Aneurysms , ischaemic limb and occlusions Flashcards
What is intermittent claudication
muscle pain that happens when active but stops when patient is at rest
symptoms of blood flow problems such as peripheral artery disease
what may someone with intermittent claudication present with
aching/burning in leg following walking
can walk a predictable distance before symptoms start
relieved within minutes of stopping
What may be seen in someone with critical limb ischamia
1 or more of
- rest pain in foot for more than 2 weeks
- ulceration
-gangrene
patients often report hanging legs out of bed at night to ease the pain
what may be seen in someone with acute limb ischaemia
1 or more of the 6 P’s
pale
pulselessness
painful
paralysed
paresthetic
perishingly cold
What factors are suggestive of thrombus in acute limb ischaemia
pre-existing claudication with sudden deterioration
no obvious source for emboli
reduced or absent pulses in contralateral limb
evidence of widespread vascular disease - stroke,TIA
What factors are suggestive of embolus in acute limb ischaemia
sudden onset of painful leg
no history of claudication
clinically obvious source of embolus - AF
no evidence of peripheral vascular disease
evidence of proximal aneurysm
What investigations are required
Duplex US for intermittent claudication- shows how blood flows to many parts of the body
Ankle brachial pressure index- detects arterial insufficiency
Handheld arterial doppler
<0.5 indicates critical limb ischaemia
Magnetic resonance angiography before any intervention
What do the results mean on a handheld arterial doppler
1- normal
0.6-0.9 - claudication
0.3-0.6 rest pain
<0.3 - impending
What is the general management
treat co-morbidities
stop smoking and exercise training
clopidogrel
atorvastatin 80mg
What is management for severe disease or critical limb ischaemia
-endovascular revascularization
percutaneous transluminal angioplasty + stent placement
endovascular techniques are typically used for short segment stenosis , aortoiliac disease and high risk patients
-surgical revascularisation
surgical bypass with autologous vein/prosthetic material
endarterectomy- unclogs arteries
surgical techniques are usually used for long segment lesions
What is the management for acute limb threatening ischaemia
ABC approach
IV opiods
IV unfractionated heparin if surgery is not immediate
vascular review
What is definitive management for acute limb threatening ischemia
intra-arterial thrombolysis
surgical embolectomy
angioplasty
bypass surgery
amputation if irreversible
