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3rd year > Vascular core conditions > Flashcards

Vascular core conditions Flashcards

1
Q

What causes critical limb ischaemia? 6

A

Obstructive atherosclerotic arterial disease

rarely: 
Vasculitis 
thromboangitis obliterans 
cystic adventitial disease
popliteal entrapment 
trauma
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2
Q

What causes acute limb ischaemia? 9

A

Thrombosis at the site of an atherosclerotic stenosis

Cardiac embolisation 
aortic dissection 
aortic embolisation 
graft thrombosis 
thrombosis of a popliteal aneurysm 
trauma 
hypercoaguable state 
air, fat or amniotic fluid embolism
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3
Q

What are the risk factors for PAD?

A

smoking
DM
HTN
dyslipidaemia

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4
Q

What are the signs of acute limb ischaemia? And how long is the onset? 6

A 
6Ps:
pain 
pallor 
pulseless
paraethesia 
paralysis
perishingly cold

Minutes, hours, days

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5
Q

What are the signs of limb ischaemia due to an embolus?5

A

Onset: seconds to minutes

ischaemia is usually profound

Skin changes to the feet: fine reticular blanching or mottling in early stages, progressing to coarse fixed mottling

History of claudication

Pulses are usually present in the other leg

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6
Q

How to you calculate an ABPI? and what do the scores mean?

A

Highest ankle BP of that leg/ highest BP of both the arms

Normal= 1
claudiation= 0.6-0.9 (0.8 refer to specialist)
Rest pain= 0.3-0.6
Impending gangrene= 0.3 or less

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7
Q

Aside from ABPI what other investigations can be done in PAD? 4

A

Duplex ultrasonography- to determine site, severity and length of occluison

MR angiography- may be offered prior to revascularisation

Digital subtraction arteriography- used in endovascular management and surgical planning

Full CV risk assessment

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8
Q

What medications should be considered in PAD to reduce CV risk factors?

A

Treat HTN
Statins- reduce risk of CV events and stroke
ACEis can reduce CV morbidity in patients with PAD

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9
Q

What drugs should be given for symptomatic PAD?

A

Antiplatelets
aspirin
clopidogrel
aspirin + dipyridamole

generally pick clopidogrel, as although it’s less effective than aspirin it has fewer SE

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10
Q

What drugs can you give for people with intermittent claudication?

A

Peripheral vasodilators:

Naftidrifuryl oxalate

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11
Q

What are the surgical options for PAD?

A

Percutaneous catheter-directed thrombolytic therapy

surgical embolectomy

endovascular revascularisation- if limb is viable

revascularisation-if the limb is marginally or immediately threatened

amputation

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12
Q

What are the complications of PAD?

A

ulceration and gangrene

Multiorgan dysfunction- e.g. AKI or acute lung injury
^ due to release of inflammatory markers and activation of complement cascade in response to ischaemia or reperfusion syndrome

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13
Q

What is an aneurysm?

A

An irreversible dilatation of a blood vessel by at least 50% of the normal diameter
affects all 3 layers of the arterial wall

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14
Q

What causes a pseudo-aneurysm?

A

Blood leaking through the wall, but it is contained by the adventitia or surrounding pervivascular tissue

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15
Q

What is the normal diameter of the AA?

A

~2cm- it increases with age

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16
Q

What is the diameter of an AAA?

A

> 3cm

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17
Q

Where do most AAA arise?

A

below the level of the renal arteries

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18
Q

Are AAA more common in F or M?

A

M

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19
Q

Is the risk of rupture of an AAA more common in F or M?

A

F

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20
Q

What causes an aneurysm? 4 (pathophysiology)

A

degradation of the elastic lamellae
leukocytic infiltrate
enhanced proteolysis
smooth muscle cell loss

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21
Q

What are the risk factors for the majority of AAAs? 7

A 
Severe atherosclerosis 
FH 
smoking 
age 
HTN 
COPD 
hyperlipidaemia
22
Q

What are the less common risk factors for AAAs? 9

A

Trauma

Infection- brucellosis, salmonellosis, TB, HIV

Inflammatory disease- Behcet’s disease, Takayasu’s disease

Connective tissue disorders- Marfan’s, Ehler’s Danlos syndrome type IV

23
Q

What are the signs and symptoms of an unruptured AAA? 4

A

Normally incidental finding- asymptomatic

Pain in back, abdomen or groin- due to pressure on nearby structures

Pulsatile abdominal swelling
May cause distal embolisation–> features of limb ischaemia

Uretrohydronephrosis- dilatation of ureter and pelvis of kidney due to obstruction

24
Q

What is the sign that indicates impending AAA rupture?

