Peripheral vascular disease Flashcards Preview

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Flashcards in Peripheral vascular disease Deck (14)
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1
Q

Causes of ‘claudication’ in presence of normal peripheral pulses

A

Neurogenic claudication (spinal stenosis)
Anaemia
Beta-blockers

2
Q

Critically ischaemic limb (6 Ps)

A
  • Pain
  • Pallor
  • Pulseless
  • Perishingly cold
  • Paraesthesia
  • Paralysis (best indicator of danger to limb)
3
Q

ABPI Measurements

A
  • > 1 Normal
  • 0.5 -1 Intermittent claudication
  • 0.3 - 0.5 Rest pain I critical limb ischaemia
  • <0.3 Gangrene + ulceration
4
Q

Diabetic foot features

A

• Peripheral neuropathy
o Loss of ankle jerk and vibration sense
o Accidental injury I tissue damage•
o Charcot joints (neuropathic arthropathy)

  • Large vessel arterial disease•
  • Small vessel arterial disease•

• Autonomic neuropathy
o Reduced sweating
o Dry, cracked skin*
o Infection•

5
Q

How to Present Your Findings In the common case of a patient with obvious varicose veins

A
  • There are varicose veins in the distribution of the [long I short I both] saphenous systems
  • There [is I is no] saphena varix
  • Trendelenburg’s test suggests [saphenofemoral I mixed saphenofemoral and perforator] incompetence
  • There [are I are no] associated features of chronic venous insufficiency [See over]
  • There [is I is no] evidence of superficial thrombophlebitis
6
Q

Varicose veins

A

• Occur as a result of valvular incompetence
o Structural predisposition (familial tendency)
o Factors that increase venous pressure: prolonged standing, obesity, pregnancy

• Sites of incompetence
o Saphenofemoral junction (SFJ) - typically causes long saphenous vein (LSV) varices
o Saphenopopliteal junction (SPJ) - typically causes short saphenous vein (SSV) varices
o Perforating veins linking deep veins and saphenous systems

• Often associated with signs of chronic venous insufficiency

7
Q

Management of varicose veins

A
•	Conservative
      o	Elastic support hose
      o	Weight loss
      o	Regular exercise
      o	Avoid prolonged standing

• Injection .sclerotherapy
o Suitable for small varices below knee due to incompetence of local perforators
o Not satisfactory for varices associated with SFJ incompetence (recurrence inevitable)

• Surgery
o SFJ incompetence & LSV varices

  • SFJ ligated (a so-called ‘high tie’)
  • LSV usually stripped from knee to groin (reduced chance of recurrence)

• Stab avulsions of remaining varices
o SPJ incompetence & SSV varices

  • SPJ ligated (SSV not stripped due to risk of damaging sural nerve)
  • Stab avulsions of remaining varices

• New techniques
o Ultrasound-guided foam sclerotherapy
o Radiofrequency or laser obliteration of LSV I SSV

8
Q

Causes of chronic venous insufficiency

A
1.	Valvular incompetence of deep veins (90%)
      o	Primary (aetiology same as for varicose veins)
      o	Secondary {damaged by DVT)	 	
  1. Obstruction of deep veins by DVT (10%)

(Chronic venous insufficiency 2’ to DVT is also known as ‘post-thrombotic syndrome’)

9
Q

What is Superficial thrombophlebitis

A
  • Inflammation and thrombosis almost invariably occurring in varicose veins
  • Redness and tenderness follow line of vein
  • Thrombosis may spread to deep system and cause DVT
10
Q

What are factors that increase venous pressure predisposing to varicose veins?

A
  • prolonged standing
  • Obesity
  • Pregnancy
11
Q

For varicose veins where are the sites of incompetence?

A

• Sites of incompetence
o Saphenofemoral junction (SFJ) - typically causes long saphenous vein (LSV) varices
o Saphenopopliteal junction (SPJ) - typically causes short saphenous vein (SSV) varices
o Perforating veins linking deep veins and saphenous systems

12
Q

How do you manage a patient with superficial thrombophlebitis?

A

• Management
o Analgesia
o NSAIDs
o Support stockings o Active exercise

  • Underlying vein usually removed as recurrence is common
  • Propagation towards deep veins is an indication for IV heparin
13
Q

When do you use injection sclerotherapy?

A

• Injection .sclerotherapy
o Suitable for small varices below knee due to incompetence of local perforators
o Not satisfactory for varices associated with SFJ incompetence (recurrence inevitable)

14
Q

What are the conservative management of varicose veins?

A
•	Conservative
      o	Elastic support hose
      o	Weight loss
      o	Regular exercise
      o	Avoid prolonged standing