Vascular

Question 1

What are the key general risk factors for Vascular Disease?

Answer 1

Similar to CVS risk factors

Male

Cardiovascular Disease Hx

Obesity

Smoking

Age

BP

Question 2

What is Peripheral Vascular Disease?

Answer 2

Artherosclerosis leading to stenosis of arteries.

Divided into:

Acute Limb Ischaemia

Chronic Limb Ischaemia: Intermittent Claudication & Critical Limb Ischaemia

Question 3

Describe Intermittent Claudication.

Answer 3

Cramping pain felt. in the calf, thigh or buttock after walking a certain distance.

Relieved by rest

Worse when going uphill

Always the same area, independent of type of movement.

Question 4

Describe Critical Limb Ischaemia.

Answer 4

Pain, even at rest.

Night Pain

Causes Ulcers and Gangrene.

Hanging legs over the side of the bed helps (due to gravity)

Rapid Deterioration of symptoms.

Question 5

What is Leriche Syndrome?

Answer 5

Aortoiliac Occlusive Disease

Causes:

Buttock Claudification

Impotence

Absent/weak distal pulses.

Question 6

Which artery would you suspect to be stenosed if a patient presents with:

a) Calf Claudication
b) Buttock Claudication

?

Answer 6

a) Femoral Artery
b) Iliac Artery

Question 7

What are the key presenting symptoms and signs of Chronic Limb Ischaemia?

Answer 7

Pain

Absent Femoral, Popliteal or foot pulses

Cold, white legs

Atrophic Skin

Colour change when raising leg (Buerger’s Test)

Question 8

What is Buerger’s Test?

Answer 8

Severe Limb Ischaemia test

Leg Pallor occurs when the leg is held at Buerger’s Angle (20 degrees)

Reactive Hyperaemia occurs when the leg is returned to a dangling position.

Question 9

What are the signs and symptoms of Acute Limb Ischaemia?

Answer 9

6 Ps

Pain

Pale

Pulseless

Perishingly Cold

Paralysis

Paraesthesia

Question 10

How would you investigate suspected Peripheral Vascular Disease?

Answer 10

Full CVS risk assessment - BP, Bloods (FBC, Lipids, Glucose), ECG

Ankle Brachial Pressure Index (<0.9 = Abnormal, <0.5 = CLI)

Colour Duplex USS

MRA/CT

Question 11

What are Ulcers?

Answer 11

Loss of the continuity of the skin’s Epithelium/Endothelium.

Arterial

Venous

Neuropathic

Question 12

How do the risk factors for Venous/Arterial Ulcers differ?

Answer 12

CVS +

DVTs, orthostatic occupations, varicose veins and being female can predispose people to Venous Ulcers.

Question 13

Describe the Signs and Symptoms of Arterial Ulcers.

Answer 13

Punched-Out Appearance - Deep

Typicall Distal (Commonly dorsum of foot in between toes)

Well Defined

Pale Base

Night Pain

Question 14

Describe the Signs and Symptoms of Venous Ulcers.

Answer 14

Large and Shallow, with sloping sides

Poorly Defined

Proximal

Painless

Stasis Eczema

Inverted Champagne Bottle sign

Atrophie Blanche (White, atrophied skin & capillaries)

Haemosiderin Deposition (areas of discolouration)

Question 15

How woukd you investigate Ulcers?

Answer 15

Arterial:

Duplex USS

ABPI

Percutaneous Angiography

ECG

Bloods

Venous

Duplex USS

Measure Surface Area

ABPI

Swab for microbiology

Biopsy

Question 16

How would you manage a patient with a Venous Ulcer?

Answer 16

Graded Compression Stockings

Debridement and Cleaning

Antibiotics

Moisturising Cream

Question 17

How would you define an AAA?

Answer 17

A localised enlargement of the Abdominal Aorta, where the diamter is >3cm or >50% larger than its normal diameter.

90% occur below Renal Arteries

True = All 3 Layers

False = Tear in 1 Layer

Question 18

Which diseases can predispose people to AAAs?

Answer 18

CTDs - Marfans, Ehlers-Danlos

Inflammatory Disease - Behcet’s, Takasayu’s Arteritis

Question 19

What are the Signs and Symptoms of a ruptured AAA?

Answer 19

Severe, Sudden pain in the Loin, groin, back or abdomen

Hypotensive Shock

OE:

Pulsatile and laterally expansile abdominal mass

Abdominal Bruit

Grey-Turners Sign (Flank Brusing due to retroperitoneal haemorrhage)

Question 20

What is Aortic Dissection?

Answer 20

A tear in the Aortic Intima forms a ‘False Lumen’ through which blood can flow.

Question 21

How does Aortic Dissection present, and how is it classified?

Answer 21

Sudden, tearing pain which radiates to the back.

Type A = Ascending

Type B = Descending

Expansion can lead to occlusion of the Subclavian (Syncope), Carotid (Syncope), Coeliac (Abdominal Pain) and Renal (Anuria) arteries.

Hypertension, Diastolic Murmur, Interarm BP Difference

Hypotension may suggest Tamponade

Question 22

What are the main Risk Factors for Aortic Dissection?

Answer 22

HTN

Artherosclerotic Disease

CTD

Smoking

Congenital Cardiac Defects

Question 23

How is Aortic Dissection diagnosed?

Answer 23

CT Angiogram

Question 24

What are Varicose Veins?

Answer 24

Subcutaneous, permanently dilated veins >3mm in diameter when measured in a standing position.

Question 25

What causes Varicose Veins?

Answer 25

Venous Valve Incompetence

Primary - Idiopathic

Secondary - Pelvic Masses (Pregnancy, Fibroids, Ovarian Masses), DVT.

Question 26

How would you diagnosis Varicose Veins?

Answer 26

Duplex USS

Question 27

How would you manage a patient with Varicose Veins?

Answer 27

Conservative Measures - Compression stockings and lifestyle changes.

Endovascular Tx - Ablation (Laser/Radiofrequency) & Microinjection Sclerotherapy

Surgical - Avulsion of Varicosities, Saphenofemoral Ligation, Stripping of Long Saphenous Vein