and liquafaction

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6
Q

Acute ischaemia manageemnt

A 
check for renal and cerebral disease 
definitive treatment 
- thrombolysis/embolectomy 
- bypass surgery 
- ambutation
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7
Q

Critical limb ischaemia define

A

ABPI <0.5
rest pain>2 wks not relieved by simple anaelgesia or
doppler ankle pressure <50 mmHg

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8
Q

Chronic arterial disease disease

A

spectrum
atherosclerosis
-> intermittent claudication
-> ischaemic limb ischaemia

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9
Q

Intermittent claudication define

A

chronic arterial disease caused by atherosclerosis
muscle pain only associated with exeercise
comes on after a constant ‘claudication’ distance
subsides within 5 mins of rest

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10
Q

Intermittent claudication in the calf: likely artery affected

A

superficial femoral a

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11
Q

Intermittent claudication in the thigh/buttock: likely artery affected?

A

arterio-illiac a.

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12
Q

Intermittent claudication ABPI

A

might be normal at rest

0.5-0.9 -> diagnostic

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13
Q

Intermittent claudication: why can it remain stable for years?

A

Collateral circulation development

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14
Q

Intermittent claudication: management

A

smoking cessation
supervised exercise therapy
antiplatelets
angioplasty/stenting/bypass (symptoms 6m+ despite best medical therapy)

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15
Q

Vascular emergencies: hard signs

A

external arterial bleeding
rapidly expanding haematoma
palpable thrill, audible bruit
obvious acute limb ischaemia, not easily corrected

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16
Q

Vascular emergencies: soft signs

A 
history of bleeding at the scene
would near a major artery
small non-pulsatile haematoma 
diminished unilateral pulse
neurogenic deficit
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17
Q

Types of claudication

A

arterial (intermittent)
venous (DVT)
neurogenic

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18
Q

Features of intermittend claudication

A 
pain in muscle groups
unilateral
exercise related
thin dry skin, sunset foot
diminished foot pulses
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19
Q

Features of venous claudication

A 
'bursting' pain 
whole leg
unilateral 
elevation relieves pain 
vericose veins and venous skin changes
hot leg 
swollen painful calf 
pulses present
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20
Q

Features of neurogenic claudication

A 
whole leg
bilateral 
pain immediately upon standing 
spine flexion relieves pain 
no skin changes 
tingling and sensation changes
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21
Q

Diabetic foot features

A 
ulceration, 
infection, 
sensory neuropathy,
failure to heal trivial injuries 
ulceration (end point)
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22
Q

