Flashcards in Vascular disorder Deck (47):
What is Fontaine Grade Of ischemia?
Grading for arterial occlusive disease
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?
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?
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
What to do when pt has obstruction below popliteal artery?
What to do when pt has superficial femoral artery occlusion?
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?
Visual disturbance with arm exercise
Diminished Bl pressure in the affected limb
D/f b/w Dry and wet gangrene!
-Reduction Of blood flow via the arteries
-Affected part doesn’t become infected in most pt
-Keep it dry and aseptic as possible
-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?
M mycotic it’s due to bacterial
C collagen disease
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?
A axillary radiotherapy/ Advanced Ca / AV shunt for dialysis/air travel
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
-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
-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
-Below 2 yrs old
-more common in males
-b/L and involve the whole leg
-Age Of onset 2-35 yrs
-More common in females
-U/L and extends only to the knee
-Age Of onset >35yrs
-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
-A congenital onset edema Seen mostly in males involves whole leg with Intermediate progression though has a +ve Fx hx
-A Edema occurs at any age Seen in both genders involve whole leg and thigh only with rapid progression though -ve fx hx
-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
MC and carried out to reduce the forth of the thigh
Most satisfactory operation for the calf
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
Assess the competence of saphenofemoral, saphenopopliteal and mid thigh perforators
-Cough Impulse test
What are the investigations of varicose veins?
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?
what are the surgical t/m for Varicose veins?
-Ligation and stripping
-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?
-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
-Vena cava filter