acute limb ischemia/PAD

Question 1

what is peripheral arterial disease

Answer 1

range of arterial syndromes that are caused by atherosclerotic obstruction of the lower-extremity arteries.

Question 2

signs and sx of PAD

Answer 2

mostly asx
intermittent claudication
thigh/buttock pain with walking that is relieved by rest
diminished/absent pulse

Question 3

sx of acute limb ischemia

Answer 3

1. pale
2. perishingly cold
3. pulseless
4. painful (severe)
5. parasthesia
6. paralysis

Question 4

RF for peripheral arterial disease

Answer 4

smoking
DM
HTN
hyperlipidaemia
age >40yrs
hx of coronary artery disease/CVS
low levels of exercise

Question 5

ix for peripheral arterial disease

Answer 5

ABPI - ABI ≤0.90

Question 6

mx of acute limb ischemia

Answer 6

1. urgent assessment (ABPI or duplex USS) for revascularisation/amputation
2. antiplt
3. analgesia
4. anticoagulation (aspirin or clopidogrel)

Question 7

mx for non-lifestyle limiting claudication

Answer 7

antiplt therapy - aspirin / clopidogrel
+ exercise
+ risk factor modification

Question 8

mx for lifestyle limiting claudication

Answer 8

antiplt
exercise
sx relief - cilostazol or naftidrofuryl
RF modification

Question 9

mx for chronic severe limb ischemia

Answer 9

assessment for revascularisation
antiplt therapy
RF modification

Question 10

follow up for PAD

Answer 10

1. claudication - annual follow up: looking for development of CVS and extremity disease
2. post-revasculation regularly for 1st 12mo, and annually thereafter

Question 11

complications of peripheral arterial disease

Answer 11

leg/foot ulcer
gangrene
permanent limb weakness/numbness
permanent limb pain

Question 12

px of PAD

Answer 12

1. if have claudication - DM and low ABPI increase risk of chronic limb ischemia
2. high mortality from critical limb ischemia
3. acute limb ischemia px depends on speed and completeness of revascularisation prior to permenant tissue and nerve damage

Question 13

definition of claudication

Answer 13

Inadequate blood flow during exercise, causing fatigue, discomfort, or pain

Question 14

definition of chronic limb ischemia

Answer 14

Compromise of blood flow to an extremity, causing limb pain at rest. Patients can develop ulcers or gangrene.

Question 15

definition of acute limb ischemia

Answer 15

A sudden decrease in limb perfusion that threatens limb viability. Associated with the “6 Ps”: pain, paralysis, paraesthesias, pulselessness, pallor, and poikilothermia.

Question 16

features of critical limb ischemia

Answer 16

pain at rest - burning or aching and worse at night
non-healing wounds
gangrene

Question 17

methods for revascularisation in acute limb ischemia

Answer 17

Endovascular therapies, for example:
* Percutaneous catheter-directed thrombolytic therapy.
* Percutaneous mechanical thrombus extraction.

Surgical interventions, for example:
* Surgical thromboembolectomy.
* Endarterectomy.
* Bypass surgery.
* Amputation if the limb is unsalvageable.