Vascular Flashcards
What are the key general risk factors for Vascular Disease?
Similar to CVS risk factors
Male
Cardiovascular Disease Hx
Obesity
Smoking
Age
BP
What is Peripheral Vascular Disease?
Artherosclerosis leading to stenosis of arteries.
Divided into:
Acute Limb Ischaemia
Chronic Limb Ischaemia: Intermittent Claudication & Critical Limb Ischaemia
Describe Intermittent Claudication.
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.
Describe Critical Limb Ischaemia.
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.
What is Leriche Syndrome?
Aortoiliac Occlusive Disease
Causes:
Buttock Claudification
Impotence
Absent/weak distal pulses.
Which artery would you suspect to be stenosed if a patient presents with:
a) Calf Claudication
b) Buttock Claudication
?
a) Femoral Artery
b) Iliac Artery
What are the key presenting symptoms and signs of Chronic Limb Ischaemia?
Pain
Absent Femoral, Popliteal or foot pulses
Cold, white legs
Atrophic Skin
Colour change when raising leg (Buerger’s Test)
What is Buerger’s Test?
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.
What are the signs and symptoms of Acute Limb Ischaemia?
6 Ps
Pain
Pale
Pulseless
Perishingly Cold
Paralysis
Paraesthesia
How would you investigate suspected Peripheral Vascular Disease?
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
What are Ulcers?
Loss of the continuity of the skin’s Epithelium/Endothelium.
Arterial
Venous
Neuropathic
How do the risk factors for Venous/Arterial Ulcers differ?
CVS +
DVTs, orthostatic occupations, varicose veins and being female can predispose people to Venous Ulcers.
Describe the Signs and Symptoms of Arterial Ulcers.
Punched-Out Appearance - Deep
Typicall Distal (Commonly dorsum of foot in between toes)
Well Defined
Pale Base
Night Pain
Describe the Signs and Symptoms of Venous Ulcers.
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)
How woukd you investigate Ulcers?
Arterial:
Duplex USS
ABPI
Percutaneous Angiography
ECG
Bloods
Venous
Duplex USS
Measure Surface Area
ABPI
Swab for microbiology
Biopsy
How would you manage a patient with a Venous Ulcer?
Graded Compression Stockings
Debridement and Cleaning
Antibiotics
Moisturising Cream
How would you define an AAA?
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
Which diseases can predispose people to AAAs?
CTDs - Marfans, Ehlers-Danlos
Inflammatory Disease - Behcet’s, Takasayu’s Arteritis
What are the Signs and Symptoms of a ruptured AAA?
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)
What is Aortic Dissection?
A tear in the Aortic Intima forms a ‘False Lumen’ through which blood can flow.
How does Aortic Dissection present, and how is it classified?
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
What are the main Risk Factors for Aortic Dissection?
HTN
Artherosclerotic Disease
CTD
Smoking
Congenital Cardiac Defects
How is Aortic Dissection diagnosed?
CT Angiogram
What are Varicose Veins?
Subcutaneous, permanently dilated veins >3mm in diameter when measured in a standing position.
What causes Varicose Veins?
Venous Valve Incompetence
Primary - Idiopathic
Secondary - Pelvic Masses (Pregnancy, Fibroids, Ovarian Masses), DVT.
How would you diagnosis Varicose Veins?
Duplex USS
How would you manage a patient with Varicose Veins?
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
