Vascular examination Flashcards
Acute vascular problems
Aneurysm
Dissection
Thromboembolism
Chronic vascular problems
Varicose veins
Limb claudication
Arterial problems signs
Deep white/light pink ulcer near heel
Venous problems signs
Haemosiderin deposition
Dry shiny leg
Varicose veins
Ulcer near medial maleolus where blood pools
What can acute vascular conditions lead to?
Limb ischemia
6 Ps of limb ischemia
Pain Pallor Parasthesia Paralysis Pulseless Perishingly cold
Outline the steps that lead to critical limb ischemia
Normally -> exercise -> proendothelial GF -> collaterals -> increased perfusion
During ischemia, e.g. due to atheroclerosis -> insufficient blood supply, pain so people stop exercising, no more collaterals -> worsening blood supply -> ischemia -> pain on rest
Hallmark feature of limb ischemia - explain why
Patients hang their leg over the side of the bed to help gravity pull more blood to their legs
What is a consequence of this leg over bed coping mechanism?
Deep heel ulcer (poor perfusion)
Osteomyelitis (because bone is so close to the wound)
Hallmark features of venous ulcers vs arterial
VENOUS
Shallow
Red granulation tissue
Irregular
ARTERIAL
Deep
Regular border
Pink/white
What can a venous ulcer become?
Marjolin’s ulcer (cell division attempting to heal the ulcer results in squamous cell cancer)
Where do the great and small saphenous veins drain?
Small saphenous vein drains into popliteal, which then drains into femoral vein along with great saph.
Both then drain into external iliac before inferior vena cava
Where does the femoral vein pass through and what does it become?
Adductor hiatus
Popliteal artery
Divisions of the popliteal artery
Anterior tibial artery
Posterior tibial artery
Peroneal artery
What does the anterior tibial artery become? Where is the pulse felt?
Dorsal pedalis
Which two artery pulses do you feel in the foot and where are they felt?
Dorsal pedalis -> between 1-2 metatarsals
Posterior tibial artery - behind medial maleolus
Buttock claudication + erectile dysfunction + diminished femoral pulses - what’s the syndrome and the cause?
Leriche’s syndrome - plaques in iliac arteries
What is Beurger’s disease? Key features
Blockage of limb vessels in young smokers
What is the syndrome where lifting your arm causes syncope? Explain
Subclavian steal syndrome - narrowing of subclavian, arm exertion narrows it further, esp if you have a cervical rib, therefore body tries to overcome this by diverting blood away from brain to a collateral after the narrowing, causing syncope !
Beurger’s disease - key features
Corkscrew collaterals seen on angiography
Raynauld’s treatment
CCB e.g. nifedipine to prevent vasoconstriction
Thrombolysis treatment
Tissue plasminogen activator
Oedema + pain upon passive movement e.g. dorsiflexion
Compartment syndrome - fascia can’t stretch so movement causes pain and pressing down ?
Type of ulcer in diabetes
Neuropathic on heel of foot
When would you do embolectomy over thrombolysis?
If there is a contraindication, e.g. someone has had a stroke
