Acute Limb Ischaemia

Question 1

What are the feature of acute limb-threatening ischaemia?

Answer 1

1 or more of the 6 P’s

• Pale
• Pulseless
• Painful
• paralysed
• Paraesthetic
• ‘Perishing with cold’

Question 2

What are the 3 main patterns of presentation seen in patients with peripheral arterial disease?

Answer 2

1. Intermittend claudication
2. Critical limb ischaemia
3. Acute limb-threatening ischaemia

Question 3

What are the features of critical limb ischaemia?

Answer 3

Features inclue 1 or more:

• Rest pain in foot for more than 2 weeks
• Ulceration
• Gangrene

> Patients often report hanging their legs out of bed at night to ease the pain

Question 4

Interprer these results of an ABPI:

• 1
• 0.6-0.9
• O.3-0.6
• <0.3

Answer 4

1 =Normal
0.6 -0.9 =Claudication
0.3-0.6 =Rest pain 
<0.5 =critical limb ischaemia
<0.3 =impending

Question 5

What are the features of intermitten claudication of PAD?

Answer 5

• Intermittent claudication: aching or burning of the leg muscles following walking
• Patient can walk a predictable distance before symptoms start
• Usually relieve within minutes of stopping
• not present at rest

Question 6

What is strongly linked to peripheral arterial disease?

Answer 6

Smoking

Question 7

What is the general management of PAD?

Answer 7

Comorbidities treated:
>Hypertension
>Diabetes mellitus
>Obesity

Treatment
>Statin
>Clopidogrel
>Exercise training

Other drugs
>Naftidrofurl oxalate: vasoldilator
>cilostazol: phsophodiesterase III inhibitor with antiplatelet and vasodilator effects

Question 8

What is the management of severe PAD or critical limb ischaemia?

Answer 8

• Angioplasty
• Stenting
• Bypass surgery

-Amputation should be reserved for patients with critical limb ischaemia who are not suitable for other interventions

Question 9

What is the management of acute limb ischaemia?

Answer 9

1. A-E assessment
2. Emergency assessment by vascular specialist
3. Secondary care depends on occlusion -surgical techniques