Vascular — 5-min cram sheet

Vascular — 5-min cram sheet

_Built from the vascular disease index. Deck-faithful._

Buzzword → answer (the vignette reflex)

• "Corkscrew collaterals" on angiography → Buerger's disease (young male smoker; claudication + Raynaud's + migratory superficial thrombophlebitis)
• Migratory superficial thrombophlebitis (Trousseau's sign) → thrombophlebitis migrans (paraneoplastic, classically pancreatic adenocarcinoma)
• Abdominal pain "out of proportion" to physical signs → acute mesenteric ischaemia
• Postprandial pain ~30 min after eating + fear of eating + weight loss ("intestinal angina") → chronic mesenteric ischaemia
• Impotence + lower-extremity claudication + buttock wasting → aortoiliac disease (Leriche syndrome)
• "Rocker bottom" deformity (collapsed medial arch) → Charcot foot (disease-defining)
• Champagne bottle sign / atrophie blanche / ankle flare (corona phlebectatica) → chronic venous insufficiency
• Punched-out, intensely painful ulcer, base devoid of granulation, absent pulses, lateral malleolus → arterial ulcer
• Ulcer just proximal to medial malleolus (gaiter's area), irregular sloping white edges → venous ulcer
• Tearing/severe chest pain extending into abdomen, sudden onset → aortic dissection (major RF = hypertension, NOT atherosclerosis)
• Acute abdominal pain + back pain + hypotension (triad) → ruptured AAA (>80% mortality)
• Numbness in webspace between great toe + 2nd toe (deep peroneal nerve) → compartment syndrome (diagnostic)
• Rest pain aggravated by elevation, relieved by hanging leg over bed → critical limb ischaemia
• "Nutmeg" liver → hepatic congestion (right-sided heart failure)

