Vascular assessment

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Information about Vascular assessment
Health & Medicine

Published on March 12, 2009

Author: stierney

Source: slideshare.net

Description

for Wound assessment course RCSI 2009

Adelaide & Meath National Children’s Hospital, Tallaght Sean Tierney, Consultant Vascular Surgeon Vascular assessment in Leg ulcers

Barrier

Balanced forces

Pathogenesis - destruction

Pathogenesis – failure of repair Oxygen >>>Nutrients

Healing - neutrophils

Healing - macrophages

Healing - macrophages

Healing - granulation

Healing - fibroblasts

Healing - collagen

Healing - epithelialisation

Normal healing

Ulcers

Causes of Ulceration Venous disease 81%* 1 o deep venous failure superficial venous failure combined 2 o DVT Arterial disease 10% Mixed (arterial venous) 7% Diabetic neuropathy 1% Malignancy 1% Rheumatoid 1% * O Brien et al. “ Prevalence and aetiology of leg ulcers in Ireland.” Ir J Med Sci 2000 17%

Venous disease 81%*

1 o

deep venous failure

superficial venous failure

combined

2 o DVT

Arterial disease 10%

Mixed (arterial venous) 7%

Diabetic neuropathy 1%

Malignancy 1%

Rheumatoid 1%

Trauma

Venous insufficiency normal Normal microvasculature

Venous insufficiency P P Normal Venous hypertension DVT & recanalisation Superficial reflux Defective deep valves

Venous insufficiency  Pressure

Venous insufficiency Normal High pressure

Venous ulcer History of venous disease DVT>>VVs Recurrent “ Painless” Signs of venous hypertension haemosiderin, lipodermatosclerosis, eczema ± flares/spider veins Note Normal ABIs Pain “ sloping”

History of venous disease

DVT>>VVs

Recurrent

“ Painless”

Signs of venous hypertension

haemosiderin,

lipodermatosclerosis,

eczema

± flares/spider veins

Note

Normal ABIs

Pain

Compression therapy * Diamond P. Management of leg ulcers in a rural community. J Wound Care 1994

Role of Surgery * Gohel et al. British Journal of Surgery 2005; 92: 291–297 open or recently healed ankle ulceration (>4 weeks) ABI < 0·85 Either superficial venous reflux mixed superficial and deep venous reflux Excluded No reflux, deep reflux only, deep occlusion

open or recently healed ankle ulceration (>4 weeks)

ABI < 0·85

Either

superficial venous reflux

mixed superficial and deep venous reflux

Excluded

No reflux, deep reflux only, deep occlusion

Role of Surgery * Gohel et al. British Journal of Surgery 2005; 92: 291–297 Healing Recurrence

Dangers of compression  Pressure

Quantifying arterial perfusion

ABI technique

ABI technique P

ABI technique – calcified vessels P

Arterial ulcer

Arterial ulcer History of intermittent claudication Pain Absent pulses Reduced ABIs Beware Colour, temperature, capillary filling unreliable “ punched out”

History of intermittent claudication

Pain

Absent pulses

Reduced ABIs

Beware

Colour, temperature, capillary filling unreliable

Vasculitis

Vasculitic ulcer History of inflammatory disease RA Unusual distribution Painful No venous disease Normal arterial system Note may coexist with arterial or venous disease

History of inflammatory disease

RA

Unusual distribution

Painful

No venous disease

Normal arterial system

Note

may coexist with arterial or venous disease

Neuropathic Ulcer

Neuropathic ulcer History of neuropathic disease MS, DM Pressure points Loss of protective sensation Painless ± venous disease ± arterial disease

History of neuropathic disease

MS, DM

Pressure points

Loss of protective sensation

Painless

± venous disease

± arterial disease

Diabetes

“ Biopsy” Malignancy

Infective

History Differential diagnosis Examination Review differential diagnosis Investigation Treat Review differential diagnosis Evaluate response

 

 

 

 

 

 

 

 

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