Vascular Disease Flashcards
Breakdown of peripheral vascular disease?
Acute -> Acute limb ischaemia
Chronic -> intermittent claudication or critical limb ischaemia
Claudication is pain on exertion, ischaemi = pain on rest
Pathophysiology of PVD?
Athersclerosis -> stenosis
Acute limb ischaemia = sudden decrease in limb perfusion
Intermittent claudication = cramping pain in calf, thigh buttock after walking for a certain distance
RFs for PVD?
Smoking, diabtese, HTN, male, >40, hyperlipidaemia
Presentation of Acute limb ischaemia?
6Ps
Pain, pale, pulseless, paralysis, paraethesia, perishingly cold
Presentation of other PVD?
Chronic = asymptomatic but hair loss, numbness, brittle, slow growing toenails, ulcers, absent pulse and atrophic skin
What is the sign of PVD?
Beurgers Test: Patient flat on bed and legt lift to 45degrees. Limb deceloping pallor indicates arterial insuffieciency. <20 degrees Beurgers indicates severe limb ischaemia.
Patient then swings legs over bed and active hyperaemia seen
Ix for PVD?
Full cardiovascular risk assessment = BP, bloods, HR, ECG
Ankle-brachial pressure index (ABPI) is gold standard.
Normal = 0.9-1.2
<0.9 abnormal, <0.5 = critical limb ischaemia
Colour duplex USS or magnetic resonance angiogram
What is Lerihe syndrome?
Aortoiliac occlusive disease
Sx: buttock claudication, impotence and absent/weak distal pulses.
1st line is CT angiogram but also use MRA
What are the distal pulses?
Femoral, popliteal, posterior tibial and dorsalis pedis
What are neuropathic ulcers associated with?
DM
What is the appearance of arterial ulcers?
PUNCHED OUT, deeper than venous Distal (dorsum of foot and between toes) Well defined edegs Pale base (gray granulation tissue)
Signs of arterial ulcers?
Hair loss, shiny and pale skin
Calf muscle wasting
Absent pulses
Nigh pain (worse supine and relieved hanging off bed)
Venous ulcers appearance?
Large and shallow with sloping, less well defined edges
More proximal than arterial ulcers (gaiter region)
Other symptoms of venous insufficiency e.g. swelling, itching and aching
Signs of venous ulcers?
Stasis eczema (retrograde blood flow = inflammatory process with metalloproteinases)
lipodermatosclerosis (panniculitis and pain, skin hardening, redness, swelling and tapering to ankle) Atrophie blanche (white shing skin with surrounding capillaries and occasionally hyperpigmentation_ Hemosiderin deposition (darker pigmentation)
Ix for arterial ulcers?
Gold = Duplex USS of lower limbs
ABPI
prcuatenous angiography
Bloods (fasting serum lipids, HbA1C, BM glucose, FBC)
Ix for venous ulcers?
DUplex USS of lower limbs, Measure surface area of ulcer (progression)
Swab for infection
Biopsy = if Marjolin ulcer possibility
WHat is a marjolins ulcers?
SqCC from areas of chronic inflammation or injury
Mx of venous ulcers?
Graded compression stockings
Debridement and cleaning
Abx if infected
Moisurising cream
What is an AAA?
Localised enlargement of the abdominal aorta where the diameter is >3cm or >50% larger than normal diameter
Types of aneurysms?
Saccular and fusiform are true
False involves a tear in one layer
Rfs for AAA?
Smoking, male, connective tissue disorder, old age, HTN, inflammatory disorders
Unruptured AAA symptoms?
Usually asymptomati, often incidental finding and may have pain in back, adbo or groin
Ruptured AAA signs?
Sudden severe pain in back, abdo groin
Syncope
Shock
Signs of any AAA?
Pulsatile and lateraly expansile mass on palpation
Abdo bruit
Grey turners sign (ruptured)
Cullens
AAA Ix?
Bloods = FBC, clotting, U&Es, LFTS and cross match
Abdo USS (gold standard for if aneurysm or not)
CT angiogram (gold for ruptured or not)
MRA (not if patient has contrast allergy or renal impairment)
What is aortic dissection?
Condition where tear in aortic intima allows blood to flow into a new false channel between the inner and outer layers of the tunica media
Classifications of aortic aneurysms?
Standford = A and B Debakey = Type 1 -> 3b A = 1 and 2 1= both ascending and descending aorta 2 = ascending only
b = 3 and 3b 3 = descenfing aorta above diaphragm 3b = above and below diaphragm
Rfs for Aortic dissection?
smoking, male, connective disorder, HTN, congenital abnormality e.g. coarctation, crack cocaine
Symptoms of Aortic dissection?
Sudden central tearing pain, can radiate to back.
Symptoms caused by blockage of aorta: Carotid -> blackout, dysphasia Cornoary -> angina Sunclavian - > LOC Renal artery -> anuria, renal failure
Signs of Aortic dissection?
HTN, BP difference in arms, murmur on back, signs of aortic regurgitation (high volume collapsing pulse, early diastolic murmur), signs of connective tissue disease
Ix for aortic dissection?
1) Bloods (FBC, X match, U&E, LFTs, cardiac enzymes)
2) ECG
3) chest Xray (widened mediastinum, loss of contour of aortic knuckle, globular heart)
4) CT Angiogram (gold standard and ordered 1st with suspected
What do you see on CT Angiogram?
False lumen
What are varicose veins?
Subcut, permanenyl dilated veins >3mm in diameter when easured in a standing position (most often superificial of the lower limbs)
Primary causes of VV?
Idiopathic valvular incompetence
Secondary cases of VV?
AV malformations, DVT and venous outflow obstructions
Venous outflow obstructions = pregnancy, ascites, ovarian cysts, peliv malignancy
Symptoms of VV?
Vidible dilation of veins, leg aching with prolonged standing, swelling and itching and bleeding
Signs of VV?
Veins feel tender or hard
Tap test = Tap VV distally and feel thrill ocer sapheno-femoral junction
Auscultation for bruits
Trendelenburg test
What is trendelenburg test?
Patient supine with leg liften and veins emptied. Tourniquet above knee and standing, veins shuld refillin 30-35 seconds. Rapid filling indicated Deep vein valvular filling. Occlusion removed = superficial valvular problem
Doppler to show saphenofemoral incompetence
Ix for VV?
Duplex USS (also to exclude DVT)
Mx for VV?
Conservative = Compression stockings and lifestyle changes e.g. weight loss, exercise and leg elevation
Endovascular treatment = radiofrequency ablation, endovenous laser ablation, microinjection sclerotherapy
Sruegry = stripping of long saphenous vein, saphenofemoral ligation, avulsion of varicosities
Complication of VV?
Venous ulcer, stasis eczema, lipodermatosclerosis, hemosiderin deposition
Sclerotherapy = skin stainining and local scarring
Surgery = haemorrhage, infection, recurrence, paraesthesia, peroneal nerve injury
