Define acute limb Ischaemia
Sudden decrease in arterial perfusion due to thrombotic or embolic causes
What are the most common sites for atherosclerotic lesions in the upper limb ?
- subclavian artery
- brachioceohalic trunk
Clinical features of upper limb Arterial disease
- pulse less, pale, arm pain, paraesthesia, cold (5Ps)
- unequal arm pressure - more than 15 diff = possible subclavian stenosis
Risk factors for PVD
- smoking
- DM
- hypertension
- hyperlipidaemia
- physical inactivity
- obesity
Define critical limb Ischaemia
- Ischaemic rest pain
- Ischaemic lesions or gangrene
- attributable to arterial occlusive disease
Where is the PVD if buttock claudication is present ?
Iliac disease
Calf claudication suggests PVD where ?
Femoral artery
Who is at risk if buerger’s disease ?
Young heavy smokers
- aka thromboangitis obliterans
What is leriches syndrome ?
Form if peripheral artery disease, involves bifurcation of aorta
- buttock claudication and impotence
First line anti platelet for PVD ?
Clopidogrel
How is intermittent claudication managed ?.
- modify risk factors
- supervised exercise programme
- vasodilator e.g. Naftidrofuryl oxalate (if exercise not helped and do not want surgery)
- revascularisation: angioplasty or bypass /graft (if angioplasty unsuccessful and severely life limiting claudication)
What is the first line imaging technique used when revascularisation is being consider in PVD ?
Duplex ultrasound
When is percutaneous transluminal angioplasty appropriate for treatment of PVD ? What is it ?
- If disease is limited to single arterial segment
- inflate balloon in narrowed segment
- can use stent to maintain patency
When is arterial reconstruction with a bypass graft appropriate to treat PVD ?.
- If atheromatous disease is extensive but distal run off is good (distal arteries filled by collateral vessels)
- autologous vein grafts superior to prosthetic grafts
Emboli causing acute limb Ischaemia often originate from where ?
Heart-AF;mural thrombosis
Pathogenesis of varicose veins ?
- Blood from superficial veins of leg passes into deep veins via perforator veins and at sapheno-femoral and sapheno- popliteal junctions
- valves normally stop blood passing back in to superficial veins
- if valves incompetent, there is venous hypertension then dilatation of superficial veins can occur
Risk factors for varicose veins ?
- prolonged standing
- obesity
- pregnancy
- family history
- the pill
Symptoms if varicose veins
- pains
- cramps
- tingling
- heaviness
- restless legs
*only slightly more common than in normal population
Signs of varicose veins
- oedemal
- eczema
- ulcers
- phlebitis
- atrophie blanc
What is the criteria for referral of patients with varicose veins to vascular service ?
- Bleeding, pain, ulceration,
- superficial vein thrombosis
- lower limb skin changes e.g. Pigmentation, eczema (due to chronic venous insufficiency
what method is used to confirm diagnosis of varicose veins ?
Duplex ultrasound
What are the treatment options for varicose veins ?
- symptomatic I.e. Analgesia, compression stockings etc
- endothermal ablation
- ultrasound guided foam sclerotherapy (if ablation not appropriate )
- surgery (if neither of above suitable)
What is saphena varix ?
- Dilatation in saphenous vein at its confluence with the femoral vein (sapheno-femoral junction)
- transmits cough impulse, may be mistaken for inguinal/fem hernia, but on closer inspection should have bluish tinge
What is a true aneurysm ?
An abnormal artery dilatation >50% of original diameter, involving ALL layers of arterial wall
