Vascular Flashcards
What is a Marjolin’s Ulcer?
Marjolin’s ulcer is a squamous cell carcinoma occurring at sites of chronic inflammation or previous injury.
Summarise the screening programme in the UK for abdominal aortic aneurysms.
In England, abdominal aortic aneurysm screening (AAA) is offered to men during the year they turn 65 with a single abdominal USS.
If normal (<3cm) the patient will require no further future scans as the chances of developing a AAA after 65 years old is small.
If larger:
- 3 - 4.4cm: Rescan every 12 months
- 4.5 - 5.4cm: Recan every 3 months
- ≥5.5, or enlarging >1cm/yr: Refer within 2 weeks to vascular surgery for probably intervention.
In addition, symptomatic AAAs have a high risk of rupture and should undergo EVAR.
Describe the management of peripheral arterial disease.
Conservative:
- Smoking cessation advice
- Lifestyle intervention
- Exercise training
Medical:
- Control HTN, diabetes, obesity
- Atorvastatin 80mg
- Clopidogrel 75mg (if not tolerated, Aspirin 75mg is 2nd line)
- (Naftifrofuryl oxalate (vasodilator) if exercise not improved and patient prefers to not have intervention)
Surgical (mainly for severe PAD/critical limb ischaemia):
- Angioplasty
- Stenting
- Bypass surgery
- (amputation)
What is the definition of critical limb ischaemia?
Critical limb ischaemia presents as pain at rest for greater than 2 weeks, often at night, not helped by analgesia.
Usually in patietns with a history of PAD.
What condition could elad to acute limb ischaemia in a person without pre-exisiting limb ischaemia?
Atrial fibrillation can lead to thrombo-embolic acute limb ischaemia.
Where do patients usually compalin of pain when the cluadication affects the iliac artery?
Iliac stenosis typically causes buttoc pain.
Can lead to Leriche Syndrome:
- Claudication of the buttock/thigh
- Absent/decreased femoral pulses
- Erectile dysfunction
What is Leriche Syndrome?
Leriche Syndrome:
- Claudication of the buttock/thigh
- Absent/decreased femoral pulses
- Erectile dysfunction
This is due to aortoiliac occlusive disease.
Where would patients with femoral artery stenosis complain of symptoms?
The calves.
What is this woman suffering from?
This is woman is suffering from chronic venous insufficiency:
- Haemosiderin (brown pigmentation)
- Lipodermatosclerosis (champagne bottle legs)
- Eczema (inflammatory reaction)
Name important risk factors for peripheral vascular disease.
- Smoking (most important)
- Diabetes
- Obesity
- Inactivity
- Hyperlipidaemia
- Atrial fibrillation (can lead to sudden thromboembolic occlusion)
- Advanced age (>40)
- HTN
Describe the interpretation of ABPI.
- >1.2: may indicate calcified, stiff arteries (advanced age, diabetes)
- 1.0-1.2: normal
- 0.9-1.0: acceptable
- 0.6-0.9: symptoms of intermittent claudication
- 0.3-0.6: Rest pain (+ ulceration. Hyperaemic changes)
- <0.3: Gengrene and ulcerative changes
What is subclavian steal syndrome?
Subclavian steal syndrome is associated with a stenosis or occlusion of the subclavian artery, proximal to the origin of the vertebral artery. As a result the increased metabolic needs of the arm then cause retrograde flow and symptoms of CNS vascular insufficiency.
What are the 6 P’s of actue limb ischaemia?
3 Signs:
- Pale
- Pulseless
- Perishingly Cold
3 Symptoms:
- Paralysis
- Pain
- Paraesthesia
One or more is requried!
What is the management of a patient with acute limb ischaemia?
This is a surgical emergency.
- Systemic anticoagulation with IV heparin bolus
- Surgery:
- Urgent angiography with revascularisation procedure (thrombectomy)
- Non-viable limb: amputation
What is the diagnostic algorithm for peripheral artery disease?
After a full assessment of femoral, popliteal, posterior tibialis and dorsalis pedis pulse:
- ABPI
- Duplex USS (first line Ix)
- Magnetic resonance angiography (performed before any intervention)
What is a cervical rib?
A cervical rib is an extra rib which arises from the 7th cervical vertebra. It occurs in 0.2-0.5% of people.
It is associated with thoracic outlet syndrome, where brachial plexus and subclavian artery are compressed.
