Vascular lecture Bicknell Flashcards
General Vasc inspection
Smoking Inhalers Diabetic med Walking stick body habitus
Examine the hands quickly
- stained
- fistula
Supra-Aortic Pulses
Radial
- rate
- rhythm
- radio/radio
Brachial
BP
Subclavian
Carotid
- listen for bruits
Top half statement
The patient appears comfortable at rest, no peripheral stigmata of chronic disease. His fingers are….
He is not tachycardic with a regular rhythm, no radio radial delay
You have indicated his BP is (normatensive)
There is a full complement of supra-aortic pulses, with no bruits
I would also like to complte with examination by examining the pre-cordium
Abdo examine
nipple to knee exposure
Scars around the sides
Palpate for aneurysm
listen for bruits centrally and over renal vessels
Lower limbs
Inspect - feel the temperature in lower legs only
Femorals - feel together then for radiofemoral delay (coarctation)
Popliteal - if feel it may be aneurysm - do pulsatile and expansile
Pedal arteries
Listen for bruits - iliacs, CFA, adductor hiatus
Arterial Anomalies - Dominant Peroneal artery
5% of pop.
absent doralis pedis but there is one lateral to malleolus and supplied by peroneal vessel
Buergers Angle
angle of the test
lie flat and lift 45 degrees. When it goes white is the Buergers angle
Buergers Test
From buergers angle swing leg round onto the floor.
Goes brick red.
Why brick red i nBuergers Test
Ischaemia makes Co2 and lactic acid so get reactive vasodilatation
What does buergers test signifyt?
Significant lower limb arterial disease
ABPI
Screening test for peripheral artery disease
Significance of ABPI in DM or renal disease
may have incompreesible calcified vessels
ABPI values
- 8 - 1 normal
- 6 - 08 claudication
below 0.6 may be critical ischamia
Claudicants and ABPI
May have any value but drops with exercise
How to present lower limbs
On exam there was no signs of scars or ulceration
no difference in temperature
pt had bilateral and equal fem pulses and no radio femoral delay
there were palpable popliteal pulses
No bruits on auscultation
Buergers tes was negative
I would like ABPIS on both sides
Midline laprotomy
Aorta
Midline and up to shoulder
Thoracolaporotomy
Rooftop incision
aorta and abdomen
left flank
Iliac artery or renal tranplant
Vertical groin incision
Common femoral artery
if blockage go around it two ways
anatomically or extra antomically
if unfit pt
axillo bifemoral bipass
Long saphernous vein
infront of medial malleolus
to behind the pubic tubercle
used in CABG or arterial graft in leg (fem pop)
vein left in situ (get pulse) or taken out and put somewhere else
Claudication History
No pain at rest
cramping pain on certain distance - repeatable
Stop and gets better
ICE them
Where is the stenosis
There will be symptoms, stenosis above the pain
in claudication further test
Exercise treadmill ABPI (drops)
Duplex - two way doppler and US
Angiography
What can claudication be confused with
nerve entrapment disc prolapse
spinal stenosis
look for sensory disturbances. Walking down stairs may be worse than up due to angle of back.
trauma
MSK
If claudication
TREAT RF for CVS
Critical ischamia
foot will die and drop off
-constant pain in distal worse on leg up
- rest pain or tissue loss
- ABPI less than 4mmHg
- greater than two weeks
Acute ischamia
6 Ps
What are 6Ps
Painful
Pulselss
Perishingly Cold
Pale
para;lysis
Paraesthesia
Casues of ischamia
Embolic (all 6Ps) from AF or valvular disease
Treat embolus
Catheter
and
heparin after
then
- Fasciotomy to avoid compartment syndrome
- Reperfusion injury - K can cause Arrest
Acute on chronic
acute with background claudication
thrombotic occlusion from atherosclerosis
4/6 P
Why? Over time collaterals have formed
Presentation of Aneurysm?
incidentally in urology
Screening programme
Rupture
Compression - popliteal on vein causing DVT
back pain
ischaemia - embolies or thrombose
screening
65 year old men invited once
if <3cm d/c
3-5.5 monitored
5.5 have operaiton
patchy trashing
painful due to ischaemia
varicose Veins
Abnormal dilated tortuase superficial vein
Primary VV
90% failure of valves and vein dilate or other way round
Complications of VV
Swelling/Oedema Thrombophlebitis haemosiderin deposition Bleeding varicose eczema Venous Ulcer
Treat VV
Glue
Avulsion or inject foam
test on VV
Tap test
trendelernbourg test
Test in VV
Duplex scan
thoracic outlet syndrome
upper limb CVT and long term swelling
Arterial - Raynoouds
Claudication, embolisation
Neuro - pain and radiculopathy
Thoracic outlet syndrome
inv
MRI, MRA, MRV
Duplex in abduction
Nerve conduction studies
why do diabetics get ulvers?
Neuro
Vascular - atherosclerosis
infection
Charcot joint
painless but huegly deformed join
Due to DM and lack of proprioception
Can get ulcer
Raynoud
White, Blue, Red
Raynod syndrome causes
Ergotamine - vasoconstrictor
CREST - autoimmune and
Thoracic outlet syndrome
Occupational - vibrational white finger
Factor V leiden
Idiopathic
Treat Raynouds
Society Website and then any causes treat.
AVM
Spectrum of disease
blue, often raised. Not pulsatile.
can cause functional and neurological problems.
think about cardiac failure
happen in gestation -
Lymphodoema
Blocked lymphatic
Causes
- Primary - itrogenic
Secondary
- Filariasis
- Iatrogenic
- Cancer
- ID
carotid artery surgery
50% stenosis
Symptoms
Asymtpomtoci with more than 50%
Common lesions
- vagus nerve hoarse voice
- hypoglossal
- glossopharyngeal nerve for swalling
- numbness of ear for auriclear nerve
