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3rd Year > Vascular conditions > Flashcards

Vascular conditions Flashcards

1
Q

What is peripheral arterial disease?

A

Occurs when there is significant narrowing of arteries distal to the arch of the aorta, most often due to athersclerosis

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2
Q

How common is PAD is people aged over 70?

A

affects 15-20%

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3
Q

Risk factors for PAD?

A 
Smoking
Diabetes mellitus
Hypertension
Hyperlipidaemia
Physical inactivity
Obesity
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4
Q

What percentage of PAD patients have co-existing clinically relevant cerebral or coronary artery disease?

A

65%

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5
Q

Symptoms of PAD?

A

Intermittent claudication

Ischaemic rest pain (more sever PAD)

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6
Q

Signs of PAD?

A 
Absent femoral, popliteal or foot pulses
Cold white legs
Atrophic skin
Punched out ulcers
Postural/dependant colour change
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7
Q

Investigations in PAD?

A 
Full cardiovascular risk assessment
FBC, ESR
Blood glucose
ECG
Doppler ultrasonography
Duplex ultrasonography
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8
Q

What do the results of an ABPI show?

A

normal=1
Claudication=0.6-0.9
Rest pain =0.3-0.6
Impending gangrene =

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9
Q

Diseased associated with PAD?

A

Coronary heart disease
Cerebrovascular disease
Diabetes

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10
Q

Why might an ABPI show a falsely high result?

A

Due to incompressible calcified vessels in severe atherosclerosis (eg diabetes mellitus)

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11
Q

What methods of risk factor modification should be undertaken in PAD?

A

Smoking cessation
Treat hypertension and high cholesterol
Prescribe an antiplatelet agent to prevent progression and reduce cardiovascular risk

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12
Q

What is the recommended first line antiplatelet agent in PAD?

A

Clopidogrel

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13
Q

How should claudication be managed?

A 
Supervised exercise programmes
Vasoactive drugs (naftidrofuryl oxalate)
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14
Q

When is intervention for PAD required?

A

If conservative measures have failed and PAD is severely affecting a patients lifestyle or becoming limb threatening

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15
Q

What is the progression of interventions for PAD?

A

Percutaneous transluminal angioplasty
Surgical reconstruction (eg bypass)
Amputation

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16
Q

What are the signs and symptoms of acute ischaemia?

6 P’s

A 
Pale
Pulseless
Perishingly cold
Paraesthetic
Painful
Paralysed
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17
Q

Management of acute limb ischaemia?

A

This an emergency and may require open surgery or angioplasty
Local thrombolysis (tissue plasminogen activator)
Anticoagulate with heparin

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18
Q

What are varicose veins?

A

Long torturous and dilated veins of the supericial venous system

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19
Q

What is the pathology of varicose veins?

A

Valves prevent blood from passing from deep to superficial veins. Of valves become incompetent there is venous hypertension and dilatation of the superficial veins occur

20
Q

Risk factors for varicose veins?

A 
Prolonged standing
Obesity
Pregnancy
The pill
Family history
21
Q

Symptoms of varicose veins?

A 
'My legs are ugly'
Pain
Cramps
Tingling
Heaviness
Restless legs
22
Q

Primary causes for Varicose veins?

A

(95%) Unknown

Congenital valve absence

23
Q

Secondary Causes for Varicose veins (5%)

A 
Obstruction
Valve destruction
Arteriovenous malformation
Constipation
Overactive muscle pumps (cyclists)
24
Q

Signs for varicose veins?

A 
Oedema
Eczema
ulcers
haemosiderin
haemorrhage
Phlebitis
Lipodermatosclerosis
25
Q

What is lipodermatosclerosis?

A

skin hardness from subcutaneous fibrosis caused by chronic inflammation and fat necrosis

26
Q

What are the requirements for referral of patients with Varicose veins?

A 
Bleeding
Pain
ulceration
superficial thrombophlebitis
'severe impact on quality of life'
27
Q

What education should given for varicose vein treatment?

A

Avoid prolonged standing and elevate legs whenever possible
Support stockings
Lose weight
Regular walks

28
Q

What are the three endovascular treatment options for Varicose veins?

A

Radiofrequency ablation
Endovenous laser ablation
Injection sclerotherapy

29
Q

What is saphena varix?

A

Dilation in the saphenous vein at its confluence with the femoral vein. may be mistaken for an inguinal or femoral hernia

30
Q

When does an artery have an aneurysm?

A

As artery with a dilation >50% of its original diameter has an aneurysm, remember this is an ongoing process

31
Q

What is the difference between true and false aneurysms?

A

True aneurysms are abnormal dilatations that involve all layers of the arterial wall
False aneurysms involve a collection of blood in the outer layer only (adventitia)

32
Q

Causes of artery aneurysm?

A 
Atheroma
Trauma
infection
Connective tissue disorders
Inflammatory
33
Q

Complications of aneurysms?

A 
Rupture
Thrombosis
Embolism
Fistulae
Pressure on other structures
34
Q

Is there any screening for Aortic aneurysms?

A

Yes. All men at age 65.

35
Q

How does a ruptured AAA present?

A

Intermittent or continuous abdo pain (radiates to back, iliac fossa or groin)
Collapse
An expansile abdominal mass
Shock

36
Q

What is the definition of an unruptured AAA?

A

> 3cm across

37
Q

Prevalence of AAA?

A

3% of those >50 years old. 3x more likely in men

38
Q

Symptoms of unruptured AAA?

A

Often none
may cause abdominal/back pain
Often discovered incidentally on abdominal examination

39
Q

AAA rupture is more likely if?

A

High BP
Smoker
Female
Strong family history

40
Q

When should a AAA be operated on?

A

> 5.5cm or expanding at >1cm per yearor symptomatic

41
Q

How can major AAA surgery be avoided?

A

Stenting (EVAR)

endovascular aneurysm repair

42
Q

What is the mortality of a ruptured AAA?

A

Treated 41%

Untreated 100%

43
Q

What is the management of a ruptured AAA?

A

Summon vascular surgeon and anaesthetist
Do and ECG, blood for amylase, Hb, crossmatch
Gain IV access and treat shock with ORh-ve blood but keep systolic BP

44
Q

What prophylactic antibiotics should be given in ruptured AAA?

A

Cefuroxime

Metronidazole

45
Q

What does ruptured AAA surgery involve?

A

Clamping the aorta above the leak and inserting a Dacron graft

3rd Year (18 decks)

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