Vascular Flashcards
PVD: How common is it?
20% of 60+y/o
Acute limb ischaemia - 1 in 12,000 per year
Chronic limb ischaemia is more common
PVD: Who does it affect?
Greater prevalence in those with CV disease & risk factors such as diabetes, smoking & dyslipidaemia
PVD: Causes
Atherosclerosis -> narrowed arteries, limiting blood flow
Critical LI - obstructive atherosclerotic arterial disease USUALLY, but rarely = vasculitis, trauma, popliteal entrapment
PVD: Risk factors
SMOKING
Diabetes mellitus
Hypertension
Dyslipidaemia
PVD: Presentation
Acute
- Onset of leg pain - mins/hrs/days
- 6 P’s - Pulseless, pallor, painful, paraethesia, paralysis, perishingly cold
Chronic
- Progressive cramp-like pain in calf on walking or foot pain at rest (worse at night)
- Non-healing wounds on lower limb
- Absent/faint peripheral pulses
PVD: Investigations
- BP
- FBC - anaemia will aggravate PAD
- ESR - inflammatory process - eg giant cell arteritis
- Thrombophilia screen
- Fasting blood glucose
- Lipid levels
- ECG
PVD: Treatment
Lifestyle: Smoking cessation, regular exercise, weight reduction, manage diabetes
Pharmacological: ACEi, Statins, antiplatelet drugs, peripheral vasodilators (Naftidrofuryl oxalate)
Surgical: Angioplasty or bypass
Conditions that present similarly to PVD
- Sciatica
- Spinal stenosis
- DVT
- Entrapment syndromes & muscle/tendon injury
- Diabetic neuropathy
AAA: How common is it?
4% M, 1% F over 65yrs
AAA: Who does it affect?
Elderly men
AAA: Causes
- Degenerative process
- Genetic component
AAA: Risk factors
- Family history
- Marfans
- Age
AAA: Presentation
- Often asymptomatic (70%)
- Symptomatic if pressure effects or ruptures -> mild abdo/back pain
- Blood clots can block other vessels
- If ruptures: sudden severe abdo & back pain + collapse
AAA: Signs on examination
Large expansile mass
AAA: Investigations
USS or CT
AAA: Treatment
Surgical
- Replace aneurysmal segment with prosthetic graft if >5.5cm
- Endovascular repair with aortic stent
Conditions that present similarly to AAA
- Acute pancreatitis
- MI
- GI haemorrhage
Varicose veins: How common is it?
M - 10-20%
F - 25-33%
Varicose veins: Who does it affect?
F>M
40% of pregnant women
Varicose veins: Causes
Incompetent valves in affected vein -> reflux of blood and increased pressure in the vein distally (worse if in deep veins)
PREGNANCY: Increased blood volume + relaxed muscle walls of blood vessels (due to hormones) + enlarged uterus puts pressure on pelvic veins & IVC
Varicose veins: Risk factors
Age, sex (F), FHx, obesity, standing/sitting for long period of time
Varicose veins: Presentation
Dark blue/purple veins - twisted/bulging
Itch/discomfort/swelling of affected leg
Varicose veins: Signs on examination
Check for complications - eg skin changes, venous leg ulcers, thrombophlebitis
Varicose veins: Treatment
Lifestyle advice - eg avoid sitting/standing for long periods, elevate legs when possible, compression stockings
Surgical: Removed/shut via intraluminal laser surgery - only covered by NHS in rare situations
