Vascular Flashcards
Summarise peripheral arterial disease
PAD = narrowing arteries supplying limbs and periphery. Get intermittent claudication.
Critical ischaemia = end stage PAD - pain at rest, ulcers and gangrene
Acute ischaemia =Raid onset due to thrombus
Leriche syndrome = occlusion aorta/ promixal common iliac artery –> TRAID: thigh/ buttock claudication; absent femoral pulse; impotence
RF: Same as MI
Presentation: Intermittent claudication in PAD. 6 Ps (pale, pallor, pulseless, paralysis, paraesthesia, perishingly cold), burning pain worse at night in critical. Generally may have pallor, cyanosis, rubor, muscle wasting, hair loss, ulcers, gangrene, reduced temperature, sensation, prolonged CRT, burgers test positive
Ix: hand held doppler for pulse presence, ABPI (ankle/ arm SBP, <0.9 = PAD), angio
Mx:
PAD: lifestyle, exercise training, statin, clopidogrel 75mg, Naftidrofuryl oxalate, angioplasty and stenting/ bypass
Critical/ acute: Urgent surgery needed to revascularise, amputate if cant restore blood supply
Summarise DVT
Pathophysiology: thrombi deveop in venous circulation, may become PE or stroke in ASD
RF: immobility, surgery, long flight, surgery, pregnancy, COCP/ HRT, malignancy, polycythaemia, SLE, thrombophilia (e.g. antiphospholipid syndrome)
Presentation: unilateral leg swelling (>3 cm difference), dilated superficial veins, tenderness over deep veins, colour change
Ix: wells score, d-dimer (may be raised in pneumonia, cancer, pregnancy, HF, surgery), doppler diagnositc
Mx:
Prevent with LMWH/ anti-embolic compression stockings. DOAC if DVT suspected and delay in scans. Iliofemoral DVT do catheter directed thrombolysis
Continue anti-coagulant for 3 months if reversible cause, 6 months if not
Summarise varicose veins
Definition: >3cm dilated superifical veins
Pathophysiology: Deep and superficial veins are connected by perforating veins, when the valves in these fail the blood from the deep veins flows back into the superficial veins
RF: age, fhx, female, pregnant, obese, standing lots, DVT
Presentation: often asx, heavy/ dragging sensation, aching, itchy, oedema, cramps, may have started to develop chronic venous insufficiency
Ix: Tap test, cough test, trendelenburgs test, perthe test, duplex US
Mx: wt loss, elevate leg, compression stocking, Surgery: ablation/ sclerothrapy/ stripping
Summarise chronic venous insufficiency
Pathophysiology: When blood does not leave veins and return to heart damage may occur. Is associated with varicose veins. Chronic pooling of blood –> skin changes
Presentation:
Haemosiderin staining (red/ brown colour from Hb leaking into skin)
Venous eczema (dry, itchy, scaly, red due to inflammation in skin)
Lipodermatosclerosis (chronic inflammation causes skin to become hard and fibrotic –> inverted champagne bottle)
atrophie blanche (smooth, white scar tissue surrounded by hyperpigmentation); ulcers, cellulitis, pain, poor healing
Mx: use emoillients on skin, steroids used by lipodermatosclerosis, manage varicose veins, manage any infections and ulcers
Arterial vs venous ulcers
Arterial:
Distal, associated PAD, small, deep, punched out, pale due to poor blood supply, painful, worse at night and when elevating and improved by lowering off bed. Mx is by managing PAD.
Venous:
Occur in gaiter area (between top foot and bottom calf), chronic venous insufficiency associated, caused by minor injury, large, superficial, irregular border, bleeding, less painful, pain relief on elevation and worse when lowered.
Mx is clinic referral - need wound care and compression therapy. Manage pain but don;t use NSAIDs.
Summarise lymphoedema
Pathophysiology: lymph fluid cant drain and so tissues become saturated with protein rich fluid
Primary: inherited
Secondary: problem lympahtic system eg axillary node clearance
Ix: limb volume can be calculated, nuclear scan, spectometry
Mx: specialist - massage, compression banages, exercise, skin care, surgery to connect lymphatic vessels to veins, treat cellulitis. Avoid bloods, cannulas, injection and measuring BP in those with lymphoedema
(Tropical disease Elephantiasis occurs by severe lymphoedema secondary to damage via worms)
Summarise AAA
Definition: Aorta dilated >3cm
RF: men, age, smoking, htn, fhx, CVD
Screening: US for all 65 yr old males
Presentation: incidental, abdo pain, pulsatile and expansile mass. Ruptured AAA presents with shock.
Ix: US intial, CT angio more detailed
Mx: lower RF, monitor those identified at risk and repair via graft if sx/ growing >1cm a year, >5.5cm diameter
Ruptured AAA surgical emergency
Summarise aortic dissection
Pathophysiology: tear between the intima and the media creating a false lumen.
Type A: before brachiocephalic artery, only ascending aorta
Type B: after braciocephalic, descending aorta
RF: CVD RF, htn massive RF, also wt lifting and cocaine and rapidly raise BP. Coarctation aorta, CABG, connective tissue disorders
Presentation: ripping/ tearing pain, goes through to back if descending aorta affected, difference in BP and pulses in each arm, diastolic murmur, focal weakness, MI sx, abdo pain, potential renal sx if progresses
Ix: CT angio
Mx: surgical emergency, analgesia, BP control with BB
Summarise Buerger disease
AKA thromboangiitis obliterans.
Affects young, male smokers!
Thrombi form in small vessels arterial system of hands and feet, get blue, painful hands at night.
Mx by quitting smoking and potentially iloprost
