Vascular Flashcards
What is peripheral vascular disease caused by?
What occurs in acute limb ischaemia?
Differentiate intermittent claudication and critical limb ischaemia.
- Atherosclerosis causing stenosis of arteries
Acute limb ischaemia is sudden decrease in arterial perfusion to limb. Surgical emergency: 4-6hrs to save limb.
- Intermittent claudication is pain on exertion. Critical limb ischaemia is pain at rest.
What are 4 Fontaine stages of peripheral vascular disease?
- Asymptomatic
2a. mild claudication
2b. moderate to sever claudication - ischaemia rest pain
- ulceration or gangrene.
Give 2 areas of claudication in PVD.
What is Leriche syndrome?
- Iliac disease affects buttock
- Femoral disease affects calf.
Leriche syndrome- aortoilliac occlusive disease:
- Buttock claudication
- Impotence
- Absent/ weak distal pulses.
Give 4 signs of PVD
What is Buerger’s test?
What is a reactive hyperaemia?
- Absent femoral, popilteal, foot pulses
- Cold, white legs
- Atrophic skin
- positive Buerger’s test.
- Raise patient’s legs to 45 deg. for few mins
- If limb develops pallor note at what angle: 20 deg is Bueger’s angle.
- <20 deg is severe limb ischaemia.
- Limb should remain pink even at 90 deg.
- Patient should then suddenly swing legs over bed.
Reactive hyperaemia: leg returns to normal pink colour then becomes red in colour.
- shows arteriolar dilatation- response to increased anaerobic metabolic waste build up in lower limb.
Give 6 Ps of acute limb ischaemia.
- Pain
- Pale
- pulseless
- perishingly cold
- paralysis
- paraesthesia.
Give 3 further investigations for PVD.
What is contraindicated management if ABPI less than 0.8?
- ABPI: normal 0.9 to 1.2. May have incorrectly normal result. < 0.8 do not apply pressure bandage.
- Colour duplex USS- shows site and degree of stenosis.
- MRA: angiography
Which conditions are associated with arterial and venous ulcers.
Arterial: CHD, PVD, hyperlipidaemia, diabetes.
Venous: recurrent DVT, orthostatic occupation.
Give 5 features of arterial ulcer
- Punched out appearance, pale base
- Distal: dorm of foot/ in between toes
- Well defined edges
- Night pain: worse supine, decreased arterial blood flow.
- Shiny skin
Give 6 features of venous ulcers
- Large and shallow: sloping sides, less well defined.
- Proximal: medial gaiter region
- Painless
- Stasis eczema
- Atrophie blanche: white atrophic skin
- Haemosiderin deposition: areas of decolouration
Give investigations for arterial and venous ulcers.
Arterial:
- Duplex USS of lower limbs
- ABPI
- Bloods: diabetes
Venous:
- Duplex USS
- ABPI
- Measure surface area of ulcer
Give management for venous ulcer.
- Graded compression stockings- high pressure at ankles, low at knees.
- Debridement and cleaning
- Antibiotics
- Moisturising cream
What is definition of abdominal aortic aneurysm?
Where do most occur?
What is a true and false aneurysm?
- abdominal aorta diameter > 3cm or >50% larger than normal.
- 90% occur below renal arteries.
- True: all 3 layers stretch intima, media, adventitia.
- False: tear in 1 layer
Give 2 connective tissue and 2 inflammatory disorders causing abdominal aortic aneurysm.
Connective:
- Marfan’s, Ehler’s-Danlos
Inflammatory:
- Behcet’s disease, Takayasu’s arteritis.
Give 2 symptoms of ruptured abdominal aortic aneurysm.
Give 3 examination findings.
- Pain in back, abdomen, loin or groin. May be sharp/ severe.
- Shock- hypotension
- Pulsatile and laterally expansile abdominal mass
- Abdominal bruit
- Retroperitoneal haemorrhage: Grey-Turner’s sign.
Give 3 imaging methods for abdominal aortic aneurysm.
- USS: can detect aneurysm but not tell if it is leaking.
- CT with contrast/ CT angiography: can show if aneurysm is ruptured.
- MRA if contrast allergy.
What occurs in aortic dissection.
What are the types of aortic dissection?
- Tear in aortic intima allows blood flow into new false channel, between inner and outer layers of tunica media.
Stanford Type A: - Debakey 1: ascending and descending - Debakey 2: Ascending Stanford type B: - Debakey 3: descending.
Give 4 risk factors for aortic dissection
What is common patient demographic?
- Hypertension
- Atherosclerotic disease
- Connective tissue disorders: Marfan’s, Ehlers Danlos
- congenital cardiac anomalies- coarctation of aorta.
- Males 40-60
- Younger males with connective tissue disorders.
Describe symptoms of aortic dissection.
Give 5 signs of aortic dissection
- Sudden central tearing chest pain. Radiates between shoulder blades.
- Other symptoms due to obstruction of other aortic branches: abdominal pain, loss of consciousness, anuria.
Signs:
- HTN
- Diastolic murmur
- Interarm BP difference >20mmHg
- Features of CTD
- Hypotension: may suggest tamponade.
What should be looked for on ECG in aortic dissection?
What investigation should be ordered as soon as diagnosis is suspected?
- Myocardial ischaemia on ECG: ST depression.
- Order CT angiogram as soon as diagnosis is suspected.
Give 3 secondary causes of varicose veins
- DVT
- Pelvic masses- pregnancy, uterine fibroids, ovarian masses
- AV malformations
Give 4 symptoms of varicose veins
- Leg aching- worse with prolonged standing
- swelling
- itching
- bleeding.
Give the examination findings of varicose veins.
- Inspection- whilst patient is standing, permanently dilated veins >3mm
- Palpation: veins tender/ feel hard. Tap test: tap varicose veins distally and feel transmitted impulse over saphenofemoral junction.
- Auscultation: bruits
- Trendelenburg test: localisation of sites of valve incompetence.
Give main investigation for varicose veins
Give 3 managements for varicose veins.
- Duplex USS
Management: - Conservative: compression stockings, lifestyle changes
- Endovascular treatment: radio frequency ablation, laser ablation, microinjection sclerotherapy
- Surgery
Give 3 surgical treatments for varicose veins.
- Avulsion of varicosities
- Saphenofemoral ligation
- Stripping of long saphenous vein.
