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Flashcards in Vascular disorder Deck (47):

What is Fontaine Grade Of ischemia?

Grading for arterial occlusive disease
G1 Asym
G2 Intermittent pain
G3 Rest pain
G4 Gangrene and d/f walking


What is Leriche syndrome?

Buttock claudication & sexual impotence resulting from aorto iliac occlusive disease


Pt complain of clarification in the calf and foot
O/E ankle pulse absent and femoral and popliteal pulses palpable.
Where is the obstruction in lower limb?

Distal Obstruction


Pt complains of U/L claudication in the calf
O/E femoral pulse palpable with absent U/L distal pulses.
Where is the obstruction?

Femoral popliteal obstruction


Pt complains of U/L claudication in the thigh and calf but sometimes pain in the buttock.
O/E bruit over iliac region and U/L absence of femoral and distal pulses.
Where is the obstruction?

Iliac obstruction


Pt complains of impotency with claudication in buttocks, thigh and calves.
O/E femoral and distal pulses absent in both limbs.
Where is the obstruction?

Aorto iliac obstruction


What is ankle brachial pressure index?

Ratio of systolic pressure at the ankle to that in the arm and can be determined vi Doppler U/S


Name the t/m options for Arterial occlusive disease?

Control Risk Fx
-Percutanoeus transluminal angioplasty
Surgical option


What to do when pt has obstruction below popliteal artery?

Femorotibial bypass


What to do when pt has superficial femoral artery occlusion?

Femoropopliteal bypass


What to do when aorto iliac obstruction?

-If both iliac sys is affected = Axillo bifemoral bypass

-If one iliac sys is affected = Aorto femoral bypass Or Femorofemoral Or Iliofemoral bypass


Pt has claudication in an arm leading to digital ischemia.What is the condition?

Subclavian artery stenosis t/m by PTA


What is the triad of Subclavian steak syndrome?

Syncopal attack
Visual disturbance with arm exercise
Diminished Bl pressure in the affected limb


D/f b/w Dry and wet gangrene!

Dry Gangrene
-Reduction Of blood flow via the arteries
-Affected part doesn’t become infected in most pt
-Keep it dry and aseptic as possible

Wet gangrene
-complication of untreated infected wound
-try to convert it into moist gangrene
-swelling decrease flow that help invasion of the muscle by bacteria


An athlete who used to run barefoot in his childhood had formed constricting scar at the level of interphalangeal joint of a toe.
What condition does he have ?

Ainhum which is auto amputation of a digit.

Early stage t/m Z plasty
Later stage t/m amputation


Name the causes of aneurysm?
Remember MCAT

M mycotic it’s due to bacterial
C collagen disease
A atheromatous
T traumatic


What is d/d b/w Raynaud diseases and Raynaud phenomena?

Diseases is due to cold exposure or stress
Phenomenon due to connective tissue diseases


What are the Rx factors for upper limb lymphedema?

Remember CHAOS

C congenital
A axillary radiotherapy/ Advanced Ca / AV shunt for dialysis/air travel

O obesity
S surgery with axillary lymph node dissection


Brunner Clinical Classification Of lymphedema

Sub clinical (No clinically apparent lymphedema but histo abnormalities present)

G1 Edema pits on pressure & swelling disappears on elevation and bed rest

G2 Edema neither pits nor reduce upon elevation

G3 Edema is associated with irreversible skin changes fibrosis papillae


D/f b/w Type 1 lymphedema and type 2 lymphedema

Both are familial forms of Pri lymphedema

Type 1
-Auto dominant
-brawny lymphedema Of both legs
-Develops from birth or before puberty
-Mutation Of VEGF gene on chromosome 5
-Also known as Nonne-Milroy Or simple Milroy disease

Type 2
-auto dominant but not in all cases
-lymphedema Of one or both legs but involve arms
-Develop b/w puberty and middle age (50 yrs)


Lymphedema occur at d/f ages

Lymphedema Congenita
-Below 2 yrs old
-more common in males
-b/L and involve the whole leg

Lymphedema Praecox
-Age Of onset 2-35 yrs
-More common in females
-U/L and extends only to the knee

