Vascular Flashcards
(33 cards)
Who does peripheral vascular disease affect?
Black > other ethnicities
All ages but more common in the over 60s
What causes peripheral vascular disease?
Atherosclerosis causing stenosis of arteries
What are the risk factors for peripheral vascular disease?
Smoking ⬆️ age Hypertension Hyoercholesterolaemia Obesity Diabetes
What are the symptoms of peripheral vascular disease?
Intermittent claudication - calf = femoral disease - buttock = iliac disease Critical ischaemia - ulceration - gangrene - rest pain - impotence
What is the Fontaine classification of peripheral vascular disease?
- Asymptomatic
- Intermittent Claudication
- Rest pain
- Ulceration/gangrene
What are the signs of peripheral vascular disease on examination?
- 6 Ps (pain, pallor, paraesthesia, pulselessness, perishingly cold, paralysis)
- atrophic skin
- punched out ulcers
- cap refill >15secs
What investigations are necessary to diagnose peripheral vascular disease?
Bloods
- FBC (polycythaemia, anaemia)
- ESR/CRP (exclude arteritis)
- U&Es (renal disease)
- lipids (dyslipidaemia)
Examination of pulses
ABPI
- intermittent claudication = 0.5-0.9
- critical limb ischaemia =
What are the treatments of peripheral vascular disease?
Treat risk factors - stop smoking, ⬇️ BP, ⬇️ cholesterol (statins), anti platelets (clopidogrel) to prevent progression
Manage claudication
- exercise = improve collateral circulation
- vasoactive drugs: naftidrofuryl
Surgical
- percutaneous transluminal angioplasty
- reconstruction - bypass graft
- amputation
How common is AAA?
Prevalence 1.3-12.7% in UK
Present in 5% of popn >60
Who does AAA affect?
5x more frequent in men
What are the causes of AAA?
Atheroma
Trauma
Infection (sylhilis, TB, HIV)
Connective tissue disorders (marfans or EDS)
What is the pathology of a AAA?
True aneurysm = affects all layers
Pseudoaneurysm = blood collection in adventitia only
Degeneration of elastic lamellae and smooth muscle loss
What is the definition of a AAA?
Artery with dilatation >50% of its original diameter
> 3cm in size = AAA
What are the risk factors for AAA?
⬆️ age Family history Smoking Gender (male) Hypertension Hyperlipidaemia COPD
What are the symptoms of an unruptured AAA?
Asymptomatic
Abdo/back pain
What are the symptoms of a ruptured AAA?
Intermittent/continuous abdominal pain
- radiates to back and iliac fossae and groin
What are the signs of AAA on examination?
Unruptured = pulsatile and expansile abdominal mass
Ruptured: collapse, shock
What investigations are necessary to diagnose AAA?
Bloods
- FBC, clotting screen, U&Es, LFT
- crossmatch
- ESR/CRP for inflammation
ECG
Imaging: CXR, USS, CT, MRI angiography
What are the treatments for AAA?
Controlling risk factors (stop smoking, ⬇️BP, lipid lowering medication)
Screening - men >65
Monitoring - regular measurement; action required >5.5cm across
Elective surgery - only if >5.5cm, expanding at >1 cm/year or symptomatic
Stenting
Who does varicose veins affect?
More common in women
What causes varicose veins?
Incompetent vein valves = venous hypertension and dilatation of superficial veins
Primary causes:
- unknown
- congenital valve absence
Secondary causes:
- obstruction
- valve destruction
- arteriovenous malformation
- constipation
- overactive muscle pumps
What are the risk factors for varicose veins?
Gender Genetics Age Occupation (Prolonged standing) Obesity Pregnancy
What are the symptoms of varicose veins?
Pain Cramps Tingling Heaviness Restless legs
What are the signs of varicose veins on examination?
Oedema Eczema Ulcers Haemosiderin staining (hyper pigmentation) Haemorrhage Phlebitis Lipodermatosclerosis
