Vascular disease workshop Flashcards
1
Q
Peripheral Vascular Disease
A
- Blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm.
- This can happen in your arteries or veins. PVD typically causes pain and fatigue, often in your legs, and especially during exercise.
2
Q
What are some venous diseases?
A
- Incompetent (varicose) veins
- Occluded veins
- Bleeding, ulceration, pain, swelling
3
Q
Atherothrombosis affects on vascular beds
A
- Ischaemic stroke
- Transient ischaemic attack
- Myocardial infarction
-
Angina:
- Stable
- Unstable
-
Peripheral arterial disease:
- Intermittent claudication
- Rest pain
- Gangrene
- Necrosis
- Renovascular disease
4
Q
Acute vs chronic lower limb ischaemia
A
- Acute → no previous history
- Acute on chronic → suddenly worse
- Chronic → longstanding problem
- Claudication
- Critical ischaemia
5
Q
Explain acute ischaemia
A
- Classically embolic
- Thrombotic (pre-existing disease)
- Trauma
- Dissection of vessel
Treatment
- Needs urgent assessment and referral to a vascular centre
- Revascularise within 6 hours of symptoms
- ….otherwise amputation or death and litigation!!
6
Q
History of ischaemia (peripheral)
A
“6 Ps”
- Pain
- Pulseless
- Pallor
- Paraesthesia
- Poikilothermia (Perishing cold)
- Paralysis
7
Q
Treatment of acute ischaemia
A
- Embolus -embolectomy
- Thrombus -Thrombolysis, angioplasty, bypass surgery
- Dissection -Surgical correction
8
Q
Explain chronic limb ischaemia
A
- Intermittent Claudication
- Chronic critical ischaemia
- Rest pain
- Tissue necrosis
- >2 weeks duration
9
Q
Explain atherosclerosis
A
- Fatty streaks from macrophages
- fibrous plaque
- Atherosclerotic plaque
10
Q
Rarer causes of atherosclerosis
A
- Buerger’s disease (and other arteritides)
- Popliteal aneurysm
- Popliteal entrapment
- Cystic adventitial disease
- Trauma
- Aortic dissection
11
Q
Risk factors of atherosclerosis
A
- Smoking
- Diabetes
- Hypertension
- Hypercholesterolaemia
- Age
12
Q
What is intermittent claudication
A
- Pain produced by the abnormal accumulation of metabolic products within the muscle.
- Resting blood flow to the affected limb is NORMAL
13
Q
History and examination Intermittent claudication
A
-
History
- Onset of pain
- Location
- Character
- Duration
- Claudication distance (gradient)
- Rest pain
-
Examination
- Inspection (pale, pink, black, nicotine stains)
- Palpation (cold, warm)
- Pulses
- Blood pressure both arms
- ABPI
14
Q
Explain ABPI measurement
A
- Requires compliant vessels
- Not useful in calcified arteries
- May be unreliable in obesity
- Difficult in ulcerated legs
- Upper limb ischaemia may confuse result
- Normal range 0.9-1.2
- Lower level suggests ischaemia
- Higher level if vessel incompressible
15
Q
Management of intermittent claudication
A
- Correct risk factors
- Modify ‘at risk’ behaviour
- Encourage patients to ‘keep walking and stop smoking’
- Structured exercise programmes
- Angioplasty
- Bypass surgery
More info…
- Intermittent Claudication does not kill. Myocardial ischaemia DOES!!
- Only 1-2% of claudicants will lose the limb
- Intervention does NOT improve limb salvage in claudicants
- Claudication does NOT always require treatment!
16
Q
Critical limb ischaemia signs and symptoms
A
- The Limb is at risk:
- Tissue necrosis/Gangrene
- Rest Pain
- Reduced ankle pressure / toe pressure
17
Q
Explain rest pain in critical limb ischaemia
A
- Affects DISTAL extremity
- Made worse by elevation
- Classically patient hangs foot out of bed or sleeps in a chair
- Occurs over days/weeks
18
Q
What is this?
A
- Venous ulcer (neuropathic ulcer)
- Most likely diabetic no sensation
- Flat foot
19
Q
What is this?
A
- Wet gangrene
- Smells
- Amputate → as increase risk of infection
20
Q
What is this?
A
- Dry gangrene
- Do not amputate, let fall off
- If leave it then less tissue will be removed
21
Q
Risk factors of chronic limb ischaemia
A
- Diabetes
- High cholesterol
- Smoking
- Overweight
- High BP
- FH of atherosclerosis
22
Q
Management of chronic limb ischaemia
A
- Analgesia / Medical Therapy
-
Angioplasty
- balloon-tipped catheter to open a blocked blood vessel and improve blood flow
- Reconstructive surgery
23
Q
What is an aneurysm?
A
- An abnormal dilatation of an artery or a vein
- A vessel is classified as aneurysmal if its diameter exceeds its expected diameter by more than 50%
24
Q
Common sites of aneurysms
A
- Infrarenal aorta
- Popliteal artery
- Iliac artery
- Femoral artery
- Splenic
- Hepatic
- Circle of Willis
25
Aetiology of aneurysm
* There is increased elastase and collagenase activity in the walls of aneurysms.
* There is a loss of elastic lamellae with a compensatory increase in the collagenous content of the adventitia.
* Similar histological changes have been seen in the non-aneurysmal proximal aorta
* Association with connective tissue disorders:
* Marfan's syndrome
26
Presentation of aneurysms
* Asymptomatic until they leak
* Pulsation can be notes
* Pain, malaise, wt. loss (Inflammatory)
* Back pain *\*Sinister\**
* Hypotension, collapse
27
Differential diagnosis of aneurysms
* Myocardial ischaemia
* Perforated ulcer
* Acute cholecystitis
* Acute pancreatitis
* Ureteric colic
* Acute diverticulitis
28
History of aneurysm
* Variable
* Usually expand \<10% per annum (2-5mm p.a.)
* BUT some show periods of rapid expansion
* Roughly 2-3% people over age of 65 with it men
29
Investigation of aneurysm
* **Aneurysm morphology**
* **Ultrasound**
* **CT**
* **MRI**
* **Catheter angiography**
30
Treatment of aneurysm
* Open repair
* Midline or transverse incision
* Laparotomy
* Cross-clamping aorta
* ~5% elective mortality (mainly cardiac)
* Endovascular repair
31
What is this?
Endoleak → can happen after a graft goes in thus, aneurysm grows around it
32
What is this?
Limb occlusion
33
Other types of aneurysms
* **Iliac - behave much as aortic**
* **Femoral – usually easily palpable**
* **Popliteal – Present with thrombosis or limb occlusion**
* **Mesenteric, splenic. Rare**
* **Calcified splenic AAA incidental on CT**
