vascular disease

Question 1

Pathophysiology - causes of vascular disease

Answer 1

• Atherosclerosis - almost always this
• Inflammatory arterial disease
• Vasospastic
• Compression
• Traumatic
• Pro-thrombotic conditions

Question 2

different areas mainly affected

Answer 2

lower limbs
brain
visceral - renal
aneurysms

Question 3

Risk Factors modifiable

Answer 3

Smoking
Hypertension
Diabetes
Hypercholesterolaemia

Question 4

Risk Factors - Non modifiable

Answer 4

Age
men

Question 5

symptoms in acute vs chronic LL vascular disease

Answer 5

Acute Ischaemia:
- 6Ps
Pulselessness
Pallor
Pain
Perishingly cold
Paralysis
Paresthesia
- Acute-embolus (AF, MI)
- Acute on chronic-thrombus

Chronic Ischaemia:
- Intermittent clocication - no pain at rest but during exercise
- foot pain at rest
- Tissue loss - necrosis / gangrene
- Burgers test

Question 6

buergers test

Answer 6

• patient lies in the supine position
• elevate legs to 45 degree angle upwards
• in 1-2 minutes the patients feet should go pallor (pale) indicating blood loss
• then get the patient to sit over the bed and see how long it takes for the feet to return to their original colour / red
• longer than 10-15s suggests ischemia

Question 7

types of aneurysms

Answer 7

True
- Weakening of the arterial wall leading to dilatation
Commonest location is the infra-renal aorta

False / pseudo

Mycotic

Question 8

Investigations

Answer 8

• history of risk factors
• duplex ultrasound and cross sectional imagine - identify blockage
• Bloods – Lipids,
  Glucose,
  Renal function,
  Vasculitic screen,
  Clotting, FBC
  ABPI

Question 9

ABPI

Answer 9

• measure systolic BP in ankles and arm
• divide the ankle result / brachial result and this is the ABPI

results:
> 1.3: Non-compressible arteries (e.g., due to calcification in diabetes).
0.9–1.3: Normal.
0.6–0.89: Mild to moderate PAD.
< 0.4: Severe PAD or critical limb ischemia.

Question 10

Treatment

Answer 10

Risk factor modification
Antiplatelets
Statin
Stop smoking
Good control of BP
Good control of DM
ACE inhibitors?

Exercise programme

Question 11

Invasive treatment –Lower Limbs

Answer 11

endovascular (through the artery:
- Stenoses
- Short occlusions
- DEB - balloon coated with cytostatic drug - transferred to the arterial wall, inhibiting smooth muscle proliferation, which causes restenosis.
- DES - stent coated with anti-proliferative drug - inhibit endothelial cell proliferation, reducing scar tissue

Bypass surgery (around the artery)
Better patency and limb salvage rates
Higher morbidity and mortality
bigger procedure - more risks

Question 12

abdominal aortic treatment

Answer 12

Endovascular
Morphology
Lower morbidity and mortality
Life long surveillance

Open surgery
Higher initial morbidity and mortality
Lower long term morbidity and mortality

Question 13

Carotid Disease procedure

Answer 13

Carotid Endarterectomy:
- incision in neck to open the artery and take the plaque out
Endovascular stenting:
- catheter in femoral artery to place stent in artery