Vascular Flashcards
What are the main vascular RF (6)
Male PMHx of cardiovascular disease Obesity Smoking Age Blood pressure
How long do we have to save a limb with acute limb ischaemia
4-6hrd
What is critical limb ischaemia
Ischaemic limb pain on rest
3 complications of PVD (3)
Limb loss
Arterial ulcers
Gangrene
What are the three forms of PVD
ACUTE
Acute limb ischaemia: sudden decrease in arterial perfusion in a limb
Surgical emergency: 4-6hrs to save limb
CHRONIC
Intermittent claudication: pain on exertion
Critical limb ischaemia: pain at rest
What is used to stage PVD
Fontaine staging
What are the stages of Fontaine staging
Stage I: asymptomatic Stage IIa: mild claudication Stage IIb: moderate to severe claudication Stage III: ischaemia rest pain Stage IV: ulceration or gangrene
RF of PVD (7)
Smoking Diabetes Hypertension Hyperlipidaemia Physical inactivity Age >40yrs Hx of cardiovascular/cerebrovascular disease
Epidemiology of PVD
More common in older men
What is Leriche syndrome (4)
aortoiliac occlusive disease
Buttock claudication
impotence
absent/weak distal pulses.
S/s of CLI (4)
Rest pain
Night pain
Ulcers
Gangrene
S/s of IC (2)
Cramping pain in calf, thigh or buttock after walking for a certain distance
Relieved by rest
Which artery is diseased if there is buttock claudication
Iliac
Which artery is diseased if there is calf claudication
Femoral
S/s of general PVD not to do with (4)
Absent femoral, popliteal or foot pulses
Cold, white legs
Atrophic skin
Colour change when raising leg (to Buergers angle)
Which test is used to test for severe limb ischaemia
Buerger’s test
What are the 6P’s of acute limb ischaemia
Pain Pale Pulseless Perishingly cold Paralysis Paraesthesia
Which Ix for PVD
Blood pressure Bloods: FBC; fasting blood glucose; lipids ECG ABPI Colour duplex USS MRA
What causes arterial ulcers
A localised area of damage and breakdown of skin due to inadequate arterial blood supply.
What causes venous ulcers
Area of damaged skin caused by incompetent valves or venous outflow obstruction in the lower limbs leading to venous stasis and ulceration.
RF of arterial ulcers (7)
Age FHx Smoking Obesity + immobility CHD or PVD Hyperlipidaemia Diabetes
RF of venous ulcers (8)
Age FHx Smoking Obesity + immobility Recurrent DVT Orthostatic occupation Varicose veins Female
Epidemiology of arterial ulcers
10-30% lower extremity ulcers1
Increased prevalence with age + obesity
Epidemiology of venous ulcers
> 2/31 lower extremity ulcers
Increased prevalence with age
Females
Presentation of an arterial ulcer (4)
Punched out appearance Deeper than VU Often distal Dorsum of foot/in between toes commonly affected Well-defined edges Pale base Grey granulation tissue Night pain
Signs of arterial ulcer (5)
Hair loss Shiny skin Pale skin Calf muscle wasting Absent pulses
Presentation of venous ulcer (4)
Large and shallow Sloping sides Less well-defined than AU More proximal than AU Medial gaiter region Painless Other symptoms of venous insufficiency Swelling Itching Aching
Signs of venous ulcer (4)
Stasis eczema Lipodermatosclerosis Inverted champagne bottle sign Atrophie blanche Area of white, atrophic skin surrounded by small capillaries Haemosiderin deposition Areas of discolouration
Ix of arterial ulcer (4 and 4 bloods)
Duplex USS of lower limbs
ABPI
Percutaneous angiography
ECG
Bloods: Fasting serum lipids HbA1c Blood glucose FBC
Ix for venous ulcer (5)
Duplex USS of lower limbs Measure surface area of ulcer (monitor progression) ABPI Swab for microbiology If signs of infection Biopsy If possibility of Marjolin’s ulcer
Mx of venous ulcer (4)
Graded compression stockings Reduce venous stasis Debridement and cleaning Antibiotics - if infected Moisturising cream for eczema/dry skin
Define an AAA with size
AAA = A localised enlargement of the abdominal aorta where the diameter is >3 cm or >50% larger than normal diameter.
What is the normal diameter of the aorta
Normal diameter of the aorta = 2 cm
RF of AAA
Smoking Age Family history Connective tissue disorders Males Hypertension Hyperlipidaemia Inflammatory disorders
Which connective tissue disorders can increase risk of AAA (2)
Marfan’s syndrome, Ehlers-Danlos syndrome
Which inflammatory disorders can increase risk of AAA (2)
Behcet’s disease, Takayasu’s arteritis (vasculitides)
Which sign can be seen in some AAA ruptures
Grey-Turners sign
Retroperitoneal haemorrhage can cause
Bloods to take if you suspect AAA (5)
FBC, clotting screen, renal function and liver function
Cross-match if surgery is planned
Which imaging is used to see if an aneurysm has ruptured
CT with contrast/CT angiography – can show if aneurysm has ruptured
What are the 2 types of aortic dissection
A – ASCENDING aorta
(most common)
B – DESCENDING aorta
Which CTD can predispose to AA
Marfan’s, Ehlers Danlos syndrome
RF for AA (7)
HYPERTENSION Atherosclerotic disease Connective tissue disorders (CTD) Congenital cardiac anomalies e.g coarctation of aorta Smoking Cocaine/amphetamine usage Heavy lifting
2 common populations of AA
Most common in males aged 40-60 years
Affects younger males with CTDs (30yrs)
Why can you get abdominal pain in AA
Symptoms due to obstruction of other aortic branches Abdominal pain (coeliac axis)
What does hypotension with a suspected AA suggest
Cardiac tamponade
Ix for AA (9)
Bloods: FBC Type and cross match Lactate U+Es; LFTs Cardiac enzymes
ECG look for signs of myocardial ischaemia
Often normal
CXR
Loss of contour of aortic knuckle
CT angiogram should be ordered as soon as diagnosis suspected
Shows false lumen
Most important Ix for AA
CT angiogram
What are varicose veins (size)
subcutaneous, permanently dilated veins >3 mm in diameter when measured in a standing position
Causes of varicose veins (6)
most commonly due to venous valve incompetence
Primary – idiopathic Secondary DVT Pelvic masses Pregnancy Uterine fibroids Ovarian masses AV malformations
RF of varicose veins (7)
Age FHx Females Previous pregnancies Previous DVT Prolonged standing Obesity
Which test is used to localise site of valve incompetence
Trendelenburg test
Ix for varicose veins
Duplex USS
Localises sites of valve incompetence or reflux
Allows exclusion of DVT
What is important to be excluded if suspecting varicose veins
DVT
Mx of varicose veins (conservative 2, endovascular 3)
Conservative
Compression stockings
Lifestyle changes – weight loss, exercise, leg elevation
Endovascular treatment:
Radiofrequency ablation
Endovenous laser ablation
Microinjection sclerotherapy
Surgical Mx of varicose veins (3)
Avulsion of varicosities
Saphenofemoral ligation
Stripping of long saphenous vein
Complications of varicose veins (5)
Lipodermatosclerosis Venous pigmentation Eczema Ulceration Superficial thrombophlebitis
Complications of varicose veins sclerotherapy (2)
Skin staining
Local scarring
Which nerve is likely to be injured in a varicose vein surgery
Peroneal