A

Severe lumbar pain of recent onset

25
Q

What are the features of a ruptured AAA? 8

A

Should be considered in any Px with hypotension and abnormal abdominal signs

pain in abdomen, back or loin- may be sudden and severe

Syncope
shock
collapse

Grey Turner’s sign- retroperitoneal bleeding
Pulsatile mass
AA bruit

26
Q

What tests may be done in suspected AAA? 12

A 
FBC 
clotting screen 
renal function test 
LFTs 
cross-matching if surgery is planned 
ESR and CRP
ECG 
CXR 
lung function tests 
USS- used in initial assessment 
CT 
MRI angiography
27
Q

What would a CT scan show in AAA? 4

A

visceral arterias
mural thrombus
the crescent sign= blood within the thrombus, may predict imminent rupture
para-aortic inflammation

28
Q

What are the differential diagnoses for AAA?

A 
acute gastritis 
appendicitis 
diverticulitis 
cholelithiasis (gallstones) 
Large/ small bowel obstruction 
MI 
peptic ulcer disease
29
Q

What level of monitoring should be done for different sized AAA?

A

3-4.4cm- annual ultrasound
4.5-5.4- 3 monthly USS
>5,5cm- surgery

30
Q

What are the indications for surgery in AAA? 4

A

> 5.5cm
rupture
rapid expansion
onset of sinister symptoms e.g. back pain, abdominal pain or tenderness

31
Q

What are the surgical options for AAA?

A

Surgical open repair- replace aneurysmal section with prosthetic graft

Endovascular repair of AAA= EVAR
- stent passed through femoral artery

32
Q

What are the pathophysiological causes of varicose veins?

A

Incompetent valves –> reflux of blood and increased pressure in the vein distally

33
Q

What are the risk factors for varicose veins? 6

A 
F>M 
pregnancy 
age 
FH 
Overweight 
leg trauma
34
Q

Why does pregnancy cause varicose veins?

A

There is an increase of blood volume –> strain on venous system
Hormones–> relaxation of muscular walls of vessles
Enlarging uterus–> pressure on the pelvic veins and IVC

35
Q

What are the signs and symptoms of varicose veins? 5

A 
Mostly cosmetic 
aching legs 
itching over veins 
swollen feet and ankles 
discomfort after prolonged standing
36
Q

What can ease the symptoms of varicose veins?

A

Leg elevation

compression stockings?

37
Q

What are the skin complications of varicose veins? 3

A

Areas of pigmentation
Venous eczema

Lipodermatosclerosis=
hardened, tight red or brown skin
which if it’s wrapped around the ankle may eventually –> champaign bottle leg

38
Q

Where are venous ulcers due to varicose veins most commonly seen?

A

In the ankle (gaiter) area

39
Q

What is thrombophlebitis?

A

tender, inflamed varicose veins
with overlying redness and heat
which feel firm due to thrombus within the vein

tend to present acutely

40
Q

What investigations can be done in varicose veins? 2

A

Duplex ultrasound

Triplex ultrasonography- colour flow imaging:
further refinement of the above
can sow minor valve leakages and incompetence in small perforator veins

41
Q

What are the differential diagnoses for varicose veins? 4

A

Cellulitis
Osler-weber-rendu sydnrome
superficial phlebitis
DVT

42
Q

How do you manage varicose veins?

A 
Lose weight 
moderate exercise 
elevate legs when possible 
avoid standing or sitting for too long 
compression stockings
43
Q

When should people with varicose veins seek further medical help? 4

A

If veins are hard or painful
There are skin changes
A break in the skin that lasts longer than 2 weeks
There is bleeding from the varicose veins

44
Q

When do you refer varicose veins to a vascular service?

A

They are symptomatic- pain, aching, itchy etc

There are skin changes

There is superficial vein thrombosis and suspected venous incompetence

Venous leg ulcer- that hasn’t healed within 2 week, refer within 2 weeks

A healed venous leg ulcer

45
Q

What are the surgical options for varicose veins?

A

stripping- surgical removal
ligation- tying off the vein
Foam sclerotherapy
Endothermal methods- radio frequency and laser ablation

46
Q

What are the complications of varicose veins?4

A

bleeding- rarely occurs, due to trauma of the veins
Thrombophlebitis
DVT
skin damage

47
Q

Where do the clots causing femoral embolisms usually come from?

A

the heart

48
Q

What are the risk factors for femoral embolism?

A

Age

heart disease

49
Q

What are the signs and symptoms of a femoral embolism?

A 
6Ps
pain 
pulseless
paralysis 
parasaethesia  
Pershingly cold
pallor
50
Q

What investigations should be done for a suspected femoral embolism?

A

Doppler USS

arteriography= contrast fluid + X-ray- shows location and extent of blockage

Examination of heart- to find source of embolus
ECG
echocardiogram
CXR

51
Q

How do you manage a femoral embolism?

A

Surgery within 12 hours
If there is numbness of paralysis do it within 4-6hours
anticoagulants

3rd year (9 decks)

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