Vascular Flashcards
Peripheral Arterial Disease (PAD or LEAD)
Range of syndromes caused when narrowed arteries reduce blood flow to limbs
The Fontaine Classification
Describes 4 stages of LEAD:
Stage 1: Asymptomatic
Stage 2a: Intermittent claudication with pain after more than 200m walking
Stage 2b: Intermittent claudication with pain after less than 200m walking
Stage 3: Rest pain
Stage 4: Ischaemic ulcers or necorsis and gangrene
Rutherford Classification
Describes 7 stages of PAD: Stage 0 – Asymptomatic Stage 1 – Mild claudication Stage 2 – Moderate claudication Stage 3 – Severe claudication Stage 4 – Rest pain Stage 5 – Ischaemic ulceration not exceeding ulcers of the digits of the foot Stage 6 – Severe ischaemic ulcers or frank gangrene
Causes of PAD
Atherosclerosis and stenosis, damage, inflammation, degenerative diseases. Rarer causes are: aortic coarctation, arterial tumour, arterial dissection, temporal arteritis.
Risk factors for PAD
Smoking, diabetes, HTN, hyperlipidaemia, Over 40 y.o, Virchow’s triad, low levels of exercise
Virchow’s Triad
Factors that contribute to thrombosis:
hypercoaguability, vessel wall injury, blood stasis
Symptoms of PAD
Asymptomatic, intermittent claudication, diminished pulse, 6 P’s, erectile dysfunction, pain in calf, thigh or bum
Skin changes: shiny, hair loss
6 Ps
Pain, paralysis, paraesthesia, pulselessness, perishingly cold, pallor
Investigations for PAD
ABPI (1.3 + abnormal, 1.0 - 1.2 normal, 0.90-0.99 Acceptable, 0.80-0.89 Some arterial disease)
Doppler
Angiography
Trendelenburg Test
Buerger’s Disease
Disease of the arteries and veins. Blood vessels become inflamed, swell and blocked with blood clots damaging skin tissue leading to infection and gangrene. Smokers are all affected.
Trendelenburg Test
Physical examination to determine the competency of the valves in the superficial and deep veins of the legs in patients with varicose veins.
1) Raise affected leg of supine patient and massage down to drain venous blood from limb.
2) Place torniquet on thigh
3) Ask patient to stand up and see if varicose veins reappear
If varicose veins do not fill problem is above the tourniquet leve. If the varicose veins fill back up, problem is below the tourniquet level
Differentials for PAD
Spinal stenosis, Arthritis, venous claudication, Chronic compartment syndrome, Symptomatic Baker’s cyst, nerve root compression
Compartment syndrome
Bleeding or pressure within a compartment causing pressure build up preventing blood flow.
Treating Acute limb Ischaemia
Urgent assessment. Revascularisation and intra-arterial thrombolysis for viable limbs. Amputation for non-viable. Antiplatelet, analgesia, anticoagulation.
Treating Claudication
Antiplatelet therapy: Clopidogrel
Exercise
Risk factor modification
Revascularization
Complications for PAD
ulcers, gangrene, permanent limb weakness and pain
Aortic Abdominal Aneurysm
Swelling of the aorta. More common in men so men in their 65th year are screened.
< 3 cm discharged from programme, >5.5 referral to a vascular surgeon
Causes of AAA
Atherosclerosis, trauma, infection
Risk factors for AAA
Smoking, increased age, prevalence in males, rupture for females, family history
Signs for AAA
Palpable, pulsatile abdominal mass, back pain
Rupture: hypotension, pain, pulsatile mass, will go into shock (sweating, hypovolaemic, tachycardic etc)
Investigations for AAA
Abdominal USS,
Computed Tomography Angiography
FBC
Cultures: positive, leukonychia
Differentials for AAA
Diverticulitis, ureteric colic, IBS, IBD, appendicitis, ovarian torsion, GI haemorrhage
Treating a rupture AAA
Resuscitation
Urgent surgical repair: open repair, endovascular repair
Perioperative antibiotics
Treating a symptomatic but not ruptured AAA
Urgent surgical repair
Cardiovascular risk reduction
Perioperative antibiotics
Inform DVLA if size is over 6cm
