Vascular Flashcards
Where is the stenosis if you get buttock claudication and impotence?
Inferior abdominal aorta and common iliac artery
Where is the stenosis if you get pain in your thigh?
External iliac artery
Where is the stenosis if you get pain in calf?
femoral artery
What are the common presenting complaints in vascular?
Abdominal pain
Varicose veins
Intermittent Claudication
Ulceration
What are the symptoms of rest pain?
Pain at night where you wake up
Occurs in the least perfused parts of the leg which are the toes and feet
Severe pain–> cramping, burning pain
What are the relieving factors of rest pain?
Walking on cold floor
Handing feet on the edge of the bed
What questions would you ask about intermittent claudication?
How far can you walk? More or less than 200 m
How does the pain stop
How is the pain while walking up a hill
Why does pain come from stenosis of peripheral artery?
Lack of oxygen causes lactic acidosis which causes build up of metabolites in the muscle
What are the precipitating factors to rest pain?Explain?
Occurs at night while lying down flat.
Due to reduced cardiac output and dilation of vessels due to warm bed
What is critical ischaemia?
Ulcer and gangrene
rest pain over 2 weeks
ABPI <0.7
What risk factors should you ask about PVD?
Smoking Diabetes
Hypertension Cardiac Disease
Hyperlipidaemia Family History
IVDU
What is fontaine classifcation?
o Stage 1 Asymptomatic = occurs in patients with diabetes and should do regular ABPI
o Stage 2 intermediate claudication
2a walk more than 200m
2b walk less than 200m
o Stage 3 ischemia at rest pain wakes you up at night
Have to dangle your legs at the end of the bed to get blood back
o Stage 4 ulceration or gangrene or both
What is virchow’s traid for vascular disease?
Blood stasis
Endothelial damage
Hypercoagulability
What causes blood stasis?
Af
Obesity
Pregnancy
Immobility
What causes endothelial damage?
Trauma
IVDU
Catheter
What causes hypercoagulabiity?
COP Malignancy Smoking Obesity Anticoagulants Genetic haematology --> factor v Leiden and protein C+S deficiency
6p’s of acute limb ischaemia
o Perishingly cold o Pallor o Pulselessness o Pain o Paresthesia o Paralysis
What action does a patient do to relieve arterial or venous ischaemia?
Arterial –> dangle leg at end of bed
Venous–> elevate the leg
Where does venous ulcers occur?
lower 1/3rd of the leg
Pretibial area
Anterior to medial malleolus
Why does venous ulcers occur?
Obesity
DVT
Calm muscle pump deficit
Varicose veins leading to chronic venous insufficiency i the superficial veins (valvular problem)
What condition is the leg in venous ulcer?
Red brown pigmentation -->Haemosiderin Oedema that can leak causes maceration, venous eczema, itchy scaly skin hair on leg Can feel the pulses Leg may be warm Dilated superficial veins
What is the characteristic of the venous ulcer?
Uneven edges Ruddy granulation tissue No dead tissue Moderate to no pain on the ulcer If any pain then helped by elevation
Where do you get arterial ulcers?
Between the toes and on the toes
Lateral malleolus
On the metatarsal of toes and heal
Cause of arterial ulcers
Age DM Smocking Hypertension Arteriosclerosis
Characteristic of the leg in arterial ulcers?
No hair on legs Leg is dry, thin and shiny Cool leg Leg become pale Lack or diminshed pulse Neuropathy can occur Thickened toe nails
Characteristics of arterial ulcers?
Well defined edges
Black and necrotic tissue
Painful
Pain relieved by hanging legs at the end of the bed
Where does diabetic ulcers occur?
On the toes, heals and bony prominences
What causes diabetic ulcers?
Trauma
Characteristic of diabetic ulcers leg?
Well perffused around the ulcer
Can palpate the pulse
Loss of sensory sensation
What is the characteristic of diabetic ulcer?
Ulcer is deep, painless, infected and punched out
Perforating ulcer
What is stage 1 of vascular management of PVD?
Statin and antiplatelet Prevent further MI and Stroke o Stop smoking and do exercise To create collateral branches and vessels Smoking inhibits collateral branches
What is stage 2 surgical vascular management of PVD?
o Angioplasty Can have coronary angioplasty Using X ray video Balloon that stretches the narrow or blocked artery o Stent Allow blood flow to move more freely
What is stage 3 surgical vascular management of PVD?
o By pass
Or
o Endarterectomy
Unblocking a coronary artery
what are you looking for around the bed in a vascular examination?
02
medication
fags
mobility aid
What are you inspecting for on the legs and what are they indications of?
Scars--> surgery Hair loss --> PVD Ulcers --> venous or arterial (look in between toes) Look on heal or behind the leg for ulcers Pallor --> PVD Discolouration --> necrosis Muscle wasting--> PVD Varicose veins Eczema etc
Why do you ask patient to wiggle there toes?
Its a gross motor assessment –> for ischaemia
If the cap refill on the toes is more than 2 seconds what test do you do?
Buerger’s Test
What pulses do you auscultate in a lower vascular examination for bruits?
Abdominal aorta
Renal
Common iliac
Femoral
What are the end pieces
Buerger’s Test Trandelenberg test Cardiovascular examination Lower limb neuro exam ABPI Sensation
What is the Buerger’s test demonstrating?
Poor arterial blood flow to the legs
What is the outcome of Buergers test?
The legs become pale when lie supine and leg is raised ( measure the angle)
When hanging over the bed goes purple then pink
Hyperemia–> metabolic waste trying to be removed
What is Buergers angle?
20 degrees
Less than that and you have acute ischaemia
What is the trandelenberg test used for?
In context of varicose veins and the whether the sapheno-femoral junction is incompetent?
What is the proceudure and outcome of the trandelenberg test?
o Ask your patient to lie down on the examination couch and raise their leg to 90 degrees which will allow the veins to empty.
o Then apply a tourniquet around the top of the thigh distal to the sapheno-femoral junction.
o Now ask your patient to stand. If the varicosity returns this indicates incompetence of the deep communicating veins.
o If no filling occurs on standing, remove the tourniquet. If this causes immediate refilling of the veins this suggests incompetence of the sapheno-femoral junction
What does a radial radial delay indicate?
Aortic coarctation
What does a significant difference in BP in arm indicate?
aortic aneurysm