Lymphedema Tarda
-Age Of onset >35yrs


Important points

-Lymphedema developing for first time after 50 yrs should prompt a thorough search for malignancy

-lymphedema associated with malignancy commences proximally in the thigh rather than distally


Browse Lymphangiographic Classification

Three types of it
-Congenital hyperplasia
-Distal obliteration
-Proximal obliteration

Congenital hyperplasia
-A congenital onset edema Seen mostly in males involves whole leg with Intermediate progression though has a +ve Fx hx

Proximal Obliteration
-A Edema occurs at any age Seen in both genders involve whole leg and thigh only with rapid progression though -ve fx hx

Distal obliteration
-A Edema occurs at puberty seen mostly in females involve ankle & calf with slow progression though often +ve fx hx


What is Podoconiosis?

One of the cause of Secondary lymphedema which is non filarial non infective blockage of limb lymphocytics by silica particles


What is the MCC Secondary lymphedema worldwide?



What is MCC Of Secondary lymphedema in developed countries?

T/m (Surgery & radiotherapy) for Breast cancer


Name the surgical t/m for lymphedema

-Sistrunck operation
MC and carried out to reduce the forth of the thigh

-Homan Operation
Most satisfactory operation for the calf

-Thompson Operation

-Charles Operation


Name the lower leg perforators
Remember MCB DH

M may or kuster (ankle perforators)
C cockett (lower leg perforators)
B boyd (Gastrocnemius perforators)

D Dodd (Mid thigh perforators)
H hunterian (Proximal thigh perforators)


What are Secondary causes Rx factors of Varicose Vein?
Remember K PAD

k Klippel trenaunay syndrome
P Pelvic mass/pregnancy
A after surgery of pelvis/AV fistula


What is Klippel trenaunay syndrome?

Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disorder in which a limb may be affected by port wine stains (red-purple birthmarks involving blood vessels), varicose veins, and/or too much bone and soft tissue growth. The limb may be larger, longer, and/or warmer than normal. The cause is unknown.


Incompetence Of long saphenous vein develop the varcosities in which site?

In the thigh


Incompetence Of short saphenous vein develop the varcosities in which site?

On the back of leg


Name the clinical tests to assess the competency of lower limb vein

-Tourniquet test(Trendelenberg)
Assess the competence of saphenofemoral, saphenopopliteal and mid thigh perforators

-Cough Impulse test


What are the investigations of varicose veins?

-Doppler probe
-Duplex US(IOC)


Name the test useful in pts with recurrent varicose veins and those with complex anatomy



Name the test useful in pts with post thrombotic venous occlusions



How to manage the varicose veins that are associated with post thrombotic damage?



How to deal with minor varicose veins and recurrences esp in the calf and lower leg?

Injection sclerotherapy


what are the surgical t/m for Varicose veins?

-Ligation and stripping
-Radiofrequency ablation
-Endovenous laser ablation


What are the causes of Leg ulceration?
Remember V TRAN

V venous diseases (in most cases)

T Traumatic ulcers
R Rheumatoid ulcer
A Arterial ischemic ulcers
N Neuropathic ulcers/neoplastic


Name the MC site of leg ulcers

On the medial side of the calf


What is marjolin ulcer?

Marjolin ulcers are malignant tumors arising in chronic wounds. Strictly defined, they include carcinomas that transform from the chronic open wounds of pressure sores or burn scars. They behave aggressively and have a propensity for local recurrence and lymph node metastases.


What are complications of DVT?

-Pulmonary embolism
-Phlegmasia alba dolens
-Phlegmasia cerulia dolens


Features of Phlegmasia alba dolens

Pallor and swelling of the entire leg
-Neither arterial insufficiency nor neurological


Features of Phlegmasia Cerulia dolens

Blue discoloration and swelling of the entire leg
-Arterial insufficiency and neurological deficits


What are the preventive techniques for DVT?

-Graduated elastic compression stockings
-External pneumatic compression
-Subcutaneous LMWH
-Vena cava filter


How to t/m the pt with severe thrombosis with venous gangrene?

Surgical thrombectomy