Sign / imaging → diagnosis

Criteria / classifications / scores at a glance

• Wagner (DFU), Grade 0–5: 0 intact skin (impending ulcer); 1 superficial; 2 deep to tendon/bone/ligament; 3 osteomyelitis; 4 gangrene of toes/forefoot; 5 gangrene of entire foot.
• CEAP — C (clinical): C0 no signs; C1 telangiectasia/reticular; C2 varicose veins; C3 oedema; C4A pigmentation+eczema; C4B lipodermatosclerosis+white atrophy; C5 healed ulceration; C6 active ulceration. (E = congenital/primary/secondary; A = anatomical; P = reflux/obstruction.)
• Fontaine (chronic PAD): I asymptomatic; IIa mild claudication; IIb moderate–severe claudication; III ischaemic rest pain; IV ulceration/gangrene.
• Rutherford — chronic PAD (cat 0–6): 0 asymptomatic; 1 mild / 2 moderate / 3 severe claudication; 4 ischaemic rest pain; 5 minor tissue loss; 6 major tissue loss.
• Stanford (dissection): Type A = involves ascending aorta (emergent surgery); Type B = distal to aortic arch.
• Aneurysm classification: aetiology (atherosclerotic/traumatic/congenital/inflammatory/dissecting); structure (true = all 3 layers / false = pseudoaneurysm); shape (fusiform/saccular); site (central/peripheral).
• Vasculitis by vessel size: Large = Takayasu · GCA · Behçet; Medium = PAN · Kawasaki · Buerger; Small = hypersensitivity angiitis.
• Lymphedema stages: 1 reversible, soft pitting, resolves with elevation; 2 irreversible, hard, pitting doesn't resolve with elevation; 3 irreversible (elephantiasis), hard with skin papillomas.
• Wells (DVT): +1 each (active cancer; paralysis/paresis/recent plaster; bedridden ≥3 days or major surgery within 12 wk; localised deep-vein tenderness; entire leg swollen; calf ≥3 cm larger 10 cm below tibial tuberosity; pitting oedema symptomatic leg; collateral superficial veins; prior DVT). −2 if alternative diagnosis at least as likely. <2 low → D-dimer first; ≥2 → compression U/S first.
• Rutherford — acute limb ischaemia: I viable (no sensory/motor, both Doppler audible); IIA marginally threatened (minimal/toe sensory, no motor, arterial ± venous audible); IIB immediately threatened (sensory >toes/rest pain, mild–mod motor, arterial inaudible); III irreversible (profound/anaesthetic sensory, profound motor rigor, arterial + venous both inaudible).
• 6 Ps of ALI: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis, Poikilothermia.
• ABI: >1.2 noncompressible/calcified (DM); 1.0–1.2 normal; 0.5–0.9 intermittent claudication; 0.1–0.4 critical limb ischaemia. CLI = ankle pressure <70 mmHg / toe pressure <50 mmHg. Trauma: ABI <0.9 → CTA.
• Hard vs soft signs (vascular trauma): hard (arterial/pulsatile bleeding, persistent haemorrhage + shock, expanding/pulsatile haematoma, thrill, bruit, absent pulse/distal ischaemia) → immediate OR; soft (small stable haematoma, related nerve injury, unexplained hypotension, prior haemorrhage, proximity to major vessel, diminished/unequal pulses) → further investigation.
• Virchow's triad: endothelial dysfunction/injury + altered blood flow (stasis or turbulence) + hypercoagulability.
• Exudate vs transudate: protein >3 g% vs <3 g%; specific gravity >1015 vs <1015; fibrinogen high (clots) vs none; cloudy vs clear; ↑ vascular permeability vs ↑ hydrostatic/↓ osmotic.
• Compression stocking classes: Class I 18–21 mmHg (minor varicosities/prevention); Class II 26–34 mmHg (uncomplicated varicose veins); Class III >34 mmHg (complicated varicose veins/venous ulcers). Contraindicated in PAD + cardiac failure; min ABPI >0.8 for safe compression.
• AAA screening & rupture risk (SVS): screen men ≥65 (all), men ≥55 (+FHx), women ≥65 (+FHx or personal smoking history). Rupture risk by size: 3–4 cm <0.5% → 4–5 cm 0.5–5% → 5–6 cm 3–15% → 6–7 cm 10–20% → 7–8 cm 20–40% → >8 cm 30–50%. Elective repair: men ≥5.5 cm; women 4.5–5.4 cm; expansion >1 cm/year; saccular; symptomatic; atypical (dissecting, mycotic pseudoaneurysm).
• Aneurysm elective-repair size thresholds (from disease entries): iliac >3.5 cm; splenic >2.5 cm; renal >2 cm (>2 cm in childbearing-age women); popliteal >2.0 cm (or thromboembolic); femoral >2.5 cm; pseudoaneurysm >2.5 cm → U/S-guided thrombin injection.

Discriminators that decide questions

1. Arterial vs venous ulcer — Arterial: punched-out margin, intensely painful, base devoid of granulation, absent pulses, lateral malleolus/dorsum/distal digits, AVOID compression. Venous: just proximal to medial malleolus (gaiter's area), irregular sloping white edges, slough + exudate, surrounding lipodermatosclerosis, Class III compression = mainstay.
2. Embolic vs thrombotic ALI — Embolic: sudden onset, no claudication history, no bruit (except aneurysm site), clinical diagnosis. Thrombotic: onset over hours/days, prior claudication history, bruit across trunk, needs angiography.
3. Dry vs moist gangrene — Dry: arterial occlusion + patent veins, line of demarcation / conical stump, slow putrefaction + mild toxaemia, no sepsis risk. Moist: occlusion of BOTH artery AND vein, poor demarcation / no line of separation, rapid putrefaction + severe toxaemia.
4. Lipoedema vs lymphoedema — Lipoedema: always bilateral, symmetrical, feet/toe sparing, Stemmer's sign negative. Lymphoedema: involves dorsum of foot, Stemmer's sign positive.
5. Phlegmasia (venous) vs acute arterial ischaemia — Phlegmasia cerulea dolens: cyanotic + swollen. Acute arterial ischaemia: pale + cold.