UKOM Sp.DVE key terms

Reproducible muscle pain or cramping in the leg, buttock, or thigh provoked by walking a predictable distance and relieved within minutes by rest, caused by flow-limiting arterial stenosis that cannot meet metabolic demand during exercise.

Ratio of systolic pressure in the ankle artery to the higher of the two brachial systolic pressures. Values at or below 0.90 support a diagnosis of peripheral arterial disease; values above 1.30 suggest non-compressible calcified vessels.

Ratio of photoplethysmographic systolic pressure in the great or second toe to brachial pressure. It remains reliable when tibial arteries are calcified, with a normal value above 0.70 and values at or below 0.55 suggesting impaired perfusion.

Severe limb hypoperfusion presenting with rest pain or tissue loss (ulcer, gangrene) together with objectively reduced perfusion such as ankle pressure below 50 mmHg or toe pressure below 30 mmHg, threatening limb viability without revascularisation.

Sudden reduction in limb perfusion developing over two weeks or less, producing pain, pallor, pulselessness, paraesthesia, paralysis and poikilothermia. It is a vascular emergency because irreversible muscle and nerve damage begins within hours.

Raised pressure within a closed fascial compartment that compromises capillary perfusion and causes muscle and nerve necrosis. After revascularisation it presents with disproportionate pain, tense swelling and pain on passive stretch, and requires urgent fasciotomy.

Tissue damage caused by restoring blood flow to ischaemic tissue, driven by oxygen free radicals, calcium overload and inflammatory activation. It can produce local swelling, rhabdomyolysis, hyperkalaemia, acidosis and systemic organ dysfunction after revascularisation.

Occlusive atherosclerosis of the distal aorta and iliac arteries, classically causing buttock and thigh claudication, absent femoral pulses and erectile dysfunction. It may be treated by endovascular reconstruction or aortobifemoral bypass.

Endovascular placement of a stent in the femoropopliteal segment to restore patency after angioplasty. Nitinol self-expanding stents are used because the artery flexes and compresses across the knee and hip.

A stent coated with an antiproliferative drug in a polymer carrier that is released locally to suppress neointimal hyperplasia. It reduces restenosis compared with bare metal stents in selected femoropopliteal and infrapopliteal lesions.

Renarrowing inside a previously stented arterial segment, usually from neointimal hyperplasia or progressive atherosclerosis. It presents with recurrent claudication or ischaemia and is managed with drug-coated balloons, additional stenting or bypass surgery.

Endovascular technique in which a balloon catheter is inflated within a narrowed artery to fracture plaque and stretch the vessel wall, improving lumen calibre. It is often combined with stenting when the result is flow-limiting dissection or recoil.

An angioplasty balloon whose surface carries an antiproliferative drug such as paclitaxel that transfers to the vessel wall during inflation, limiting neointimal hyperplasia without leaving a permanent implant.

Focal permanent dilatation of the abdominal aorta to at least 30 mm or more than 50 percent greater than normal adjacent diameter. Most are infrarenal and asymptomatic; rupture risk rises steeply with diameter, especially above 55 mm.

Exclusion of an aortic aneurysm by transfemoral placement of a stent-graft that seals in the landing zones above and below the aneurysm sac. It has lower early mortality than open repair but requires lifelong imaging surveillance for endoleak and migration.

Persistent blood flow within the aneurysm sac after endovascular repair, outside the stent-graft lumen. Types I to V are classified by source, and types I and III require reintervention because they maintain sac pressurisation and rupture risk.

Tearing of the aortic intima that allows blood to enter the media and split its layers, creating a true and false lumen. Stanford type A involves the ascending aorta and is a surgical emergency; type B is managed medically unless complicated.

Organ or limb ischaemia caused by a dissection flap obstructing branch vessel flow or by false lumen pressurisation. It may affect coronary, cerebral, renal, mesenteric or limb circulation and is an indication for urgent intervention in type B dissection.

Stent-graft placement in the descending thoracic aorta to treat aneurysm, dissection, penetrating ulcer or traumatic transection. It requires adequate proximal and distal landing zones and carries a risk of spinal cord ischaemia.

Neurological deficit from inadequate perfusion of the spinal cord, most often after extensive aortic repair when the artery of Adamkiewicz or intercostal collaterals are covered or divided. Prevention includes cerebrospinal fluid drainage and maintaining adequate mean arterial pressure.

Placement of a lumbar drain to lower cerebrospinal fluid pressure and improve spinal cord perfusion during and after high-risk aortic surgery. Drainage is titrated to a pressure target, and the drain is removed promptly to avoid complications such as intracranial haemorrhage or infection.

Scheduled imaging of a known aneurysm or a repaired aorta to detect growth, endoleak or migration and to time intervention. Small abdominal aneurysms are typically scanned every 6 to 12 months, and post-EVAR patients are followed lifelong.

Impaired venous return from sustained ambulatory venous hypertension, producing oedema, skin pigmentation, lipodermatosclerosis and ulceration, usually around the medial malleolus. It results from deep or superficial venous reflux or obstruction.

Combined B-mode imaging and Doppler assessment of venous compressibility and flow used to diagnose deep vein thrombosis and to map reflux in superficial veins. Reflux is defined as retrograde flow lasting more than 0.5 seconds in superficial and 1 second in deep veins.

Treatment of an incompetent truncal vein by delivering radiofrequency or laser energy through a catheter to heat and close the vein wall. It is performed under tumescent anaesthesia and is less invasive than surgical stripping.

Formation of thrombus in a deep vein, most commonly in the lower limb, causing pain, swelling and tenderness. Proximal DVT carries a high risk of pulmonary embolism and is treated with anticoagulation, with thrombolysis reserved for limb-threatening cases.

