Vascular Flashcards by Laura Mills

What is ABPI and how is it measured?

Ankle-brachial pressure index

Measure BP at ankle and then at arm
Calculate ratio between the two

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How are ABPI results interpreted?

0.9< = normal

0.8-0.9 = mild

0.5-0.8 = moderate

0.5> = severe

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What are some clinical features of chronic limb ischaemia?

Intermittent claudication

Buerger’s angle - <20 degrees indicates severe ischaemia

Cold limb

Hair loss on limb

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What is chronic limb ischaemia?

Peripheral arterial disease that results in a symptomatic reduced blood supply to the limbs

Typically atherosclerosis

Commonly affects the lower limbs

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What are the stages of chronic limb ischaemia?

Based on clinical features

Stage 1 - asymptomatic

Stage 2 - intermittent claudication

Stage 3 - ischaemic rest pain

Stage 4 - ulceration or gangrene

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What are some investigations done when investigating chronic limb ischaemia?

ABPI
Doppler USS
CTA/MRA
Cardiovascular risk assessment - ECG,
BP, lipids

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What’s the medical management for chronic limb ischaemia?

Lifestyle changes - supervised exercise
programmes

Statin therapy (ideally atorvastatin 80mg OD)

Anti-platelet therapy (ideally clopidogrel
75mg OD)

Optimise diabetes control

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When is surgical management indicated and what is available in chronic limb ischaemia?

If medical management fails or critical limb ischaemia develops - surgery

Angioplasty =/- stunting
Bypass grafting
Combination of both

Amputation

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What is critical limb ischaemia?

Advanced form of chronic limb ischaemia

Ischaemic rest pain >2wks

Presence of ischaemic lesions or gangrene

ABPI <0.5

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What are some clinical features of critical limb ischaemia?

Cold limb, hyperaemic(reactive) limb (red, warm, swollen)

Weak or absent pulses

Hair loss

Skin changes - ulceration, gangrene, atrophic skin

May have received Abx

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What is the management for critical limb ischaemia?

urgently referred for surgical intervention:
- Inpatients should be treated within 5 days
- Stable, and suitable for an outpatient pathway patients should be treated within 2 weeks

Surgeries available:
Angioplasty +/- stenting
Bypass grafting
Combination of the above
Amputation

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What is acute limb ischaemia and what are some causes?

Sudden decrease in limb perfusion that threatens the viability of the limb

Causes:
-Embolisation - proximal clot moves
-Thrombosis in situ - ruptured plaque
-Trauma - compartment syndrome

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What the clinical features of acute limb ischaemia?

6 Ps

Pain - ! Severe
Pallor
Perishingly cold
Pulselessness
Parasthesia
Paralysis/calf tenderness

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What investigations for done for suspected acute limb ischaemia?

Routine bloods incl. G+S

USS Doppler

CT Angiogram/arteriogram

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What’s the management for acute limb ischaemia?

IV heparin if inoperable

Surgical emergency

Surgical:
-Embolectomy - radiologically guided
-Intra-arterial thrombolysis
-Bypass surgery
-Angioplasty

If irreversible limb ischaemia (mottled skin, hard woody muscles):
-amputation
-palliation

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What is the long term management for acute limb ischaemia?

Lifestyle changes - regular exercise, smoking cessation, weight loss

Anti-platelet agent

OT/PT

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What are some complications that can arise due to acute limb ischaemia management and what are they a result of?

result of ischaemia-reperfusion injury where sudden change in perfusion

Compartment syndrome
AKI
Hyperkalaemia

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How does venous insufficiency occur?

Occurs as result of failure in the venous system

Assoc with long periods of standing

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What are some clinical features of venous insufficiency?

Chronically swollen lower limbs - aching, pruritic, painful

Venous claudication

Skin changes:
-varicose eczema and thrombophlebitis
-haemosiderin skin staining
-lipodermatosclerosis (champagne bottle legs)
-atrophie blanche

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What investigations are done for suspected venous insufficiency?

ABPI - see in suitable for compression, not suitable if arterial disease present

Doppler USS

Routine bloods

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What management is available for venous insufficiency?

Conservative:
-TED compression stockings
-Feet elevation

Surgical:
-deep venous stenting (only in special pts)

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What are varicose veins?

Tortuous dilated segments of vein associated with valvular incompetence

Incompetent valves lead to venous hypertension and dilation

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What are some clinical features of varicose veins?

Study These Flashcards

Unsightly visible veins
Skin discolouration
Aching or itching

Later:
Skin changes
Thrombophlebitis
Ulceration
Bleeding

What investigations are done for varicose veins?

Study These Flashcards

USS duplex

What is the referral criteria for vascular surgery to treat varicose veins?

