Vascular assessment
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Vascular assessment

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for Wound assessment course RCSI 2009

for Wound assessment course RCSI 2009

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Vascular assessment Vascular assessment Presentation Transcript

  • 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%
  • 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”
  • 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
  • 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”
  • 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
  • Neuropathic Ulcer
  • Neuropathic ulcer
    • 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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