Types of diabetic foot types

A

ischaemic

neuropathic

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23
Q

Diabetic foot prophylactic

A

regular inspections,
nail care,
choriopodist debridement

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24
Q

Diabetic foot ischaemic ulceration management

A 
local/systemic infection
-> flucloxacillin/ doxycycline 14 d 
-> tazocin/ meropenenm 14+ d if severe 
debridement +/- digit amputation 
X-ray- ?osteomyelitis 
revascularisation (angioplasty or femoro-distal bypass)
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25
Burger's disease
chronic disease of non-atherosclerotic iflammation and thrombosis thromboagitis abliterans small and medium peripheral arteries and vessels smoking related -> ulcers and gangrene
26
Burger's disease: management
``` smoking cessation increase activity (unless there's critical ischaemia) ```
27
Raynaud's phenomenon: define
Digital pallor due to vasospasm of the digital arteries - > cyanosis (deoxygenated blood) - > rubor (reactive hyperthermia)
28
Primary Raynaud's phenomenon: define and management
Young women Cold temperatures No ulceration or infarction -> reassurance +/-rifedipine (CCB)
29
Secondary Raynaud's phenomenon: define and managements
Digital pallor due to vasospasm of digital arteries In older people, causes - connective tissue disease - vibration induced injury - artherosclerosis Fixed obstruction -> ulceration and necrosis
30
Aneurysm define
Abnormal focal dilatation (>50% of normal diameter) | Of an endothelial-lined vascular structure
31
Common spractice yes of aneurysm
Infrarenal aorta Popliteal Femoral Subclavian
32
Aneurysm aetiology
``` Atherosclerotic (non specific) Mycotic (infective) -syphilis -salmonella -septic emboli ```
33
True aneurysm define
All 3 layers of the arterial wall - fusiform- symmetrical - succular-asymmetrical
34
False aneurysm define and progression
Wall of an artery is damaged and blood enters space between two layers - > haematoma (pulsation) surrounded by compacted thrombosis and connective tissue then either - > thrombosis spontaneously if small or - > continues to expand if>2cm (esp if on anticoag)
35
AAA define
Dilatation of the abdominal aorta 1.5 x normal diameter or >3cm in total (Normal AA diameter = 2cm)
36
AAA symptoms
Usually asymptomatic | Abdo, back, loin, illiac fossa or groin pain
37
AAA rupture into...
Retroperitoneum or peritoneal cavity
38
AAA commonest location
Infra renal
39
AAA diagnosis
USS
40
AAA screening
65 y.o males
41
AAA management
<5.5 cm -> conservative (regular surveillance, lifestyle changes, mess: statins, aspirin, BP control) 5.5cm+ -> EVAR (endovascular aneurysm repair) or open repair
42
Stroke define
An episode of facial neurological dysfunction of >24h of presumed vascular aetiology
43
TIA define
An episode of focal neurological dysfunction of <24 hours of presumed vascular aetiology
44
Amaruosis fugax define
Transient and usually incomplete loss of vision of n on eye Occlusion of a branch of the retinal artery by cholesterol emboli -> "curtain or veil" coming across the eye Lasts a few minutes and disappears Never synchronously bilateral
45
Ischaemic Cerebrovascular episodes: commonest cause
Atheroembolism from the carotid bifurcation (50%)
46
Cause of amaurosis fugax
Arthero emboli of the opthalmic a
47
Carotid artery disease assessment
Colour flow Doppler duplex ultrasound | MRI and CT- helpful in treatment planning
48
Carotid endarectomy indication
60-70% diameter reduction of the interval carotid artery
49
Severe carotid artery disease management
Carotid endarterectomy | Stenting
50
Principles of carotid endarterectomy
Shunt to maintain blood flow to the head Occluding plaque is removed Artery repaired by primary closure or patch graft
51
Carotid endarterectomy complications
Death Major or minor stroke Wound haematoma Hypoglossal nerve damage
52
Ruptured AAA clinical features
Sudden collapse Abdo pain Low BP Pulsation abdo mass
53
Ruptured AAA: implications
Leak into the retroperitoneal space -> tamponade General vasoconstriction and prothrombotic state
54
Ruptured AAA management
Senior surgical help + theatre prep -antibiotic prophylaxis -aorta clamping and EVAR/open repair NO FLUIDS (permissive hypotension)
55
Ruptured AAA complications
``` Death (50%) MI Renal failure LL embolism GI ischaemic/infarct Abdominal compartment syndrome ```
56
Varicose veins: define
Tortuous and dilated segment of veins | Associated with valvular incompetency
57
Venous system: name superficial vessels
Long (great)and short (lesser) | Sap genius systems
58
Venous system: deep
Vessels between the muscle compartments of the legs | Follow major arteries
59
Venous system: perforations purpose
Connection of the super principal and deep systems
60
Commonest location of incompetent valves leading to varicose veins
Sapheno- femoral junction
61
Varicose veins causes
Congenital Primary idiopathic Pelvic masse (inc. pregnancy) Pelvic venous abnormalities
62
Varicose veins: tap test
Tap downwards over the veins from sapheno femoral junction | Incompetent valve-> impulse felt lower down
63
Varicose vein trendelenberg test
Tests competence of sapheno-femoral and sapheno-popliteal junctions, mid thigh perforator Pt laying down -> elevate the leg and apply tourniquet high in the thigh (later at different levels) Pt stands up and vein filling is observed - vein filling means there's incompetency above the tourniquet
64
Varicose veins: special tests
Tap test | Trendelenbergs test
65
Vanricose veins diagnosis
Doppler duplex USS
66
Varicose veins: name 3 types
Trunk Reticular Talangiectasia
67
Trunk varicose veins define
Involve great and lesser saphenous veins or their main branches Large (>4mm) subcutaneous and palpable No skin discolouration 1/3 of population affected
68
Reticular varicose veins define
Deep in the dermis Small <4mm, impalpable Discolouration of the overlying skin: deep blue Present of 80% of the population
69
Talangiectasia varicose veins
``` Spider or thread veins Superficial in the dermis Usually <1mm Impalpable Discolouration of the overlying skin purple or bright red 90% of adults ```
70
Varicose veins management
Conservative If ABPI >0.8: constriction garments, if < elastic support hose, weight loss, exercise, avoiding prolonged standing Surgery: remove varicies, intercept connections (perforator) that are incompetent Endovascular management: radio frequency ablation, LASER ablation, USS guided foam sclerotherapy
71
Arterial ulceration features
``` Ischaemic Feet and toes (pressure points) Usually don't bleed Yellow/brown/black Punched out boarder General poor circulation Progressive atherosclerosis/ embolus Very painful ```
72
Venous ulceration features
``` Caused by venous stasis Gaiter region Can bleed Red base, haemosidrin around Irregular shape Pt with varicose veins, swelling, clots Venous HTN due to inadequate calf muscle pumping Uncomfortable not painful ```
73
Venous ulceration management
Gradual compression stockings | Arterial disease must be excluded
74
Repercussion injury pathophysiology
Ischaemic tissue releases activated neutrophils, feee radicals, enzymes, H+, CO2, K+ and myoglobin -> released into circulation
75
Repercussion injury: consequences
``` Acute Respiratory Distress Syndrome (ARDS) Myocardial stunting Endotaxaemia Acute tubular necrosis -> multiple organ failure ```
76
Compartment syndrome pathophysiology
Ischaemia -> endothelial injury Increased capillary permeability and swelling Thought fasicular boundaries -> increased interstitial pressure -> muscle necrosis despite apparently adequate blood flow
77
Compartment syndrome clinical features
Passive stretch test: Pain on passively stretching/extending toes Fasciotomy +/- debridement of necrotic tissue

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