Vascular Disorders Flashcards
What does ‘vascular disorders’ include?
DVT and PE
Abdominal Aortic Aneurism
Peripheral vascular disease
What is a DVT?
Fibrin-rich clot formed in deep venous system of lower limb due to activation of clotting cascade
What are the symptoms of DVT?
Hot, swollen and tender calf
Pitting oedema
What are the investigations for DVT?
Well’s score
D dimer
Doppler USS
What are the symptoms of PE?
Acute dyspnoea
Pleuritic chest pain
Haemoptysis
Collapse
What is the diagnostic investigation for PE?
CTPA
V/Q scan if CTPA contraindicated
What may an ECG show in PE?
Right ventricular strain
RBBB
Tachycardia
S1, QIII, TIII
What is the treatment for PE or DVT?
LMWH first
Warfarin or DOAC (rivaroxiban or apixaban)
Thrombolysis if haemodynamically unstable
Vena caval filter if recurrent emboli despite medication
What is peripheral arterial disease?
Stenosis of arteries in the leg due to atherosclerosis
What is the first stage of peripheral artery disease?
Intermittent claudication
What is intermittent claudication?
Ischaemia of leg muscles during exertion
What are the symptoms of peripheral arterial disease?
Calf pain which is only present on exertion and goes away at rest
What is the investigation for peripheral artery disease?
ABPI (ankle brachial pressure index)
Doppler USS
CT/MRI angiography
What are the values of ABPI that indicates normal, peripheral arterial disease or critical ischaemia?
Normal - 1-1.2
Peripheral arterial disease - 0.5-0.9
Critical ischaemia - <0.5
What is the treatment for peripheral arterial disease?
Smoking cessation
Other lifestyle
Anti-platelets
Graded exercise - must keep going even if painful
What are the surgical options for peripheral artery disease?
Angiplasty +/- stenting
Bypass
What is critical limb ischaemia?
Ischaemia signified by ulceration, gangrene or pain at rest and needs urgent attention
What are the signs of acute limb ischaemia?
Pain at rest, worse at night Pallor Perishingly cold Pulseless Paraesthesia Paralysis
What is salvageable acute limb ischaemia?
0-4 hours
White foot
Painful
Sensorimotor defect
What is partly salvageable acute limb ischaemia?
4-12 hours
Mottled
Blanches on pressure
What is non-salvageable acute limb ischaemia?
>12 hours Fixed mottling Non-blanching Compartments tender/red Paralysis
What is the treatment for salvageable limb ischaemia?
Embolectomy, fasciotomy or thrombolysis
What is the treatment for non-salvageable limb ischaemia?
Amputation
What is an aneurism?
Dilation of a vessel by more than 50% of its normal diameter
