What is intermittent claudication?
Pain in the back of the calves after exertion, relieved after a while by rest
What causes intermittent claudication?
Insufficient blood reaching the exercising muscle, i.e. muscle is starved of oxygen
What classification/staging is used to grade claudication?
Name two non-invasive investigations for lower limb ischaemia
Ankle brachial pressure index (ABPI)
Duplex ultrasound scan
Name three invasive investigations for lower limb ischaema
Magnetic resonance angiography
How is ABPI measured?
Ankle pressure / Brachial pressure (mm Hg)
using systolic pressures
What range for ABPI would indicate claudication?
Name some non-invasive therapy for limb ischaemia
Is angioplasty + stenting indicated for lower limb ischaemia?
What is endarterectomy?
Cutting out the inside of an artery (remove plaque and fibrous tissue)
Describe critical limb ischaemia
Pain in toes/foot/leg at rest, worse at night (lying down), relieved by walking about for a bit
Can cause ulcers/gangrene
What is the general pathogenesis behind AAA?
Defect in collagen-elastin regulation, causing excessive dilation + increase in aortic wall stress
What are some typical features of AAA?
May be asymptomatic unless ruptured
What does expansile mean? How does it differ from pulsatile?
Expansile mass pushes hands in opposite directions; pulsatile mass pushes hands up and down
What 2 non-invasive investigations are done for AAA?
What is the investigation of choice for AAA?
Ultrasound - tells us whether there is an AAA or not
What can a CT scan tell us about an AAA?
Whether it is ruptured or not
At what size would an AAA be considered/referred for elective repair?
What is involved in endovascular aneurysm repair (EVAR)?
Stent inserted via groin and passed up until the weakened part of the artery aneurysm is reached, where it seals off the aneurysm from inside the artery
What are the benefits of EVAR over open surgery?
What are the benefits of open surgery over EVAR?
Possible in almost everyone
Rare further interventions
Which veins in the leg make up the deep venous system?
Tibials, popliteals, femorals
Which veins in the leg make up the superficial venous system?
How do varicose veins arise?
Back pressure due to incompetent valves causes blood to pool in superficial veins
What are secondary varicose veins?
Arise due to DVT
What is thrombophlebitis?
Inflammation of veins caused by a clot, causing scarring/fibrosis
Name a non-interventional management of varicose veins
N.B. contraindicated in those with low ABPI
Name interventional management of venous insufficiency
Foam sclerotherapy (chemical thrombophlebitis) Endovenous ablation