Vascular

Question 1

PVD: How common is it?

Answer 1

20% of 60+y/o
Acute limb ischaemia - 1 in 12,000 per year
Chronic limb ischaemia is more common

Question 2

PVD: Who does it affect?

Answer 2

Greater prevalence in those with CV disease & risk factors such as diabetes, smoking & dyslipidaemia

Question 3

PVD: Causes

Answer 3

Atherosclerosis -> narrowed arteries, limiting blood flow
Critical LI - obstructive atherosclerotic arterial disease USUALLY, but rarely = vasculitis, trauma, popliteal entrapment

Question 4

PVD: Risk factors

Answer 4

SMOKING
Diabetes mellitus
Hypertension
Dyslipidaemia

Question 5

PVD: Presentation

Answer 5

Acute
- Onset of leg pain - mins/hrs/days
- 6 P’s - Pulseless, pallor, painful, paraethesia, paralysis, perishingly cold
Chronic
- Progressive cramp-like pain in calf on walking or foot pain at rest (worse at night)
- Non-healing wounds on lower limb
- Absent/faint peripheral pulses

Question 6

PVD: Investigations

Answer 6

• BP
• FBC - anaemia will aggravate PAD
• ESR - inflammatory process - eg giant cell arteritis
• Thrombophilia screen
• Fasting blood glucose
• Lipid levels
• ECG

Question 7

PVD: Treatment

Answer 7

Lifestyle: Smoking cessation, regular exercise, weight reduction, manage diabetes
Pharmacological: ACEi, Statins, antiplatelet drugs, peripheral vasodilators (Naftidrofuryl oxalate)
Surgical: Angioplasty or bypass

Question 8

Conditions that present similarly to PVD

Answer 8

• Sciatica
• Spinal stenosis
• DVT
• Entrapment syndromes & muscle/tendon injury
• Diabetic neuropathy

Question 9

AAA: How common is it?

Answer 9

4% M, 1% F over 65yrs

Question 10

AAA: Who does it affect?

Answer 10

Elderly men

Question 11

AAA: Causes

Answer 11

• Degenerative process

- Genetic component

Question 12

AAA: Risk factors

Answer 12

• Family history
• Marfans
• Age

Question 13

AAA: Presentation

Answer 13

• Often asymptomatic (70%)
• Symptomatic if pressure effects or ruptures -> mild abdo/back pain
• Blood clots can block other vessels
• If ruptures: sudden severe abdo & back pain + collapse

Question 14

AAA: Signs on examination

Answer 14

Large expansile mass

Question 15

AAA: Investigations

Answer 15

USS or CT

Question 16

AAA: Treatment

Answer 16

Surgical

• Replace aneurysmal segment with prosthetic graft if >5.5cm
• Endovascular repair with aortic stent

Question 17

Conditions that present similarly to AAA

Answer 17

• Acute pancreatitis
• MI
• GI haemorrhage

Question 18

Varicose veins: How common is it?

Answer 18

M - 10-20%

F - 25-33%

Question 19

Varicose veins: Who does it affect?

Answer 19

F>M

40% of pregnant women

Question 20

Varicose veins: Causes

Answer 20

Incompetent valves in affected vein -> reflux of blood and increased pressure in the vein distally (worse if in deep veins)

PREGNANCY: Increased blood volume + relaxed muscle walls of blood vessels (due to hormones) + enlarged uterus puts pressure on pelvic veins & IVC

Question 21

Varicose veins: Risk factors

Answer 21

Age, sex (F), FHx, obesity, standing/sitting for long period of time

Question 22

Varicose veins: Presentation

Answer 22

Dark blue/purple veins - twisted/bulging

Itch/discomfort/swelling of affected leg

Question 23

Varicose veins: Signs on examination

Answer 23

Check for complications - eg skin changes, venous leg ulcers, thrombophlebitis

Question 24

Varicose veins: Treatment

Answer 24

Lifestyle advice - eg avoid sitting/standing for long periods, elevate legs when possible, compression stockings
Surgical: Removed/shut via intraluminal laser surgery - only covered by NHS in rare situations