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Introduction to the examination and clinical cases
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- By Jonathan Smout, Freeman Hospital, UK, Asif Mahmood, Hope Hospital, UK
- Edited by Vish Bhattacharya, Gerard Stansby
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- Book:
- Postgraduate Vascular Surgery
- Published online:
- 03 May 2011
- Print publication:
- 20 January 2011, pp 3-34
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- Chapter
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Summary
Popliteal aneurysm
The basics
Popliteal aneurysms (PAs) are the commonest peripheral aneurysm (Figure I.1). Approximately half are bilateral and half are associated with an aortic aneurysm. Conversely, 5–10% of patients with an abdominal aortic aneurysm (AAA) have a PA. The majority of PAs present with distal ischaemic complications in either the acute or chronic situation. The prevalence of the PA is thought to be around 1% for those in their eighth decade. When presenting acutely with distal limb ischaemia, limb loss occurs in up to 50% of cases. PAs almost exclusively occur in males. When treatment is indicated PAs are generally treated by surgical exclusion although endovascular management is a newer development in selected cases. Occasionally patients with patent PAs and very diseased run-off may be managed long term with anticoagulation to reduce the risk of aneurysm thrombosis.
The case
Popliteal aneurysms are usually easy to identify as an expansile, or prominent, pulsation in the popliteal fossa. The artery is best palpated against the tibia in the midline of the popliteal fossa, with the knee in the extended position (or with a few degrees of flexion). The artery can also be palpated with the knee flexed to 130°; in this position the popliteal fascia loosens to aid palpation. However, in doing so the manoeuvre deepens the artery from the skin surface. When thrombosed, PAs may be more difficult to diagnose clinically. It is important to assess the distal circulation for evidence of embolisation into the foot or calf vessels.
22 - Vasospastic disorders and vasculitis
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- By Mohammed Sharif, Belfast City Hospital, UK, Jonathan Smout, Freeman Hospital, UK, Gerard Stansby, Freeman Hospital, UK
- Edited by Vish Bhattacharya, Gerard Stansby
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- Book:
- Postgraduate Vascular Surgery
- Published online:
- 03 May 2011
- Print publication:
- 20 January 2011, pp 254-271
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- Chapter
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Summary
Key points
Understanding of the nomenclature used for the classification of vasospastic disorders into primary and secondary Raynaud's phenomena is essential
The management of these disorders requires a multidisciplinary team approach involving physicians, rheumatologists and vascular specialists
Treatment of Raynaud's includes general supportive measures, pharmacotherapy and correction of underlying disorders
Vasculitis is associated with a range of medical conditions and can present as digital ischaemia
A diagnosis of vasculitis is suggested by constitutional symptoms and confirmed by raised inflammatory markers, autoantibodies and biopsy of the skin lesions
Immunosuppressive therapy is the mainstay of treatment in vasculitic disorders
Introduction
Raynaud's phenomenon refers to a clinical state characterised by episodic vasospasm, usually involving the distal small arteries of the upper limb although sometimes toes and feet are also affected. In addition, there are other vascular disorders characterized by inflammatory changes in the arterial wall, known as ‘vasculitidies’, which can present with digital ischaemia.
Vasospasm (Raynaud's phenomenon)
Maurice Raynaud first described this clinical picture in 1862. The classical presentation of Raynaud's phenomenon is characterised by a sequence of colour changes in the following order:
pallor, reflecting initial vasospasm;
cyanosis as a result of deoxygenation of stagnant blood during maximum vasospasm;
rubor, representing inflow of oxygenated blood and reactive hyperaemia as the vasospasm subsides.
Episodes usually last for 30–60 min. However, some patients present with only cold hands and do not exhibit the classical triple colour response although they demonstrate a similar blood flow pattern to classical vasospasm.