Chronic venous symptoms and signs, including pain, swelling, pigmentation and ulceration, developing months to years after deep vein thrombosis because of valvular damage and persistent obstruction.

Measures to prevent deep vein thrombosis and pulmonary embolism in at-risk patients, including early mobilisation, graduated compression stockings, intermittent pneumatic compression and pharmacological agents such as low molecular weight heparin, balanced against bleeding risk.

Accumulation of protein-rich interstitial fluid because lymphatic transport is inadequate, producing non-pitting swelling, skin thickening and a positive Stemmer sign. Causes include filariasis, cancer treatment and congenital lymphatic dysplasia.

Application of graduated external pressure, through bandages or stockings, to reduce venous hypertension and oedema and to improve lymphatic drainage. It is central to venous ulcer healing and lymphedema management but requires adequate arterial perfusion.

An open skin defect below the knee caused by sustained venous hypertension, typically in the gaiter area with surrounding skin changes. Healing relies on compression, and refractory ulcers may require correction of superficial reflux.

Surgically created connection between an artery and a vein, usually in the forearm, that dilates and arterialises the vein for repeated cannulation during haemodialysis. It is the preferred access because of lower infection and thrombosis rates.

Synthetic conduit, usually polytetrafluoroethylene, interposed between an artery and vein to provide dialysis access when native veins are unsuitable. It matures faster than a fistula but has higher rates of stenosis, thrombosis and infection.

Distal limb ischaemia caused by blood diverted through a high-flow access, presenting with pain, pallor, coolness or tissue loss. Treatment options include flow reduction, banding, distal revascularisation-interval ligation or access ligation.

Serial measurement of dialysis access blood flow and venous pressures to detect stenosis before thrombosis. Falling flow or rising pressures prompt imaging and pre-emptive angioplasty, though trial evidence for surveillance alone is limited.

Immune-mediated thrombocytopenia caused by antibodies against platelet factor 4-heparin complexes, paradoxically causing thrombosis rather than bleeding. Management requires stopping heparin and starting a non-heparin anticoagulant such as argatroban.

Drugs such as aspirin, clopidogrel or ticagrelor that inhibit platelet aggregation to reduce arterial thrombotic events. They are used after endovascular intervention and bypass, with dual therapy reserved for defined periods after stenting.

Temporary substitution of a long-acting anticoagulant with a shorter-acting agent around surgery to limit thromboembolic risk while minimising bleeding. Current guidance often favours continuing or briefly interrupting therapy rather than routine bridging.

The process of giving a patient material information about a proposed procedure, including benefits, risks, alternatives and consequences of refusal, and obtaining voluntary agreement from a patient with capacity.

A collaborative process in which the clinician explains options and evidence and the patient expresses values and preferences, leading to a jointly agreed plan. It is central to elective vascular decisions such as aneurysm repair or amputation level.

A patient's ability to understand, retain, weigh and communicate information relevant to a specific decision. If capacity is lacking, treatment must follow best interests and legal frameworks, including advance decisions and proxy authority.

Discussion with a patient about future care preferences and goals, recorded as advance statements or decisions so that treatment can be guided if the patient later loses capacity.

A professional and legal obligation to inform patients promptly and openly when a safety incident has caused or may cause harm, to apologise and to explain what will be done in response.

A structured method for investigating an adverse event to identify contributing system failures rather than blaming individuals, producing recommendations that reduce the likelihood of recurrence.

A regular multidisciplinary conference in which complications and deaths are reviewed to identify learning points and system improvements. It supports quality assurance and professional accountability within a blame-free framework.

A quality improvement cycle that compares current practice against an agreed standard, implements change and re-measures performance. It differs from research because it evaluates delivery of established care rather than generating new knowledge.

A study design in which participants are allocated by chance to interventions and followed prospectively, minimising selection bias and supporting causal inference. It underpins the highest levels of evidence used in vascular guidelines.

The number of patients who must receive an intervention for one additional patient to benefit, calculated as the reciprocal of the absolute risk reduction. It translates trial results into practical clinical impact.

Use of real-time X-ray imaging during endovascular procedures, applying the principles of time, distance and shielding, pulsed low-dose settings and collimation to keep occupational and patient dose as low as reasonably practicable.

Imaging technique that subtracts a pre-contrast mask image from post-contrast images to display vessels without overlying bone. It remains the reference standard for arterial imaging and is used during endovascular intervention.

Acute kidney injury occurring within days of iodinated contrast administration after other causes are excluded. Risk is reduced by adequate hydration, minimising contrast volume and withholding nephrotoxic drugs.

Open surgical revascularisation in which a prosthetic graft from the aorta is tunnelled to both common femoral arteries, used for extensive aortoiliac occlusive disease or as an adjunct during aneurysm repair.

Infection involving a vascular prosthesis, presenting with fever, pain, false aneurysm or sinus formation. It is a serious complication requiring long antibiotic courses and often graft excision with extra-anatomic or in-situ reconstruction.

Surgical division of fascia to decompress a compartment and restore perfusion. It is indicated for compartment syndrome after revascularisation or trauma, and the wound is usually left open with delayed closure or grafting.

Breakdown of skeletal muscle releasing myoglobin, potassium and creatine kinase into the circulation, which can cause acute kidney injury and arrhythmia. It may follow prolonged ischaemia, trauma or reperfusion.

Ulceration or gangrene of the limb caused by inadequate perfusion, most often from peripheral arterial disease or diabetes. Its presence defines chronic limb-threatening ischaemia and drives urgent revascularisation decisions.

The blood-filled channel created within the aortic media by a dissection flap. Its patency and pressure influence branch vessel perfusion and aneurysm formation, and thrombosis of the false lumen is associated with better remodelling.