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Skin pigmentation is due to haemosiderin deposition. This patient also has thrombophlebitis of the long saphenous vein with overlying pigmentation arrow Crepe bandaging to compress vein and minimise propogation of thrombus Analgesia preferably non-steroidal anti-inflammatory drug Crepe bandaging to compress vein and minimise propogation of thrombus Analgesia preferably non-steroidal anti-inflammatory drug Varicose eczema occurs over prominent varicose veins and in the lower third of the leg. It...
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C reactive protein concentration gt 10 mg l and erythrocyte sedimentation rate gt 18 mm h are raised at time of diagnosis of giant cell arteritis but fall to normal levels after starting immunosuppressant therapy C reactive protein concentration gt 10 mg l and erythrocyte sedimentation rate gt 18 mm h are raised at time of diagnosis of giant cell arteritis but fall to normal levels after starting immunosuppressant therapy Polyarteritis nodosa is uncommon in the United Kingdom. It is associated...
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Spiral computed tomogram of both carotid systems showing a tight stenosis in the proximal segment of left internal carotid artery H H MjHH.it Magnetic resonance angiography has developed rapidly over the past five years. It has the advantage of imaging a moving column of blood and does not require ionising radiation or iodinated contrast, but the technique has obvious drawbacks in terms of cost efficiency and accessibility to scanners. A variety of imaging sequences are used depending on the...
ABC of arterial and venous disease Varicose veins
Varicose veins are tortuous, twisted, or lengthened veins. Unless the enlargement is severe, size alone does not indicate abnormality because size can vary depending on ambient temperature and, in women, hormonal factors. In addition, normal superficial veins in a thin person may appear large, whereas varicose veins in an obese person may be hidden. Varicose veins can be classified as trunk, reticular, or telangiectasia. Telangiectasia are also referred to as spider veins, star bursts, thread...
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If ischaemia is complete, the patient must be taken directly to the operating theatre because angiography will introduce delay, thrombolysis is not an option, and lack of collateral flow will prevent visualisation of the distal vasculature. If ischaemia is incomplete the patient should have preoperative angiography since simple embolectomy or thrombectomy is unlikely to be successful, thrombolysis may be an option, and the surgeon requires a road map for distal bypass. Embolic occlusion of the...
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Angioplasty L Bypass or endarterectomy Algorithm for treatment of critical limb ischaemia Surgical treatment options for aortoiliac disease Methods of pain relief for critical limb ischaemia Slow release opiate analgesia for example, morphine sulphate Prostacyclin analogues for example, Iloprost or prostaglandin Ej alprostadil Chemical or surgical lumbar sympathectomy Dorsal column spinal stimulation Not licensed in United Kingdom Scottish Intercollegiate Guidelines Network. Drug therapy for...
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risk of coronary heart disease over 10 years Angiotensin converting enzyme inhibitors Statins regular monitoring of liver renoprotective but caution in renal artery stenosis 17 of hypertensive diabetics
Secondary prevention of transient ischaemic attack and stroke
Kennedy R Lees, Philip M W Bath, A Ross Naylor Stroke or transient ischaemic attack is common and likely to be fatal or cause serious disability. A second stroke will not necessarily be of the same type as the initial event, although haemorrhages tend to recur. Patients with previous stroke commonly succumb to other vascular events, in particular myocardial infarction. Effective secondary prevention depends on giving attention to all modifiable risk factors for stroke as well as treating the...
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Distribution of non-venous and venous ulcers of lower limb. The majority of venous ulcers are in the gaiter area and the majortiy of non-venous ulcers in foot Distribution of non-venous and venous ulcers of lower limb. The majority of venous ulcers are in the gaiter area and the majortiy of non-venous ulcers in foot Inner side of Over toe joints first metatarsal Inner side of Over toe joints first metatarsal Common sites of venous, arterial, and neuropathic ulceration. Adapted from Tibbs et al...
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Cardioembolic or vascular aetiology Up to a quarter of ischaemic strokes are due to embolism from the heart or major vessels. In these patients, full anticoagulation should be considered. Embolic stroke can affect any vascular territory but can rarely be diagnosed conclusively. Certain features should prompt a search for an embolic source. Transthoracic echocardiography is usually adequate, but transoesophageal echocardiography is justified if the results are equivocal or the index of suspicion...
ABC of arterial and venous disease Ulcerated lower limb
Ulceration of the lower limb affects 1 of the adult population and 3.6 of people older than 65 years. Leg ulcers are debilitating and painful and greatly reduce patients' quality of life. Ulcer healing has been shown to restore quality of life. Lower limb ulceration tends to be recurrent, and the total annual cost of leg ulceration to the NHS has been estimated at 400m. Mixed venous-arterial disease Necrobiosis lipoidica diabetecorum Venous disease, arterial disease, and neuropathy cause over...
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Treatment of small vessel vasculitis Induction therapy to 3 months after remission, usually 6 months from diagnosis Cyclophosphamide, 2.0 mg kg day maximum 200 mg day . Age gt 60 years, reduce dose by 25 , gt 75 years by 50 Prednisolone, 1 mg kg day maximum 80 mg day reduced weekly to 25mg day by 8 weeks and then more slowly to 10 mg day by 6 months In severe, life threatening disease eg, pulmonary haemorrhage, severe crescentic glomerulonephritis with creatinine gt 500 mol l , consider plasma...
ABC of arterial and venous disease Acute limb ischaemia
Limb ischaemia is classified on the basis of onset and severity. Complete acute ischaemia will lead to extensive tissue necrosis within six hours unless the limb is surgically revascularised. Incomplete acute ischaemia can usually be treated medically in the first instance. Patients with irreversible ischaemia require urgent amputation unless it is too extensive or the patient too ill to survive. Apart from paralysis inability to wiggle toes or fingers and anaesthesia loss of light touch over...
ABC of arterial and venous disease Chronic lower limb ischaemia
Peripheral vascular disease commonly affects the arteries supplying the leg and is mostly caused by atherosclerosis. Restriction of blood flow, due to arterial stenosis or occlusion, often leads patients to complain of muscle pain on walking intermittent claudication . Any further reduction in blood flow causes ischaemic pain at rest, which affects the foot. Ulceration and gangrene may then supervene and can result in loss of the limb if not treated. The Fontaine score is useful when...
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Classification of primary lymphoedema Classification of primary lymphoedema Primary lymphoedema with bilateral below knee swelling due to hypoplasia of peripheral lymphatic vessels Primary lymphoedema with bilateral below knee swelling due to hypoplasia of peripheral lymphatic vessels Kaposi-Stemmer sign inability to pinch a fold of skin at base of second toe because of thickened skin indicates lymphoedema Kaposi-Stemmer sign inability to pinch a fold of skin at base of second toe because of...
ABC of arterial and vascular disease Vasculitis
COS Savage, L Harper, P Cockwell, D Adu, A J Howie Vasculitis is inflammation of blood vessel walls. The clinical and pathological features are variable and depend on the site and type of blood vessels that are affected. Diseases in which vasculitis is a primary process are called primary systemic vasculitides. The main types of vasculitides can be described using clinical features and pathological findings according to the Chapel Hill Consensus Conference. These names and definitions will be...
Noninvasive methods of arterial and venous assessment
Richard Donnelly, David Hinwood, Nick J M London Although diagnostic and therapeutic decisions in patients with vascular disease are guided primarily by the history and physical examination, the use of non-invasive investigations has increased significantly in recent years, mainly as a result of technological advances in ultrasonography. This article describes the main investigative techniques. Principles of vascular ultrasonography In the simplest form of ultrasonography, ultrasound is...