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YEAR 3 & 5 CORE CONDITIONS > Vascular > Flashcards

Vascular Flashcards

1
Q

What mainly causes peripheral arterial disease? What are some less common causes?

A

Atherosclerosis causing stenosis of the arteries

Others:

  • Vasculitis
  • Trauma
  • Thromboangiitis obliterans (Buerger’s disease)
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2
Q

What causes acute limb ischaemia?

A

Thrombosis usually at the site of stenosis

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3
Q

What is the chief feature of peripheral arterial disease?

A

Intermittent claudication exacerbated by walking, relieved by rest

Calf = femoral artery
Buttock = iliac artery
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4
Q

What are some features of critical limb ischaemia?

A
  • Ulceration
  • Gangrene
  • Foot pain at rest e.g. burning pain at night relieved by hanging legs over side of bed
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5
Q

What is Leriche’s syndrome?

A

Embolus at the aortic bifurcation

  • Absent femoral pulse
  • Claudication/wasting of buttock
  • Pale cold leg
  • Impotence
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6
Q

Who is most at risk of thomboangiitis obliterans (Buerger’s disease)?

A

Young heavy smokers

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7
Q

What classification is used for peripheral arterial disease?

A

Fontaine classification

  1. Asymptomatic
  2. Intermittent claudication
  3. Ischaemic rest pain
  4. Ulceration/gangrene
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8
Q

What are the signs on examination of peripheral arterial disease?

A 
6 Ps
Pallor
Pulseless
Painful
Paralysed
Paraesthesia
Perishingly cold

Buerger’s test - leg goes pale when raised (if less than 20 degree angle, it is severe ischaemia)

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9
Q

What test is done for peripheral vascular disease? Describe how you would do this

A

ABPI

  • Position patient at 45 degrees
  • Allow patient 20 mins rest before procedure
  • Record brachial pulse in each arm and take highest
  • Record dorsalis pedis pulse then record posterior tibial pulse and take highest of the 2
  • Repeat on other leg

ABPI = Highest of ankle BP / highest of arm BP

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10
Q

What ABPI ratios indicate what?

A

1.0 - 1.2 = normal
<0.9 = peripheral arterial disease
<0.5 = critical limb ischaemia

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11
Q

What can cause falsely high results in ABPI?

A

Incompressible calcified arteries

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12
Q

What is the drug treatment for peripheral vascular disease?

A

1st line - Clopidogrel

2nd line - naftidrofuryl oxalate (peripheral vasodilator)

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13
Q

What is the surgical management of peripheral arterial disease?

A
  1. Percutaneous transluminal angioplasty - balloon inflated in narrowed segment
  2. Surgical revascularisation - bypass graft
  3. Amputation - can prevent death from sepsis and gangrene
  4. Embolectomy - if acute limb ischaemia
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14
Q

Define aneurysm; true aneurysm; false aneurysm

A

Aneurysm = an artery with a dilatation
>50% of its original diameter

True aneurysm = dilatations that involve all layers of the arterial wall

False/pseudoaneurysm = collection of blood in outer layer only (adventitia) after trauma

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15
Q

What are the main risk factors for AAA?

A
  • Severe atherosclerotic damage to aortic wall
  • Family history - there is genetic component to the degeneration of elastic lamellae + smooth muscle
  • Smoking
  • Hypertension
  • Connective tissue disorders

(AAAs are less common in diabetics)

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16
Q

What size of aorta defines an AAA?

A

Normal diameter = 2cm
AAA = 3cm
Surgery if >5.5cm

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17
Q

How might an AAA present?

A

Unruptured:

  • Usually asymptomatic
  • May cause abdominal/back pain

Ruptured:

  • Sudden onset of tearing epigastric pain in abdomen that radiates to back, groin, iliac fossa, testicles
  • Shock/collapse
18
Q

What is the screening programme for AAA?

A

All males > 65 years are invited for ultrasound screening

19
Q

What is the emergency management of an AAA?

A 
Do ECG
Take bloods - amylase, crossmatch, Hb
Catheterise
Give fluids to treat shock but keep BP<100 systolic
Surgery
20
Q

What are varicose veins?

