SU27.1-8 | Vascular and Lymphatic Surgery — Glossary

Amputation through the thigh, used when below-knee tissue will not heal; gives poorer prosthetic rehabilitation.

Persistent, painless blue discolouration of the hands without the episodic triphasic Raynaud sequence.

Sudden arterial occlusion (embolic or thrombotic) threatening the limb within hours, recognised by the six P's.

Surgical removal of a limb or part of a limb, indicated for a dead, dangerous or useless part.

Endovascular dilatation of a stenosed artery with a balloon, often with a stent; best for shorter, more proximal lesions.

Ratio of highest ankle to higher brachial systolic pressure; normal 0.9–1.3, <0.9 disease, <0.4 critical, >1.3 falsely high (calcified vessels).

A screening autoantibody whose presence (with specific antibodies such as anti-centromere or anti-Scl-70) points to a connective-tissue cause of secondary Raynaud's.

Non-invasive first-line imaging combining B-mode and Doppler to show the site and severity of arterial disease.

Lipid-driven plaque disease of large and medium arteries; the commonest cause of occlusive arterial disease.

Fever, drenching night sweats and unexplained weight loss accompanying lymphoma, indicating systemic disease.

Amputation preserving the knee joint, giving far better prosthetic mobility and rehabilitation than above-knee amputation.

A non-atherosclerotic inflammatory thrombosing disease of small/medium distal vessels in young male smokers; treated chiefly by smoking cessation.

A bedside test: elevation produces pallor (angle indicates severity) and dependency produces sluggish reactive hyperaemia in an ischaemic limb.

First-line drug (e.g. nifedipine) for frequent or severe Raynaud's, relaxing vascular smooth muscle to reduce attacks.

The mechanism by which contracting calf muscles squeeze the deep veins to propel venous blood toward the heart against gravity.

Clinical staging of chronic venous disease (C0–C6) from no signs through varicose veins and skin changes to active venous ulcer.

Itchy, inflamed, cold-induced skin lesions of the digits, a vasomotor reaction distinct from Raynaud's phenomenon.

Sustained venous hypertension producing oedema, skin pigmentation, eczema, lipodermatosclerosis and venous ulceration.

The gold-standard investigation that maps venous reflux in varicose veins and confirms or excludes deep-vein thrombus.

Rest pain for more than two weeks and/or tissue loss (ulcer/gangrene); the limb is at risk and needs revascularisation.

Surgical removal of dead and infected tissue, the urgent first step in wet and gas gangrene.

Thrombosis of the deep veins of the limb, presenting as a unilateral swollen, warm, tender leg and threatening pulmonary embolism.

Foot disease in diabetes from the combination of peripheral neuropathy, ischaemia and infection, prone to ulceration and limb-threatening gangrene.

The antifilarial drug used to treat active Wuchereria bancrofti infection and, with albendazole, in mass drug administration programmes.

An ischaemic ulcer at the fingertip; in Raynaud's it is a red flag for severe or secondary disease.

Tissue death from gradual arterial occlusion without superadded infection; the part becomes black, shrivelled and mummified with a clear line of demarcation.

Gross, end-stage lymphoedema with massive limb swelling and thickened, warty, hyperkeratotic skin, classically from chronic filariasis.

Removal of an embolus from an artery, classically with a balloon (Fogarty) catheter, in acute embolic limb ischaemia.

A clot (often from the fibrillating left atrium or post-MI mural thrombus) that lodges in an artery, classically causing acute ischaemia in an otherwise healthy vessel.

First-line minimally invasive treatment of incompetent superficial veins using radiofrequency or laser energy.

A lymph node above the medial epicondyle of the elbow, examined as part of the systematic lymphatic examination.

Surgical removal of a whole lymph node for histology; required to diagnose and subtype lymphoma because nodal architecture must be assessed.

Surgical decompression of muscle compartments performed after reperfusion to prevent or treat compartment syndrome.

Infection by the mosquito-borne nematode Wuchereria bancrofti whose adult worms obstruct the lymphatics; the leading cause of secondary lymphoedema in India.

Death of the skin/muscle flaps of an amputation stump, often indicating the level chosen was too low for the blood supply.

Staging of chronic limb ischaemia: I asymptomatic, IIa claudication >200 m, IIb claudication <200 m, III rest pain, IV ulceration/gangrene.

Macroscopic death (necrosis) of tissue with subsequent putrefaction, arising from ischaemia, infection or both.

Clostridial (chiefly Clostridium perfringens) myonecrosis producing gas in the tissues, crepitus and severe toxaemia; a surgical emergency.

The major superficial vein of the medial leg and thigh, draining into the femoral vein at the sapheno-femoral junction in the groin.

Occupational secondary Raynaud's from prolonged use of vibrating tools such as chainsaws and drills.

A lymphoma characterised by Reed-Sternberg cells that typically spreads contiguously between adjacent node groups and is highly curable.

A device placed in the IVC to trap emboli, reserved for DVT patients in whom anticoagulation is contraindicated or fails.

