Vascular Flashcards by Jess Marchal

What mainly causes peripheral arterial disease? What are some less common causes?

Atherosclerosis causing stenosis of the arteries

Others:

Vasculitis
Trauma
Thromboangiitis obliterans (Buerger’s disease)

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What causes acute limb ischaemia?

Thrombosis usually at the site of stenosis

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What is the chief feature of peripheral arterial disease?

Intermittent claudication exacerbated by walking, relieved by rest

Calf = femoral artery
Buttock = iliac artery

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What are some features of critical limb ischaemia?

Ulceration
Gangrene
Foot pain at rest e.g. burning pain at night relieved by hanging legs over side of bed

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What is Leriche’s syndrome?

Embolus at the aortic bifurcation

Absent femoral pulse
Claudication/wasting of buttock
Pale cold leg
Impotence

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Who is most at risk of thomboangiitis obliterans (Buerger’s disease)?

Young heavy smokers

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What classification is used for peripheral arterial disease?

Fontaine classification

Asymptomatic
Intermittent claudication
Ischaemic rest pain
Ulceration/gangrene

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What are the signs on examination of peripheral arterial disease?

6 Ps
Pallor
Pulseless
Painful
Paralysed
Paraesthesia
Perishingly cold

Buerger’s test - leg goes pale when raised (if less than 20 degree angle, it is severe ischaemia)

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What test is done for peripheral vascular disease? Describe how you would do this

ABPI

Position patient at 45 degrees
Allow patient 20 mins rest before procedure
Record brachial pulse in each arm and take highest
Record dorsalis pedis pulse then record posterior tibial pulse and take highest of the 2
Repeat on other leg

ABPI = Highest of ankle BP / highest of arm BP

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What ABPI ratios indicate what?

1.0 - 1.2 = normal
<0.9 = peripheral arterial disease
<0.5 = critical limb ischaemia

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What can cause falsely high results in ABPI?

Incompressible calcified arteries

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What is the drug treatment for peripheral vascular disease?

1st line - Clopidogrel

2nd line - naftidrofuryl oxalate (peripheral vasodilator)

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What is the surgical management of peripheral arterial disease?

Percutaneous transluminal angioplasty - balloon inflated in narrowed segment
Surgical revascularisation - bypass graft
Amputation - can prevent death from sepsis and gangrene
Embolectomy - if acute limb ischaemia

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Define aneurysm; true aneurysm; false aneurysm

Aneurysm = an artery with a dilatation
>50% of its original diameter

True aneurysm = dilatations that involve all layers of the arterial wall

False/pseudoaneurysm = collection of blood in outer layer only (adventitia) after trauma

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What are the main risk factors for AAA?

Severe atherosclerotic damage to aortic wall
Family history - there is genetic component to the degeneration of elastic lamellae + smooth muscle
Smoking
Hypertension
Connective tissue disorders

(AAAs are less common in diabetics)

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What size of aorta defines an AAA?

Normal diameter = 2cm
AAA = 3cm
Surgery if >5.5cm

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How might an AAA present?

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Unruptured:

Usually asymptomatic
May cause abdominal/back pain

Ruptured:

Sudden onset of tearing epigastric pain in abdomen that radiates to back, groin, iliac fossa, testicles
Shock/collapse

What is the screening programme for AAA?

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All males > 65 years are invited for ultrasound screening

What is the emergency management of an AAA?

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Do ECG
Take bloods - amylase, crossmatch, Hb
Catheterise
Give fluids to treat shock but keep BP<100 systolic
Surgery

What are varicose veins?

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Long, tortuous + dilated veins of the superficial venous system

What is the pathology behind varicose veins?

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Normally, blood from superficial veins pass into deep veins via perforator veins and at the saphenofemoral + saphenopopliteal junctions
Valves prevent blood from passing from deep to superficial veins - if they become incompetent, there is venous hypertension + dilatation of superficial veins

What are the risk factors for developing varicose veins?

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Prolonged standing
Obesity
Pregnancy
Family history
Contraceptive pill

What are some secondary causes of varicose veins?

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Obstruction - DVT, foetus, tumour
AV malformations
Overactive muscle pumps e.g. cyclists
Congenital valve absence

What signs might you see on examination of varicose veins?

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Oedema
Eczema
Ulcers
Atrophie blanche - scar at site of healed ulcer
Lipodermatosclerosis - skin hardness from fibrosis due to chronic inflammation + fat necrosis
Fluid thrills felt at level of valve on tapping

What veins are affected if medial, below knee and calf variscosities?

Medial = long saphenous Below knee = short saphenous Calf = perforators

What test assesses the veins in the leg? Describe how you would do it

Trendelenburg's test - Lift patient's leg as high as comfortable to empty the veins - Whilst their leg is elevated, place torniquet over saphenofemoral junction - Ask patient to stand - Rapid filling of varicosities with torniquet suggests incompetent perforator veins below levels of SFJ

How can you educate a patient about managing their varicose veins?

- Avoid prolonged standing - Elevate legs when possible - Wear compression stockings - Lose weight - Regular walks because calf muscles aid venous return

What endovascular treatments can be done for varicose veins?

Radiofrequency ablation - catheter inserted into vein and heated to 'close' the vein Injection sclerotherapy - foam injected to damage endothelium of veins and occlude them Surgery - stripping of veins

Where are arterial ulcers most common?

- At tips of toes or between toes - Over phalangeal heads - Above lateral malleolus

What does an arterial ulcer look like?

Ulcer - Punched out lesion - Well defined edges - Black/necrotic tissue - No exudate

What does the leg around an arterial ulcer look like?

Leg - Hair loss - Cool, pale - Thin, dry, shiny skin - Thickened toe nails

Describe the pain of an arterial ulcer

Pain - Burning pain - Exacerbated by exercise and lying down - Relieved by rest and hanging foot out of bed

Where are venous ulcers most common?

- Lower 1/3rd of leg - Pre-tibial area - Anterior to medial malleolus

What are the main causes of venous ulcers?

DVT Obesity Calf muscle pump deficits Valvular incompetence in superficial perforating veins

What does a venous ulcer look like?

- Uneven edges - Ruddy granulation tissue - No dead tissue - Exudate

What does the leg around a venous ulcer look like?

- Red/brown pigmentation = haemosiderin - Evidence of past healed ulcers - Venous eczema - Tortuous superficial veins - Warm - Hair is still on legs

Describe the pain of a venous ulcer

- Moderate to no pain at all | - Pain is eased by raising the leg

Where are neuropathic ulcers usually seen?

- On sole of feet | - Under the heel

What usually causes a neuropathic ulcer?

Diabetic with peripheral neuropathy

What does a neuropathic ulcer look like?

- Even margins - Deep - Cellulitis - Not much exudate

What is the rest of the leg like in neuropathic ulcers?

- Diminished sensation in foot | - Warm foot

Vascular Flashcards

(41 cards)