Week 226 Peripheral Vascular Disease Flashcards
Week 226
What are the 6 P’s that indicate Peripheral vascular disease (severe)?
- Pain
- Paraesthesia
- Paralysis
- Pallor
- Perishingly Cold Limb
- Pulselessness
- (Punched out - AKA Arterial - Ulcers)
Week 226
Pain from Claudication in say, the leg, is worsened if you do what to the limb?
Raise it. OUch!
Week 226
What is the name given to this Clinical sign? What does it indicate?
This is levido reticulares (lace like purplish discolouration)
This is a sign of atherosclerotic stenosis and occlusion.
Week 226
Describe the key characteristics of Arterial ulcers.
- Over bony prominences
- Smaller than venous ulcers
- Sharply demarcated border
- Punched out
- Necrotic centre
- Blanched appearance of surrounding skin
Week 226
What are the key characteristics of venous ulcers?
- Over soft tissue or bone
- Most common in gaiter region
- Larger than arterial
- Relatively painless
- Ireegular, poorly defined border
- Superficial appearance
- Granulating centre
- Increased exudate
- Hyperpigmented surrounding skin
Week 226
What is Buerger’s test? What is it used for?
With pt lying on back, perform a straight leg raise
(to a maximum of 45 ̊), and
note the angle at which leg becomes pale
o
After 2 mins, swing legs over edge of bed. A diseased leg will turn a ‘sunset red’ due to
reactive hyperaemia.
This is a sign of atherosclerotic occlusion and stenosis.
Week 226
What is the ABPI? Why is it useful in peripheral vascular disease diagnosis?
- Ankle Brachial Pressure Index
- Ratio of: Highest of Dorsalis pedis/Post. Tibial BP: Highest of Brachial BP
- Calculated for EACH leg.
- Health = 0.9-1.1
- In arterial ulceration it’s less than 0.5
Week 226
In a healthy person, what do doppler pulse studies of the leg show?
- A triphasic waveform.
- FWD flow in systole, rebound and reverse in early diastole, and forward in late diastole
Week 226
In a patient with peripheral vascular disease, what do you expect to see on a Doppler Pulse study?
Monophasic waveform.
Week 226
What are the treatment options for peripheral vascular disease?
- Surgical restorartion (balloon, stenting, bypass graft)
- Keep dry and clean
- Analgesia
- Antiplatelets and statins
Week 226
What is the primary cause of venous hypertension?
Valvular incompetence
Week 226
What causes venous Eczema?
Inflamation and fibrosis of skin due to chronic venous oedemam which causes haemosiderin deposition.
Week 226
What is Lipodermatosclerosis?
This is a symptom of venous hypertension. Brown, smooth, tightened skin. Caused by scarring of skin and underlying fat. Results in inverse champagne bottle shape.
Week 226
When is the venous refill test used? What is it?
Pt asked to use calf muscle pump to empty superfic veins. Pt then stood still to allow refill.
Venous refill time should be >120secs in healthy pts
Symptomatic pts will have VRT <40s.
Ulceration likely in pts with VRT <10
Week 226
What is the Trendelenburg test?
Used to determine which incompetent valves are responsible for varicose veins. Elevate leg and compress SFJ. Slow filling suggests problem at SFJ, fast filling suggests incompetent perforators.