A

Long, tortuous + dilated veins of the superficial venous system

21
Q

What is the pathology behind varicose veins?

A

Normally, blood from superficial veins pass into deep veins via perforator veins and at the saphenofemoral + saphenopopliteal junctions
Valves prevent blood from passing from deep to superficial veins - if they become incompetent, there is venous hypertension + dilatation of superficial veins

22
Q

What are the risk factors for developing varicose veins?

A
  • Prolonged standing
  • Obesity
  • Pregnancy
  • Family history
  • Contraceptive pill
23
Q

What are some secondary causes of varicose veins?

A

Obstruction - DVT, foetus, tumour
AV malformations
Overactive muscle pumps e.g. cyclists
Congenital valve absence

24
Q

What signs might you see on examination of varicose veins?

A
  • Oedema
  • Eczema
  • Ulcers
  • Atrophie blanche - scar at site of healed ulcer
  • Lipodermatosclerosis - skin hardness from fibrosis due to chronic inflammation + fat necrosis
  • Fluid thrills felt at level of valve on tapping
25
Q

What veins are affected if medial, below knee and calf variscosities?

A

Medial = long saphenous
Below knee = short saphenous
Calf = perforators

26
Q

What test assesses the veins in the leg? Describe how you would do it

A

Trendelenburg’s test

  • Lift patient’s leg as high as comfortable to empty the veins
  • Whilst their leg is elevated, place torniquet over saphenofemoral junction
  • Ask patient to stand
  • Rapid filling of varicosities with torniquet suggests incompetent perforator veins below levels of SFJ
27
Q

How can you educate a patient about managing their varicose veins?

A
  • Avoid prolonged standing
  • Elevate legs when possible
  • Wear compression stockings
  • Lose weight
  • Regular walks because calf muscles aid venous return
28
Q

What endovascular treatments can be done for varicose veins?

A

Radiofrequency ablation - catheter inserted into vein and heated to ‘close’ the vein
Injection sclerotherapy - foam injected to damage endothelium of veins and occlude them
Surgery - stripping of veins

29
Q

Where are arterial ulcers most common?

A
  • At tips of toes or between toes
  • Over phalangeal heads
  • Above lateral malleolus
30
Q

What does an arterial ulcer look like?

A

Ulcer

  • Punched out lesion
  • Well defined edges
  • Black/necrotic tissue
  • No exudate
31
Q

What does the leg around an arterial ulcer look like?

A

Leg

  • Hair loss
  • Cool, pale
  • Thin, dry, shiny skin
  • Thickened toe nails
32
Q

Describe the pain of an arterial ulcer

A

Pain

  • Burning pain
  • Exacerbated by exercise and lying down
  • Relieved by rest and hanging foot out of bed
33
Q

Where are venous ulcers most common?

A
  • Lower 1/3rd of leg
  • Pre-tibial area
  • Anterior to medial malleolus
34
Q

What are the main causes of venous ulcers?

A

DVT
Obesity
Calf muscle pump deficits
Valvular incompetence in superficial perforating veins

35
Q

What does a venous ulcer look like?

A
  • Uneven edges
  • Ruddy granulation tissue
  • No dead tissue
  • Exudate
36
Q

What does the leg around a venous ulcer look like?

A
  • Red/brown pigmentation = haemosiderin
  • Evidence of past healed ulcers
  • Venous eczema
  • Tortuous superficial veins
  • Warm
  • Hair is still on legs
37
Q

Describe the pain of a venous ulcer

A
  • Moderate to no pain at all

- Pain is eased by raising the leg

38
Q

Where are neuropathic ulcers usually seen?

A
  • On sole of feet

- Under the heel

39
Q

What usually causes a neuropathic ulcer?

A

Diabetic with peripheral neuropathy

40
Q

What does a neuropathic ulcer look like?

A
  • Even margins
  • Deep
  • Cellulitis
  • Not much exudate
41
Q

What is the rest of the leg like in neuropathic ulcers?

A
  • Diminished sensation in foot

- Warm foot

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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