vascular Flashcards
peripheral vascular disease:
- underlying pathogenesis?
- risk factors?
atherosclerosis, which narrows the affected arteries
- “angina in the legs”
- over half have concurrent IHD
CV risk factors - smoking - dyslipidaemia - obesity - diabetes - HTN etc
nb rarely caused by vasculitis, trauma or more rare things
peripheral vascular disease:
- presentation of acute limb ischaemia? 6
a leg which is:
- pale
- perishingly cold
- parasthesia
- paralysis
- painful
- pulseless
peripheral vascular disease:
- presentation of chronic limb ischaemia? (incl 4 stages)
incl signs, symptoms
specific clinical test for end stage??
1) ASYMPTOMATIC
2) INTERMITTENT CLAUDICATION
- cramping pain in calf, thigh or buttock after walking a given distance
- reproducible + relieved by rest
3) ISCHAEMIC REST PAIN
- worse at night (i.e. when legs up)
- reduced peripheral pulses
4) CRITICAL ISCHAEMIA (ulceration + gangrene)
- ‘pushed out’ painful arterial ulcers
- postural/dependent colour change
- burning pain at night, relieved by hanging legs over side of bed (as gravity helps)
- very long capillary refill (on toes)
Buerger’s angle
= angle that leg goes pale when raised off the couch
- less than 20 degrees in severe ischaemia
peripheral vascular disease:
- clinical/bedside investigation? (incl values)
- bloods? (incl reasons) 5
- other investigation?
- imaging? 2
ABPI (ankle-brachial pressure index)
- normal = 1.2-0.9
- PVD = 0.5-0.9
- critical limb ischaemia <0.5
^nb beware falsely high results from incompressible calcified atherosclerosis, e.g. DM
- HbA1c + glucose (exclude DM)
- ESR/CRP (exclude arteritis)
- FBC (anaemia, polycythaemia)
- U&E (renal disease)
- lipids (dyslipidaemia)
- ECG (cardiac ischaemia)
nb screen for thrombophilia + serum homocysteine if <50 years old
- colour ultrasound of leg
- if considering intervention: MR/CT angiography to map extent etc
peripheral vascular disease:
- non-pharm treatment? 3
- pharm management of risk factors? 3
- medical treatment? 1
- surgical treatment? 3
- stop smoking
- loose weight
- graduated exercise (improves collateral circulation)
- treat HTN
- treat cholesterol
- prescribe clopidogrel or aspirin
peripheral vasodilators (think of like how nitrates are used for angina)
- percutaneous transluminal angioplasty (i.e. balloon)
- surgical reconstruction
- amputation (last line!! beware phantom limb pain!)
name of peripheral vasodilator given in peripheral vascular disease?
when recommended for use?
naftidrofuryl oxalate
offers modest benefit
- recommended only in people who don’t want surgery + exercise fails to improve symptoms
DDx for pain in lower limb when walking (except peripheral vascular disease)? 5
- sciatica
- spinal stenosis
- entrapment syndrome
- DVT
- muscle/tendon injury
AAA:
- commonest site?
- who screened?
- symptoms of unruptured?
- below renal arteries (but above bifurcation)
men over 65!
often none
- may cause abdominal/back pain
AAA:
- symptoms + signs of rupture?
- what often mistaken for?
- intermittent or continuous abdominal pain (radiates to back, iliac fosse or groins)
- expansile abdo mass
- collapse (dt low cerebral perfusion)
- shock
often misdiagnosed as renal colic!
AAA:
- 1st line imaging?
- what increases risk of rupture? 4
- at what diameter are they operated on?
- surgical treatment?
abdo ultrasound
- raised BP
- smoker
- female
- positive FH
- 5.5cm (watch + wait before this!)
EVAR (endovascular stent)
- nb surgical mortality is about 5%
Varicose veins:
- appearance?
- pathophysiology?
- gender + age affected most?
- other risk factors? 4
swollen, enlarged veins on leg + feet
- may be blue/dark purple in appearance
- often lumpy, bulging or twisted
(normally age-related) failure of valves in veins
- female
- older
- pregnancy (often improve afterwards)
- obesity
- FH
- long periods of standing
varicose veins:
- symptoms? 5
- what makes symptoms worse? 2
- possible complications? 2
nb can be asymptomatic, bar appearance
- aching, heavy + uncomfortable legs
- swollen feet + ankles
- burning or throbbing in legs
- muscle cramps in legs (especially at night)
- dry, itchy + thin skin over affected vein
- warm weather
- standing for long periods of time
(improve if walk around or elevate legs)
- thrombophlebitis
- venous ulcers
varicose veins:
- when people should see their GP? 3
- treatment options available?
- when treatment given?
- causing pain or discomfort
- skin over veins is sore/irritated
- aching in legs is irritating at night + disturbing sleep
- endothermal ablation (heat used to seal veins)
- sclerotherapy (uses foam to close veins)
- ligation + stripping (surgically removed)
on NHS
- if complications, such as ulcers + repeated thrombophlebitis
nb can get done privately
nb often recur even after treatment
