Vascular Vivas Flashcards
Peripheral arterial disease
Intermittent claudication
Critical limb ischaemia
Acute limb threatening limb ischaemia
Buttock claudication
Iliac disease
Thigh claudication
Femoral disease
Leriche syndrome
Aorto-iliac occlusion
ED
Absent femoral pulses
Claudication
Critical limb ischaemia
ABPI: 0.3-0.5
Night pain
Rest pain
Non-healing ulcers
Gangrene
Acute limb threatening ischaemia
Complete blockage of peripheral artery with inadequate circulation
Thrombosis most common but embolus also possible
6Ps of acute limb ischaemia
Pale
Pulseless
Painful
Paralysed
Parasthesia
Perishingly cold
How does embolus cause a different presentation of acute limb ischaemia?
No claudication hx
Sudden onset
AF/MI source
Management of thrombotic acute limb ischaemia
local Thrombolysis
Angioplasty
Bypass
If irreversible: Amputation
Management of embolic acute limb ischaemia
Embolectomy via Fogarty catheter
Local thrombolysis
Bypass
If irreversible: Amputation
What should all patients with PAD be taking?
Clopidogrel + Atorvastatin
Parameters of AAA
<3 = normal
3 - 4.4 = small. Rescan every 12m
4.5 - 5.4 = medium. Rescan every 3m
>,5.5 = large. 2w referral to vascular
AAA screening
Men aged 65y
US abdomen
Describe management of large AAA
Elective endovascular repair or open
Stent placed into abdominal aorta via femoral artery to prevent blood collecting in aneurysm
What constitutes high rupture risk for AAA?
Symptomatic
>,5.5cm
Rapidly enlarging (>1cm/ year)
Venous ulcers
Lower 3rd leg, above medial malleolus
Shallow
Irregular borders
Haemosiderin deposition, oedema, varicose veins
Venous ulcer Mx
- Compression stockings
- Skin grafting if not resolved in 12w
What are varicose veins?
Dilated, tortuous, superficial veins that occur secondary to incompetent venous valves, allowing backflow of blood
Reflux in which veins most commonly causes varicose veins?
Great saphenous vein
Small saphenous vein
4 RFs for varicose veins
Age
Female
Pregnancy
Obesity
4 skin changes a/w varicose veins
Varicose eczema (aka venous stasis)
Haemosiderin deposition → hyperpigmentation
Lipodermatosclerosis → hard/ tight skin
Atrophie blanche → hypopigmentation
List 4 complications of varicose veins
Bleeding
Superficial thrombophlebitis
Venous ulceration
DVT
Ix for varicose veins
Venous duplex US: retrograde venous flow
Conservative Mx of varicose veins
Leg elevation
Weight loss
Regular exercise
Graduated compression stockings
5 Reasons for referral to secondary care for varicose veins
Significant/ troublesome lower limb Sx e.g. pain, discomfort or swelling
Previous bleeding from varicose veins
Skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema)
Superficial thrombophlebitis
Active or healed venous leg ulcer
3 interventions for varicose veins
Endothermal ablation: radiofrequency ablation or endovenous laser Tx
Foam sclerotherapy: irritant foam→ inflammatory response → closure of vein
Surgery: Ligation or stripping
Arterial ulcers
Pressure points- lateral foot, tips of toes
PUNCHED out
Well defined borders
Severe PAIN
Dry necrotic base +/- gangrene
6 signs of arterial insufficiency
Cool
Reduced/ absent pulses
Hair loss
Atrophic skin
Prolonger CRT
Low ABPI
Management of arterial ulcers
Smoking cessation
WL
Statins
Reduce BP
Wound care
Angioplasty
Bypass graft
Neuropathic ulcers
Plantar surface of metatarsal head + hallux, heels
PUNCHed out
Well defined
Warm feet
PainLESS
Neuropathic ulcer Mx
Relieve pressure
Optimise glycaemic control
Wound care
