Vascular Flashcards
(38 cards)
Abdominal aortic aneurysm features
- Pulsatile abdominal mass
- Abdominal or back pain = suggests rapid expansion or impending rupture
- Signs of rupture = severe pain, hypotension, shock
- Compression symptoms if very large = early satiety, N&V
Abdominal aortic aneurysm investigations
- USS = investigation of choice for screening/monitoring
- CT angiography = used preoperatively for surgical planning
When are Abdominal aortic aneurysms first screened for, and how often are they monitored?
A single abdo US is offered to all men at age 65, follow up screening depends on the size of the aneurysm:
- 3 - 4.4cm = yearly repeat US
- 4.5 - 5.4 = repeat US every 3 months
- > 5.5 = surgical intervention
Abdominal aortic aneurysm management
Surgery = open repair or endovascular aneurysm repair (EVAR)
This is offered to all pt w/ AAA’s > 5.5 cm, or those with rapidly expansion
Rapid expansion = growing > 5mm in 6 month, or > 10mm over a year
Define Acute limb ischaemia
Severe, symptomatic hypoperfusion of a limb that has been occurring for less that 2 weeks
In reality, surgical intervention is ideally w/in 4-6 hours of presentation
What are the causes of Acute limb ischaemia?
- Thrombosis = atherosclerotic plaque rupture
- Embolism = AF
- Vasospasm = Raynaud’s
- External vascular compromise = trauma, compartment syndrome
Acute limb ischaemia features
6 P’s:
- Pulseless
- Painful
- Pale
- Paralysis
- Perishingly cold
- Paraesthesia
How is Acute limb ischaemia stratified?
Using the Rutherford criteria:
- Stage I = viable limb, arterial signal can be picked up on Doppler
- Stage IIa = mild sensory deficit, no motor deficit
- Stage IIb = severe sensory deficit (more than just toes), mild motor deficit, rest pain - needs immediate treatment whilst limb is still salvageable
- Stage III = severe sensory and motor deficit (non-viable limb)
Acute limb ischaemia management
Thrombotic causes:
- Angiography (stages I-IIa)
- Urgent bypass surgery (stage IIb)
Embolic causes:
- Immediate embolectomy
- If that fails, on-table thrombolysis
If limb is non-viable (stage III) = amputation - keep them nil by mouth and give IV heparin
Define Aneurysm
A localised dilation or expansion of a segment of a blood vessel to more than 50% of its usual diameter
Arterial ulcer features
- Occur distally (heel or toe tips)
- Small and deep
- Punched out margins
- Don’t bleed or ooze
- Painful, elevated by hanging foot off the bed
Venous ulcer features
- Occur in the gaiter area
- Large and shallow
- Sloping edges
- Bleed and ooze
- Painful when leg elevated
- Associated w/ chronic venous changes
What are the features if chronic venous insufficiency
- Haemosiderin deposition = dark patches on the skin
- Lipodermatosclerosis = hardening of the skin
- Atrophie blanche = painful papules which ulcerate and then leave white scars
- Ulcers
Define Buerger’s disease
A non-atherosclerotic vasculitis characterised by the occlusion of small and medium-sized arteries
Strongly linked to smoking
Buerger’s disease features
- Typically presents as acute limb ischaemia w/out a background of peripheral claudication
- Raynaud’s
- Ulcers on fingers and toes often associated w/ gangrene
- Superficial thrombophlebitis
Buerger’s disease investigations
- Arterial Doppler = diminished pulses distal to the occlusion
- Arterial Duplex = Martorell’s sign (corkscrew-shaped collateral vessels)
- CT angiography
Buerger’s disease management
- Smoking cessation
- Vasoactive medication to improve blood flow (nifedipine, iloprost, prostaglandin E1)
- Management of critical limb ischaemia
Carotid artery stenosis management
Conservative (don’t meet surgical criteria):
- Clopidogrel 75mg
- Statins
- BP control
- Smoking cessation
Surgical:
- For pts w/ stenosis of 70 - 99% and symptoms of a stroke or TIA in the corresponding vascular territory
- Surgery = carotid endarterectomy
Define Peripheral arterial disease
Substantial narrowing of the arteries distal to the aortic arch
Peripheral arterial disease features
- Intermittent claudication’s
- Pale, cold leg
- Hair loss
- Ulcers
- Poor wound healing
- Weak/absent peripheral pulses
Peripheral arterial disease investigations
CV assessment = FBC, BP, BM, lipids, ECG
ABPI is diagnostic:
- 0.9 - 1.2 = normal
- 0.8 - 0.9 = mild disease
- 0.5 - 0.8 = moderate disease
- <0.5 = severe disease
Imaging:
- Duplex
- MR arteriogram = in pts who are candidates for revascularisation
- CT arteriogram = in the rest of pts
Define Critical limb ischaemia
Severe peripheral arterial disease with:
- Rest pain
- Tissue loss (ulcers)
- Ankle artery pressure < 50mmHg
Peripheral arterial disease management
Conservative:
- Modify RF
- Smoking cessation
- Refer to supervised exercise program
Medical:
- Clopidogrel 75mg daily
- Atorvastatin 80mg
- Optimise glycaemic control
- Manage HTN
- Analgesia = naftidrofuryl oxalate (vasodilator) can be prescribed if supervised exercise is ineffective, and pt doesn’t want surgery
Surgical:
- Endovascular revascularisation
- Surgical bypass (for larger, extensive stenosis)
- Pts w/ intermittent claudication not resolved by RF modification or exercise should be referred
- Anyone w/ critical limb ischaemia should be urgently referred
Define Superficial thrombophlebitis
The formation of a blood clot in the superficial venous vasculature, often associated w/ inflammation of the vessel walls
