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Vascular: Pripheral Arterial Disease & Carotid Disease, image - Coggle…

- - - - Calf
        
        Distal Superficial femoral artery most common artery PAD
      - Pain brought on by exercise and relieved by rest
      - Onset, duration, progression, QOL
    - - When lying flat
    - - SMOKERS
      - DM
      - Obesity
      - Fhx - not as important as CVD
      - Age
      - Gender Male
      - Hypertension
      - Hypercholesterolaemia
      - Hyperhomocystaeinaemia
    - - Start prox - Femoral - popliteal - dorsalis paedis
      - Femoral
        
        Half way between anterior superior iliac spine and and the symphasis pubis
        
        Mid inguinal point
      - Popliteal
        
        Flex leg / Relax leg ,lift leg, between heads of gastrocnemius
      - Dorsalis pedis
        
        1/3 from the mid point of the malleoli to the first interdiital space
        Lateral to extensir hallucis longus in upper 1/3 of foot
      - Posterior Tibial
  - - - ABI
        
        Ankle systolic pressure / Brachial systolic pressure
        
        Normal 1-1.1
        Intermittent Claudication 0.6 - 0.9
        Rest pain 04.-0.5
        Ulcers / gangre ≤ 0.3
    - - Duplex Angiography
      - CT/MR angiography
        
        3D reconstructions
        
        Indications
        
        Aorto-iliac disease
        
        Obese - duplex can't see
      - Indications: When planning internvention
    - - ABI
      - Toe pressure
        
        normal 70/80/90 mmHg
        Rest pain <30mmhg
      - Treadmill testing
        
        ABI post exercise
      - Duplex Angiography
        
        Only if planning intervention
        
        Non invasive
        Outpt
        1st line screening
        
        Duplex = B mode US and doppler effect
  - - - Exercise programme
      - Diet
      - Smoking cessation
      - Reduce Weight
    - - Antiplatelet agent - Aspirin (or clopidogrel)
      - Lipid lowering: Statin
      - Blood pressure control < 120/80: ACE inhibitor
      - Regulate DM Hba1c <7%
      - Risk Factor Modification
    - - Endovascular
        
        Balloon angioplasty +/- Stent
        1️⃣st line for most
      - Open
        
        Bypass Graft
        
        2️⃣line
        
        Anatomical (follows anatomical route of BF):
        
        Aortobifemoral #
        
        Fem-pop (above knee and below knee)
        
        Infra-inguinal Occlusive Disease
        
        Fem-distal (tibial or peroneal)
        
        Extra-anatomical (Doesn’t follow anatomical route of BF):
        
        Fem-fem crossover, #
        
        Axillo-fem/bifem #
        
        Graft Material
        
        Saphenous Vein
        
        Reveresed
        
        Valvulotomy and use in situ
        Better size match
        
        Use
        
        Fem-fem
        
        Single scare - harvesting and surgery at same time
        
        1️⃣
        
        Synthetic
        
        Disadvantages
        
        Occlusion - kink
        
        Risk of infection
      - Often use Combo
      - Indications
        
        Critical ischaemia
        
        Severe claudication
- - - - Cumulative risk of ipsilateral stroke at 2 yeasr 9% in surgically treated group compared to 26% in medically treated group
      - Showed benefit of surgery over best medical treatment for pts who
        Symptomatic ( had TIA / CVA)
        AND >70% stensosis
      - Relative risk reductionof 65% but NNT 6
      - If <70% medical tx - Best Medical Tx
        Aspirin
        Statin
        Strict BP
  - - - Risk Factor Modifications
        
        Antihypertensives: ACE
        
        Lipids: Statins
        
        DM: Improve control
      - Antiplatelets
        
        Aspirin
        
        Alternative: Clopidogrel
    - - Endartercetomy
        
        Procedure: Removal of diseased intima and media of vessels
        
        Greatest of stroke risk within 2 weeks
        
        Complications
        
        Vagus nerve
        
        Hypoglossal nerve
        
        Bleeding - suction drain
        
        Infection
        
        Stump pressure
        
        Shunt
        
        Clamp
        
        Timing: Within 2 weeks of symptoms
      - Carotid Angioplasty and Stenting
        
        Carotid angioplasty and stending higher risk of stroke than endarterectomy
        
        Indication: Hostile neck
        
        H/N cancer
- - - - Fusiform most common
      - Saccular
  - - - 7-8% over 65
  - - - Severe abdo / back pain
        Circulatory collapse
        Pulsatile mass
    - - High output cardiac failure
        Loud machinery murmur audible within abdo