Vascular Flashcards
What is takayasu arteritis
Granulomatous inflammation of the aorta and its major branches.
Causes poor peripheral blood flow and a lack of distal pulses.
Where is the sapheno-femoral junction?
4cm below and lateral to the pubic tubercle
Presentation of takayasu arteritis
Systemic illness- Malaise, fever, Weight loss
Arm claudication
Visual disturbance
What is Churg Strauss syndrome
Rare Systemic vasculitis that is associated with eosinophilia and asthma.
Prodromal period of rhinitis and allergies
Associated with pANCA
What is Bechets disease
Chronic vasculitis
Strong association with HLA-B5
Occlusive vasculitis and venulitis
Clinical features of Bechets disease
Recurrent oral or genital ulceration
Recurrent iritis
skin lesions
thrombophlebitis
what is polymyalgia rheumatica
found in 50% of patients with temporal arteritis
causes proximal muscle pain in the shoulders and hips
no weakness
syx worse in the morning
What is giant cell arteritis
Inflammatory arteritis of the cranial branches arising from the aorta
F:M 2:1
Most common >50
Features of giant cell arteritis
Malaise, temple headache, Scalp tenderness Jaw claudication Visual disturbance Visual loss (due to ischaemic Optic neuritis)
giant cell arteritis findings on examination
Enlarged, tender, non-pulsatile temporal artery
Patchy granulomatous inflammation on biopsy
Management of giant cell arteritis
Prednisolone
What is wergener’s disease
Granulomatous necrotising vasculitis
Triad of involvement - Upper airway pathology, respiratory disease, renal disease
Features of wergener’s disease
Upper airway pathology - Epistaxis, saddle nose, rhinitis, deafness, proptosis
Spiritually disease - pulmonary nodules, pulmonary haemorrhage
Renal Disease- glomerulonephritis
c ANCA
What is polyarteritis nodosa
Necrotising vasculitis of small and medium vessels
Associated microaneurysm formation
What is microscopic polyangiitis
Necrotising focal sentimental glomerulo-nephritis
Renal features of haematuria and proteinuria
cANCA pANCA +ve
What is Kawasaki’s disease
Acute febrile systemic vasculitis affecting children
Clinical features of Kawasaki’s disease
Fever for 5 or more days \+4 of: -cervical lymphadenopathy -oral mucosal erythema -Conjunctivitis -Rash -Extremity change such as oedema and desquamation
Main complication Kawasaki’s disease
Coronary aneurysm development
Can cause heart attack and sudden death
Features of henoch schonlein purpura
Child (usually <5)
Purpuric rash over buttocks / extensor surfaces
Associated with arthralgia, abdominal pain, nephritis
What is a fogarty catheter used for?
Surgical embolectomy
Cause of thrombophlebitis migrans
Recurrent thrombophlebitis in different body areas
Caused by pancreatic cancer
What is the definition of a true aneurysm
Abnormal dilation of an artery involving all three layers of the arterial wall
Adverse events associated with aneurysm formation
Rupture
Occlusion
Distal Ischaemia
Thromboembolic disease
Management of abdominal aortic aneurysm < 5.5 cm diameter
Annual abdominal ultrasound/CT scan
Risk factors for aortic dissection
Hypertension Male Atherosclerosis Collagen disorder Trauma
What is the difference between type A and type B aortic dissections
Type B begin distal to the origin of the left subclavian artery - Can be managed conservatively
Type A involve be ascending aorta - Always require emergency surgical repair
Features of an arterial ulcer
Deep, painful, sharply defined
Usually on shin or foot
Peripheral pulses decreased or absent
Features of arterial disease
Intermittent claudication Cold feet Hair loss Toenail dystrophy Dusky cyanosis Ischaemic ulcers
What is a marjolin’s ulcer
A squamous cell carcinoma occurring in an area of scarred or traumatised skin
E.g. Burns/chronic wounds / ulcers
Raised, fleshy, firm papule
slow-growing
Features of neuropathic ulcers
Pressure points Painless Punched out \+/- infection + malodour Warm, dry skin, good pulses. Reduced sensation
What is a martorell’s ulcer
Ischaemic ulcer of the leg above the ankle
Painful
Occurs due to hypertension
What is a saphena varix
Dilation of the long saphenous vein
Occurs due to valve incompetence at salhenofemoral junction
Management if venous ulcers
Exclude arterial component
Compression bandage
Excise necrotic tissue
If this fails - split skin grafting
Symptoms of leriche syndrome
Bilateral buttock pain (claudiation) Erectile dysfunction (Due to aorto-iliac obstruction)
Management of leriche syndrome
Risk factor symptoms
Endarterectomy
Bypass grafting
Symptoms of critical ischaemia
Rest pain in foot
Hanging leg out of bed at night to get comfortable
Signs of critical limb ischaemia
Pale Cold Pulseless Skin damage over pressure sites Slow cap refill Small angle on burgers test + reactive hyperaemia APBI <0.4
Features of Dry gangrene
Due to decresed blood supply
Area is cold, dry and black and will slough off
Features of wet gangrene
Follows infection in the tissues - streptococci / staphylococci.
Swelling and inflammation causes blood vessels blockage.
discharges
Symptoms of compartment syndrome
Muscle necrosis Severe pain Pain on passive movement Tense muscles Acute renal failure from rhabdomyolysis Volkmanns ischaemic contracture Nerve necrosis
Causes of compartment syndrome
Arterial surgery with prolonged clamping Crush injuries Haematomas Fractures Tight plasters
Wells criteria for DVT
Possible score −2 to 9
Active cancer : +1 point
Calf swelling ≥ 3 cm +1 point
Swollen unilateral superficial veins +1 point
Unilateral pitting oedema +1 point
Previous DVT: +1 point
Swelling of entire leg: +1 point
Localized tenderness along the deep venous system: +1 point
Paralysis, paresis, or recent cast immobilization : +1 point
Recently bedridden ≥ 3 days / major surgery in the past 12 wks +1 point
Alternative diagnosis at least as likely: −2 points
Possible symptoms of carotid artery disease
TIA
Stroke
Amaurosis fugax
Causes of unilateral clubbing
Upper limb artery aneurysm
Brachial AV malformation
Investigation of a suspected AAA
Blood tests:
FBC, clotting screen, renal function and liver function.
ESR and/or CRP if an inflammatory cause is suspected.
ECG, CXR and possibly lung function tests.
Ultrasound
CT with contrast / MRI angiography if suspected rupture
