Vascular Flashcards
(30 cards)
Define acute limb Ischaemia
Sudden decrease in arterial perfusion due to thrombotic or embolic causes
What are the most common sites for atherosclerotic lesions in the upper limb ?
- subclavian artery
- brachioceohalic trunk
Clinical features of upper limb Arterial disease
- pulse less, pale, arm pain, paraesthesia, cold (5Ps)
- unequal arm pressure - more than 15 diff = possible subclavian stenosis
Risk factors for PVD
- smoking
- DM
- hypertension
- hyperlipidaemia
- physical inactivity
- obesity
Define critical limb Ischaemia
- Ischaemic rest pain
- Ischaemic lesions or gangrene
- attributable to arterial occlusive disease
Where is the PVD if buttock claudication is present ?
Iliac disease
Calf claudication suggests PVD where ?
Femoral artery
Who is at risk if buerger’s disease ?
Young heavy smokers
- aka thromboangitis obliterans
What is leriches syndrome ?
Form if peripheral artery disease, involves bifurcation of aorta
- buttock claudication and impotence
First line anti platelet for PVD ?
Clopidogrel
How is intermittent claudication managed ?.
- modify risk factors
- supervised exercise programme
- vasodilator e.g. Naftidrofuryl oxalate (if exercise not helped and do not want surgery)
- revascularisation: angioplasty or bypass /graft (if angioplasty unsuccessful and severely life limiting claudication)
What is the first line imaging technique used when revascularisation is being consider in PVD ?
Duplex ultrasound
When is percutaneous transluminal angioplasty appropriate for treatment of PVD ? What is it ?
- If disease is limited to single arterial segment
- inflate balloon in narrowed segment
- can use stent to maintain patency
When is arterial reconstruction with a bypass graft appropriate to treat PVD ?.
- If atheromatous disease is extensive but distal run off is good (distal arteries filled by collateral vessels)
- autologous vein grafts superior to prosthetic grafts
Emboli causing acute limb Ischaemia often originate from where ?
Heart-AF;mural thrombosis
Pathogenesis of varicose veins ?
- Blood from superficial veins of leg passes into deep veins via perforator veins and at sapheno-femoral and sapheno- popliteal junctions
- valves normally stop blood passing back in to superficial veins
- if valves incompetent, there is venous hypertension then dilatation of superficial veins can occur
Risk factors for varicose veins ?
- prolonged standing
- obesity
- pregnancy
- family history
- the pill
Symptoms if varicose veins
- pains
- cramps
- tingling
- heaviness
- restless legs
*only slightly more common than in normal population
Signs of varicose veins
- oedemal
- eczema
- ulcers
- phlebitis
- atrophie blanc
What is the criteria for referral of patients with varicose veins to vascular service ?
- Bleeding, pain, ulceration,
- superficial vein thrombosis
- lower limb skin changes e.g. Pigmentation, eczema (due to chronic venous insufficiency
what method is used to confirm diagnosis of varicose veins ?
Duplex ultrasound
What are the treatment options for varicose veins ?
- symptomatic I.e. Analgesia, compression stockings etc
- endothermal ablation
- ultrasound guided foam sclerotherapy (if ablation not appropriate )
- surgery (if neither of above suitable)
What is saphena varix ?
- Dilatation in saphenous vein at its confluence with the femoral vein (sapheno-femoral junction)
- transmits cough impulse, may be mistaken for inguinal/fem hernia, but on closer inspection should have bluish tinge
What is a true aneurysm ?
An abnormal artery dilatation >50% of original diameter, involving ALL layers of arterial wall
