4. Vascular Disease Flashcards
- What does claudication mean?
2. Describe the 3 types of claudication, with specific clinical features distinctive to each type.
- impairment in walking or pain/discomfort/numbness/tiredness in the legs
- VASCULAR - intermittent cramping pain in the calves; predictable, reproducible and relieved by rest. Starts distally and progresses proximally
NEUROGENIC - caused by nerve root compression/stenosis of spinal canal. dermatomal pain. shooting/tingling. relieved by leaning forwards. unpredictable, positional
ORTHOPAEDIC - early morning stiffness; located at the joint
Describe the Rutherford Classification of Chronic Limb Ischaemia
- asymptomatic
- mild intermittent claudication
- severe claudication
- rest pain/nocturnal pain
- minor tissue loss (non-healing ulcer, focal gangrene, diffuse pedal ischaemia)
- major tissue loss - gangrene extending above trans-metatarsal level
4 investigations for chronic limb ischaemia
- ABPI - ratio of BP at the ankle to BP in upper arm. Ratio of <0.9 indicates need for risk factor modification; <0.5 indicates critical limb ischaemia
- Doppler/duplex ultrasound
- MRI angiogram (non invasive)
- catheter angiography (offers opportunity for therapeutic intervention)
Describe the pharmacological management of chronic limb ischaemia
- Statin
- Clopidogrel
- cilostazol - phosphodiesterase II inhibitor; promotes vasodilation
- Niftidrofuryl - 5HT2 antagonist; vasodilator
What is acute limb ischaemia?
sudden decrease in perfusion to the limb
Name the 6Ps of acute limb ischaemia
Pain Pallor Parasthesia Paralysis Pulseless Perishingly cold sensation
- What is Rutherford’s classification used to assess?
2. Which 2 parameters does it use to do this?
- assess prognosis of acute limb ischaemia
2. sensory loss and muscle weakness
Name the 2 main causes of acute limb ischaemia
- Embolic event - commonly secondary to cardiac thrombus
2. thrombotic disease - acute on chronic ischaemia
Within what time limits does revascularation need to be performed within?
at least 12 hours
What is the major complication of revascularisation?
reperfusion injury
Describe the pathophysiology of reperfusion injury
- capillaries more permeable - increase in diffusion and fluid filtration into tissues - can result in compartment syndrome
- activated endothelial cells produce more ROS but less NO following reperfusion leading to inflammation
What is an ulcer?
a chronic sore (abnormal break in the skin) that takes >2 weeks to heal
- What are venous ulcers caused by?
- Describe the appearance of a venous ulcer
- Name other features of venous ulcers
- venous insufficiency (blood unable to return to heart)
- shallow; irregular borders; typically found over medial malleolus
- Painful. associated symptoms of chronic venous disease (aching, itching, varicosities)
- What are arterial ulcers caused by?
- Describe the appearance of arterial ulcers
- Name other features of venous ulcers
- reduction in arterial blood flow
- small, deep lesions; well defined borders; necrotic base
- cold limbs, absent pulses
How are venous ulcers managed?
- leg elevation
- increased exercise
- multicomponent compression bandaging