Symptomatic varicose veins Lower limb skin changes Superficial vein thrombosis Venous leg ulceration (active or healed)

What management options are available for varicose veins?

Conservative: -pt education, weight loss, exercise -compression stockings (4-layer) Surgical: -thermal ablation -foam sclerotherapy -vein ligation/stripping

What are some causes of leg ulcers?

Venous - most common Arterial insufficiency Diabetic-related neuropathy Prolonged or excessive pressure over bony prominence Infection Marjolin’s ulcer

What are arterial ulcers are what appearance do they have?

Ulcer caused by reduction in arterial blood flow - decreased perfusion of tissues - subsequent poor healing Small deep lesion Well-defined borders Necrotic base

What are some clinical features of arterial ulcers?

May be painful Develop over long period of time Little to no healing Hx of intermittent claudication/ critical limb ischaemia Features of PAD

What investigations should be done for arterial ulcers?

ABPI USS duplex CTA/MRA

What management options are available for arterial ulcers?

Conservative: -lifestyle changes e.g. smoking cessation Medical: -RF modification e.g. statin, antiplatelet Surgical: -angioplasty +/- stent -bypass grafting

What are venous ulcers and what is their normal appearance?

Ulcers caused by venous insufficiency Shallow Irregular borders Granulating base Usually over medical malleolus Prone to infection

What are some clinical features of venous ulcers?

Painful (worse at end of day) Gaiter region of legs Features of venous insufficiency

What are some investigations done for pt with venous ulcers?

ABPI USS duplex

What are some management options for venous ulcers?

Conservative: -lifestyle e.g. weight loss -leg elevation and exercise Medical: -multicomponent compression bandaging Surgical: -endogenous - ablation based in trunks -open - stripping or avulsion

What are diabetic ulcers are what is their usual appearance?

Ulcers Occur as a result of peripheral neuropathy -loss of protective sensation -repetitive stress and unnoticed injuries Variable in size and depth, with a “punched out appearance”

What are some clinical features of diabetic ulcers?

Painless Most commonly on sites of pressure on feet Peripheral neuropathy, peripheral vascular disease and foot deformity may be present

What investigations are done for diabetic ulcers?

Blood glucose levels HbA1c ABPI

What are some management options for diabetic ulcers?

Conservative: -lifestyle changes e.g. weight loss -non-weight bearing shoes Medical -optimise diabetic control and risk factor modification -referral to diabetic foot MDT Surgical -debridement of necrotic tissue -amputation

What is an abdominal aortic aneurysm?

Dilation >50% of AA Usually infra-renal

What are some potential causes of AAA?

Atherosclerosis Trauma Infection Connective tissue disorder e.g. Marfan’s, Ehlers Danlos Inflammatory disease

What are some positive risk factors for AAA?

Male Increasing age Smoking Obesity Caucasian

What are negative risk factors for AAA?

Female gender Asian Diabetes

What are some clinical features of AAA?

Usually asymptomatic and picked up incidentally/on screening or until rupture - Pulsatile swelling - above umbilicus Classical triad Pain (back/abdo) Hypotension Pulsatile mass HIGH INDEX OF SUSPICION FOR RUPTURE = FLANK BRUISING

What investigations are done in suspected AAA?

USS abdomen CT aortagram

What is the management for AAA <5.5cm?

Monitoring via duplex USS Cardiovascular risk factor reduction: -smoking cessation -statin and aspirin -BP control -weight loss

When should the DVLA be notified about a patients AAA and when does it disqualify them from driving until repaired?

AAA >6cm - notify DVLA AAA >6.5cm - disqualified from driving until repair

What screening programme is available for AAA and who is eligible?

National Abdominal Aortic Aneurysm Screening Programme Abdominal USS Men aged 65yrs

What monitoring is available for AAA?

3-4.4cm =yearly USS 4.5-5.4cm =3-monthly USS

What is the management for AAA >= 5.5cm OR increasing >1cm per year OR symptomatic?

Surgical repair: Open Endovascular with a stent

What is carotid artery disease?

Build-up of atherosclerotic plaque in one or both common and internal carotid arteries, resulting in stenosis or occlusion

What are some clinical features of carotid artery disease?

Usually asymptomatic Focal neurological deficits: TIA Stroke

What is a duplex USS?

duplex" refers to two modes of ultrasound used, Doppler and B-mode.

What investigations are done for carotid artery disease?

Duplex ultrasound USS CT Angiogram - If stroke/TIA suspected - urgent non-contrast CT Bloods (fo cardiovascular risk) ECG

What management options are available for carotid artery disease?

Medical: -Cardiovascular risk factor modification - anti-platelet, statin, BP and diabetes control -Smoking cessation -Exercise Surgical: Carotid Endarterectomy

Vascular Flashcards

(55 cards)