Vascular conditions Flashcards by Ben Edgar

What is peripheral arterial disease?

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

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How common is PAD is people aged over 70?

affects 15-20%

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Risk factors for PAD?

Smoking
Diabetes mellitus
Hypertension
Hyperlipidaemia
Physical inactivity
Obesity

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

65%

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Symptoms of PAD?

Intermittent claudication

Ischaemic rest pain (more sever PAD)

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Signs of PAD?

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

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Investigations in PAD?

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

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What do the results of an ABPI show?

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

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Diseased associated with PAD?

Coronary heart disease
Cerebrovascular disease
Diabetes

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Why might an ABPI show a falsely high result?

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

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

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

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What is the recommended first line antiplatelet agent in PAD?

Clopidogrel

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How should claudication be managed?

Supervised exercise programmes
Vasoactive drugs (naftidrofuryl oxalate)

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When is intervention for PAD required?

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

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What is the progression of interventions for PAD?

Percutaneous transluminal angioplasty
Surgical reconstruction (eg bypass)
Amputation

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What are the signs and symptoms of acute ischaemia?

6 P’s

Pale
Pulseless
Perishingly cold
Paraesthetic
Painful
Paralysed

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Management of acute limb ischaemia?

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

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What are varicose veins?

Long torturous and dilated veins of the supericial venous system

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What is the pathology of varicose veins?

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

Risk factors for varicose veins?

Prolonged standing
Obesity
Pregnancy
The pill
Family history

Symptoms of varicose veins?

'My legs are ugly'
Pain
Cramps
Tingling
Heaviness
Restless legs

Primary causes for Varicose veins?

(95%) Unknown

Congenital valve absence

Secondary Causes for Varicose veins (5%)

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

Signs for varicose veins?

Oedema
Eczema
ulcers
haemosiderin
haemorrhage
Phlebitis
Lipodermatosclerosis

What is lipodermatosclerosis?

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

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

``` Bleeding Pain ulceration superficial thrombophlebitis 'severe impact on quality of life' ```

What education should given for varicose vein treatment?

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

What are the three endovascular treatment options for Varicose veins?

Radiofrequency ablation Endovenous laser ablation Injection sclerotherapy

What is saphena varix?

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

When does an artery have an aneurysm?

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

What is the difference between true and false aneurysms?

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)

Causes of artery aneurysm?

``` Atheroma Trauma infection Connective tissue disorders Inflammatory ```

Complications of aneurysms?

``` Rupture Thrombosis Embolism Fistulae Pressure on other structures ```

Is there any screening for Aortic aneurysms?

Yes. All men at age 65.

How does a ruptured AAA present?

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

What is the definition of an unruptured AAA?

>3cm across

Prevalence of AAA?

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

Symptoms of unruptured AAA?

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

AAA rupture is more likely if?

High BP Smoker Female Strong family history

When should a AAA be operated on?

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

How can major AAA surgery be avoided?

Stenting (EVAR) | endovascular aneurysm repair

What is the mortality of a ruptured AAA?

Treated 41% | Untreated 100%

What is the management of a ruptured AAA?

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

What prophylactic antibiotics should be given in ruptured AAA?

Cefuroxime | Metronidazole

What does ruptured AAA surgery involve?

Clamping the aorta above the leak and inserting a Dacron graft