Vascular disease Flashcards
Risk factors for peripheral vascular disease
Hx of CVD/cerebrovascular Smoking Diabetes HTN Hyperlipidaemia Physical inactivity Age >40yo Male *essentially anything that contributes to atherosclerosis
Compare the types of chronic PVD
Intermittent claudication
- pain on exertion (stable angina)
- relieved by rest, cramping pain in calf (femoral disease), thigh/buttock (iliac disease) after walking a certain distance
Critical limb ischaemia
- pain on rest (unstable angina)
- rest pain, night pain, relieved by hanging legs over bed, ulcers, gangrene
Mx of acute limb ischaemia
Surgical emergency: 4-6 hrs to save limb
MI of legs
What staging is used for PVD?
Fontaine Staging I - asymptomatic IIa - mid claudication IIb - moderate to severe claudication III - ischaemia rest pain IV - ulceration or gangrene
Signs and sx of PVD
Absent femoral, popliteal, foot pulses Cold white legs Atrophic skin Colour change when raising legs - Buerger's test: pallor when leg held at angle (Buerger's angle) then reactive hyperaemic when leg moved to dangle over bed
Leriche syndrome triad
Aortoiliac occlusive disease
- buttock claudication
- impotence
- absent/weak distal pulses
6 Ps of acute limb ischaemia
Pain* Pale Pulseless Poikilothermia Paralysis Paraesthesia* *earlier signs
Ix for PVD
Full cardiovascular risk assessment
- BP
- bloods: FBC, fasting glucose, lipids
- ECG
- ABPI
- colour duplex USS (show site + degree of stenosis)
- MRA/CT
What are the ranges for an ABPI reading?
0.9-1.2 = normal
<0.9 = abnormal
<0.5 = indicates chronic limb ischaemia
*beware reading less accurate in diabetic pts
What are the three types of ulcers and why do they occur?
Ulcers: loss of continuity of epithelium/endothelium
1) Arterial = inadequate arterial blood supply due to atherosclerosis leading to severe narrowing and reduced capillary blood flow
2) Venous = incompetent valves/venous outflow obstruction leads to venous stasis and venous HTN
3) Neuropathic = peripheral neuropathy leads to continuous microtraumas, allowing breakdown of tissues
Compare RFs of arterial and venous ulcers
Arterial (10-30% lower extremity ulcers)
- age, FHx, smoking, obesity + immobility, CHD/PVD, hyperlipidaemia, diabetes
Venous (67% lower extremity ulcers)
- age, FHx, smoking, obesity + immobility, recurrent DVT, orthostatic occupation, varicose veins, female
Signs and sx of arterial ulcers
Punched out appearance (deeper than venous)
Often distal; dorsum of foot, in between toes
Well-defined edges
Pale base (grey cannulation tissue)
Night pain
Hair loss, shiny skin, pale skin, absent pulses, calf muscle wasting
Signs and sx of venous ulcers
Large and shallow, less defined than arterial, sloping sides
More proximal; medial gaiter region
Painless
Venous insufficiency; itching, aching
Stasis eczema
Lipodermatosclerosis (inverted champagne bottle sign)
Atrophic blanche (white, atrophic skin surrounded by small capillaries)
Haemosiderin deposition (due to blood stasis)
Ix for arterial ulcers
Duplex USS lower limbs ABPI Percutaenous angiography ECG Bloods; fasting serum lipids, HbA1c, glucose, FBC
Ix for venous ulcers
Duplex USS lower limbs
Measure surface area of ulcer (monitor progression)
ABPI
Swab for microbiology (if signs of infection)
Biopsy (potential for Marjolin’s ulcer; SqCC in area of chronic inflammation/injury)
Mx of venous ulcers
Graded compression stockings - reduce venous stasis Debridement and cleaning Antibiotics if infected Moisturising cream for eczema/dry skin
*Good prognosis if pts mobile + compliant
What is an AAA?
Aortic abdominal aneurysm
- enlargement of abdominal aorta where diameter is >3cm or 50% larger than normal diameter
- true: all 3 layers, false: tear in 1 layer
What are the RFs for an AAA?
Smoking Age FHx Connective tissue disorders (Marfan's, Ehlers-Danos) Males Hypertension Hyperlipidaemia Inflammatory disorders (Behcet's, Takayasu's arteritis)
Compare sx of an unruptured and ruptured AAA
Unruptured
- no sx
- usually incidental finding
- potential back, abdo, loin or groin pain
Ruptured
- sharp/severe pain in back, abdo, loin or groin
- shock; hypotension, increased HR
Signs of an AAA
Pulsatile and laterally EXPANSILE abdominal mass on palpation***
Abdo bruit
Grey-Turner’s sign (more commonly caused by pancreatitis)