Acute & Chronic Limb Ischemia Flashcards
What does Pulse pressure mean?
The difference between systolic and diastolic pressure
What does Mean Arterial Pressure mean?
The pressure that propels the blood into the tissues
MAP = diastolic + 1/3 pulse pressure
What are differentials for a cold painful pale pulseless leg?
- Acute/Chronic limb ischemia
- Critical limb ischemia
- lembar stenosis & sciatica
- DVT
- Diabetic neuropathy
- Stroke
- Heart failure- peripheral oedema
What are IX for a cold painful pale pulseless leg?
- ABPI
- Doppler
- ECG - Afib
- FBC, baseline U&Es & LFTs
- CT angiogrpahy
- HBa1C
What is the Rutherford Classification?
What is limb claudication?
pain or discomfort in the legs during physical activity & is relieved by rest
What is peripheral arterial disease?
Occlusion or narrowing the arteries that supply blood to the legs commonly caused by atherosclerosis
What are differentials for limb claudication?
- Neurogenic claudication
- Musculoskeletal - arthritis, sciatica
- Venous insuffciency
- Peripheral neuropathy
What is the epidemiology of peripheral arterial disease?
Most common in men & prevalence increases with age
It is associated with coronary artery & cerebrovascular disease and their asssociated modifiable risk factors such as HTN, diabtetes & smoking
What is the fontaine classification?
Used in peripheral arterial disease
I - asymptomatic
IIa- mild claudication
IIb - moderate to severe claudication
III- ischemic rest pain
IV - ulceration or gangrene
What is leriche’s syndrome
- Claudication
- Absent femoral pulses
- Erectile dysfunction
What IX should be done in peripheral arterial disease?
- ABPI
- Duplex
- CT angiography
- magnetic resonance angiography
- contrast angiography
What is acute limb ischemia?
A sudden decrease in limb perfusion that causes a potential threat to limb viability in patients who present within 2 weeks of an acute event.
Due to embolus, thrombus or trauma
What are the 6 Ps of acute limb ischemia?
- Pain
- Pulselessness
- Pallor
- Paraesthesia
- Paralysis
- Poikilothermic - perishingly cold
What is diagnostic in acute limb ischemia?
CT angiogaphy
What is the management of acute limb ischemia?
Analgesia & Heparin
FBC, U&Es, LFTs, Clotting profile
Further ix include; endovascular therapies (PCI), thromboembolectomy, endarterectomy, bypass, amputation
complications include compartment syndrome & reperfusion injury
What is Dry Gangrene?
Develops when blood flow to affected area is impaired, the tissue driesup & turns brown/purple/blue/black.
It can be left to auto-amputate or can be amputated after revascularisation.
It is common in people with diabetes
What is Wet Gangrene?
Liquefactive necrosis due to infection.
The tissue swells & blisters - it is called wet due to pus
Infection can spread throughout the body & can become life threatening
What is the treatment for wet gangrene?
IV antibiotic
Amputation or revascularisation & debridement
What are the 3 types of arteries?
- Large elastic
- Medium muscular
- Arterioles
What are the 3 layers in arteries?
- Tunica intima
- Tunica media
- Tunica adventita/externa
What are the 3 types of capillaries?
- Continuous
- Fenestrated
- Discontinuous
regulation of blood flow
