Vascular Flashcards
(31 cards)
How is the ABPI calculated?
Ankle SBP / Brachial SBP
What are the ranges of ABPI when considering peripheral vascular disease?
> 0.9 = normal
0.6 - 0.9 = mild PVD
0.3 - 0.6 = moderate - severe PVD
< 0.3 = end stage PVD - critical limb ischaemia
What are the 6 Ps of critical limb ischaemia?
Pain
Pallor
Pulseless
Paralysis
Paraesthesia
Perishingly cold
What is the normal diameter of the Abdominal aorta?
1.5 cm in females
1.7cm in males
When is an abdominal aorta considered aneurysmal?
A diameter over 3cm
What is the screening process for AAA?
Men aged 65 are invited for a one off abdominal ultrasound of the abdominal aorta
What is considered a small AAA and what further action is required?
A diameter of 3-4.4cm
Repeat US every 12 months
What is considered a medium AAA and what further action is required?
A diameter of 4.5-5.4cm
Repeat US every 3 months
What is considered a large AAA and what further action is required?
> 5.5.cm
Urgent referal to vascular surgery
What is considered a low rupture risk in terms of AAA and what is the management plan?
Asymptomatic AAA and less than 5.5 cm
Repeat abdominal US in line with guidance and optimise CV risk factors (e.g. quit smoking)
What is considered high rupture risk in terms of AAA and what is the management plan?
Symptomatic AAA, over 5.5cm, or rapidly enlarging (1cm/year)
Required urgent referal to vascular surgery for EVAR or open repair
How might a ruptured AAA present?
Severe, central abdominal pain that radiates to the back
A pulsatile and expansible abdominal mass
Shock or collapse
What is the management for a haemodynamically unstable AAA rupture?
Straight to theatre
If patient is frail with multiple co-morbidities then consider a palliative approach
What is the management of a AAA rupture in a haemodynamically stable patient?
CT angiogram and possible EVAR
In PVD and all patients with established cardiovascular disease, what medications should they be started on?
A statin - atorvostatin 80mg
Clopidogrel 75mg (or aspirin if contraindicated)
What is the surgical management for severe PVD?
- Endovascular revascularisation - percutaneous transluminal angioplasty +/- stent
Short segment stenosis (<10cm), aortic illiac disease, high-risk patients - Surgical revascularisation - bypass or endarterectomy
- Long segment lesions (>10cm), multifocal lesions, lession of the common femoral a., purely infrapopliteal disease
What drugs are licensed for PAD?
Naftirofuryl Oxalate - vasodilater reserved for patients with a poor quality of life
What is the initial investigation for suspected acute limb ischemia?
Handheld doppler
Generally, what causes limb ischaemia?
Thrombus (due to a ruptured atherosclerotic plaque)
Embolus (secondary to AF)
What symptoms might patients with varicose veins experience?
Aching and throbbing
Itching
What investigation should be done for varicose veins?
Venous duplex ultrasound - will demonstrate any retrograde venous flow
What are the conservative treatments for varicose veins?
Elevate legs
Weight loss
Regular excercise
Graduated compression stockings
What CXR sign might be seen in Aortic dissection?
Widening of the aorta
What is subclavian steal syndrome?
Occurs due to proximal stenotic lesion of the subclavian artery which results in retrograde flow through the vertebral or internal thoracic arteries