Cramping muscle pain (classically calf) on walking a reproducible distance, relieved within minutes by rest — the mildest stage of limb ischaemia.

The clear boundary between dead and viable tissue that forms in dry gangrene as the body walls off the necrotic part.

Hardening and pigmentation of the subcutaneous tissue of the lower leg due to chronic venous hypertension.

Inflammation and enlargement of lymph nodes, typically tender, accompanying infection such as lymphangitis.

Acute bacterial (usually streptococcal) infection of lymphatic vessels, seen as tender red streaks tracking toward tender regional nodes.

Swelling from accumulation of protein-rich interstitial fluid due to impaired lymphatic drainage; characteristically non-pitting when established.

A malignant neoplasm of lymphoid (lymphoreticular) tissue, divided into Hodgkin and non-Hodgkin lymphoma.

A physiotherapy technique, part of decongestive therapy, used with compression and skin care to manage lymphoedema.

The desiccated, shrunken, blackened appearance of tissue in dry gangrene.

Examination of the nailfold capillaries; dilated, dropped-out or distorted capillaries suggest an underlying connective-tissue disease.

A heterogeneous group of lymphoid malignancies that are often more widely disseminated at presentation than Hodgkin lymphoma.

Narrowing or blockage of arteries reducing tissue perfusion; in the limb it produces claudication, rest pain and tissue loss.

Infection of bone, sought in the diabetic foot by probe-to-bone testing and imaging, as it influences the level of debridement or amputation.

Veins connecting the superficial to the deep venous system; their valves normally direct flow from superficial to deep.

Pain perceived as arising from the amputated part, a recognised complication of amputation.

Lymphoedema from a developmental abnormality of the lymphatics, subdivided by onset into congenita, praecox and tarda.

Idiopathic Raynaud's with no underlying illness; typically young women, symmetrical, benign, with no tissue loss.

An intravenous vasodilator used for severe digital ischaemia with ulceration in Raynaud's.

Embolisation of deep-vein thrombus to the pulmonary arteries, causing breathlessness, pleuritic pain or collapse; the feared complication of DVT.

Episodic, cold- or stress-triggered digital arterial spasm producing a triphasic colour change in the fingers and toes.

Severe forefoot/toe pain at rest, worst at night and relieved by hanging the foot down; signals advanced (critical) ischaemia.

Restoring arterial inflow (by angioplasty/stent or bypass) to save limb length and allow an amputation to heal at a lower level.

An alternative grading of chronic and acute limb ischaemia in categories (0–6) used to standardise severity.

Acquired lymphoedema from damage to or obstruction of previously normal lymphatics (filariasis, node clearance, radiotherapy, infection, malignancy).

Raynaud's due to an identifiable underlying cause; may cause digital ulcers/gangrene and abnormal investigations.

The signs of acute limb ischaemia: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis and Perishing cold (a cold limb).

The superficial vein of the posterior calf, draining into the popliteal vein at the sapheno-popliteal junction behind the knee.

Inability to pinch a fold of skin at the base of the second toe; a positive sign supports a diagnosis of lymphoedema.

The residual limb after amputation, constructed with viable flaps and good length to allow fitting of a prosthesis.

A left supraclavicular lymph node whose enlargement (Troisier's sign) can indicate an abdominal or thoracic malignancy.

Grafting (vein or prosthetic) to carry blood around an occlusion; preferred for long occlusions with a good distal target.

Chemical or surgical interruption of the sympathetic supply to abolish vasoconstrictor tone, reserved for resistant severe digital ischaemia.

A connective-tissue disease that is the commonest and most important cause of secondary Raynaud's, often with skin tightening and telangiectasia.

Compression of the subclavian vessels and/or brachial plexus (e.g. by a cervical rib) that can cause secondary digital ischaemia.

The classic indications for amputation: Dead (non-viable), Dangerous (life-threatening), and Damn nuisance (useless or intractably painful).

The classic Raynaud's change: white (pallor from spasm) → blue (cyanosis from desaturation) → red (reactive hyperaemia on rewarming).

Failure of venous valves to prevent backflow, allowing reflux and raised venous pressure — the basis of varicose veins.

Dilated, tortuous superficial veins caused by valvular incompetence and reflux; primary, or secondary to DVT or pelvic obstruction.

A condition of episodic, reversible excessive arterial spasm rather than fixed structural occlusion.

A shallow, sloping-edged, relatively painless ulcer at the gaiter area (medial malleolus) with surrounding skin changes and preserved foot pulses.

One-way valves ensuring venous blood flows only upward and from superficial to deep; their failure (incompetence) causes reflux.

The three factors promoting thrombosis: venous stasis, endothelial (vessel-wall) injury and hypercoagulability.

A clinical prediction score for the probability of DVT that, with D-dimer, guides the need for compression duplex ultrasound.

Tissue necrosis with superadded infection (often with venous obstruction); swollen, foul-smelling, spreading and systemically toxic — a surgical emergency.

The nematode responsible for lymphatic filariasis, with nocturnal periodicity of microfilariae detectable on a night blood smear.