vascular problems Flashcards
causes of vasculitis
infections
drugs
autoimmune disorders malignancy
large vessel vasculitis
temporal arteritis
Takayasu’s arteritis
medium vessel vasculitis
polyarteritis nodosa
Kawasaki disease
small vessel vasculitis
ANCA-associated vasculitides
granulomatosis with polyangiitis (Wegener’s granulomatosis)
eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
microscopic polyangiitis
immune complex small-vessel vasculitis
Henoch-Schonlein purpura
Goodpasture’s syndrome (anti-glomerular basement membrane disease)
cryoglobulinaemic vasculitis
hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)
history of venous ulcer
- Often painful, worse on standing
- History of venous disease e.g. varicose
veins, deep vein thrombosis
common sites of venous ulcer
Malleolar area (more common over medial than lateral malleolus)
lesion of venous ulcer
- Large, shallow irregular ulcer
- Exudative and granulating base
features of venous ulcer
- Warm skin
- Normal peripheral pulses
- Leg oedema
- haemosiderin and melanin
deposition (brown pigment) - lipodermatosclerosis
- atrophie
blanche (white scarring with dilated
capillaries) - venous eczema
- thinning of skin
- loss of hair
Ix for venous ulcer
- Normal ankle/brachial pressure index
(i. e. ABPI 0.8-1)
Mx for venous ulcer
non-adherent dressings
potent topical steroid to surrounding eczematous skin
ABPI normal then compression bandaging
after excluding arterial insuffuciency
RFs
history of arterial ulcer
common sites
RFs
- claudicants
- smokers
- antihypertensives
- Painful especially at night, worse when legs are elevated
- History of arterial disease e.g. atherosclerosis
Pressure and trauma sites e.g. pretibial,
supramalleolar (usually lateral), and at
distal points e.g. toes
lesion of arterial ulcer
Small, sharply defined deep ulcer
- Necrotic base
ass features of arterial ulcer
Cold skin
- Weak or absent peripheral pulses
- Shiny pale skin
- Loss of hair
Ix for arterial ulcer
Mx
- ABPI < 0.8 - presence of arterial insufficiency
- Doppler studies and angiography
- Vascular reconstruction
- Compression bandaging is contraindicated
RFs
history of neuropathic ulcer
common sites
diabetes, leprosy
Often painless
- Abnormal sensation
- History of diabetes or neurological disease
Pressure sites e.g. soles, heel, toes,
metatarsal heads
lesion for neuropathic ulcer
Variable size and depth
- Granulating base
- May be surrounded by or underneath a
hyperkeratotic lesion (e.g. callus)
ass features of neuropathic ulcer
- Warm skin
- Normal peripheral pulses*
*cold, weak or absent pulses if it is a
neuroischaemic ulcer - Peripheral neuropathy
Ix for neuropathic ulcer
- ABPI < 0.8 implies a neuroischaemic ulcer
- X-ray to exclude osteomyelitis
Mx for neuropathic ulcer
Wound debridement
- Regular repositioning, appropriate
footwear and good nutrition
Qs to ask in a suspected ulcer
varicose veins or previous DVT
diabetic - neuropathic or arterial
smoke, cholestrol, IHD, cerebrovascular
other Ix you may request for an ulcer
skin biopsy - concerned about the development of neoplastic lesions or pyoderma gangrenosum
urinalysis fasting glucose to exclude diabetes
FBC for anaemia of chronic disease or chronic blood loss
swab to culture
autoimmune and vasculitic screen - suspecting inflammatory cause
prognosis of venous ulcer
heal slowly in elderly ppl
can be delayed by secondary infection
how to prevent further recurrence of ulcers
wearing compression hoisery regularly
keeping legs elevated when seated
avoid trauma to the skin
