Arterial disease

Question 1

whats another name for the deep femoral artery?

Answer 1

profunda femoris

Question 2

what are the main causes of arterial disease?

Answer 2

atherosclerosis

vasculitis i.e. buergers disease

Question 3

what are the risk factors for arterial disease?

Answer 3

male
age
smoking
hypercholesterolaemia
hypertension
diabetes

Question 4

describe the fontaine classification of arterial disease?

Answer 4

stage 1: asymptomatic
stage II: mild claudication pain in limb. a) >200metres b) <200 metres
stage III: rest pain, mostly in the feet
stage IV: necrosis and/or gangrene of the limb

Question 5

how can you tell the difference between arterial or venous causes of claudication?

Answer 5

if its venous disease then the patient will be in more pain when lying down as they don’t have gravity to pull the blood down into the feet.

Question 6

what are 3 signs of chronic ischamia?

Answer 6

pallor (pale colour)
hair loss
ulceration (not enough blood supply to keep the tissue alive)

Question 7

describe the examination to investigate if someone has arterial disease.

Answer 7

look for signs of ischaemia
feel for capillary refill, temp, pulses and peripheral sensation
Hand held doppler over dorsalis pedis and postural tibial pulses
Ankle brachial pressure index
Buerger’s test

Question 8

describe what the ankle brachial pressure index is.

Answer 8

Ankle pressure divided by the brachial pressure.
Symptom free will be 1 or more.
Intermittent claudication 0.96-0.5
Rest pain 0.5-0.3
Gangrene and ulceration <0.2

Question 9

in the burger’s test, when the patients leg is put back down, if it goes bright pink how does this occur and why?

Answer 9

about 1/3 of capillaries open up

this is due to a complete loss of auto regulation

Question 10

what is the best medical therapy for peripheral arterial disease?

Answer 10

antiplatelets
statins
BP control
smoking cessation
exercise
diabetic control

Question 11

when is BMT and surgery offered to patients?

Answer 11

when their symptoms are moderate/severe

Question 12

what imaging investigations can be carried out to show where a blockage is?

Answer 12

Duplex
CT Angio / MR Angio
Digital subtraction angiogram
If they have renal disease they may go straight to X-ray to avoid contrast

Question 13

what are the general risks from a surgical bypass?

Answer 13

bleeding
scar
pain
wound infection
LRTI
DVT / PE
MI 
cerebrovascular accident / stroke
Death

Question 14

what are the technical complications that can happen from a surgical bypass?

Answer 14

damage to nearby vein, artery, nerve
distal emboli
graft failure (stenosis or occlusion)

Question 15

what are the causes of arterial embolus?

Answer 15

MI
Atrial fibrillation
Proximal atherosclerosis

Question 16

what are the causes of acute limb ischaemia?

Answer 16

arterial embolus
thrombosis
trauma
dissection
acute aneurysm thrombosis

Question 17

what are the 6 P’s for the presentation of acute limb ischaemia?

Answer 17

pain
pallor
perishingly cold
paraesthesisa
paralysis
pulseless

Question 18

what is compartment syndrome?

Answer 18

muscle ischaemi, inflammation, oedema, venous obstruction

Question 19

what is a sign and symptom of compartment syndrome?

Answer 19

Tense, tender calf

Rise in creating kinase

Question 20

patients with compartment syndrome are at risk of what?

Answer 20

renal failure due to myoglobulinaemia

Question 21

what is the management for acute limb ischaemia?

Answer 21

Analgesia

Anti-coagluate

Question 22

what investigation is carried out in acute limb ischaemia and why?

Answer 22

ECG to check for AF

Question 23

what are the surgical options for ALI management if the cause is due to

a) thrombosis in situ?
b) embolus

Answer 23

a) endovascular thrombolectomy or thrombolysis
open embolectomy

b) embolectomy

Question 24

what is the time limit before acute limb ischaemia can cause irreversible muscle ischameia?

Answer 24

6-8 hours

Question 25

what makes diabetic foot disease hard to diagnose?

Answer 25

diabetics have loss of sensation so may not feel the pain

Question 26

why do diabetics have a susceptibility to infection?

Answer 26

impaired neutrophil function

Question 27

what is the pathophysiology which causes diabetic foot disease?

Answer 27

microvascular peripheral artery disease
peripheral neuropathy
mechanical imbalance
susceptibility to infection

Question 28

what is the management for diabetic foot disease?

Answer 28

prevention
good wound care
tracking infection - consider systemic antibiotics
investigations for osteomyelitis, gas gangrene, necrotising fasciitis

Question 29

what are the surgical management options for diabetic foot disease?

Answer 29

revascularisation - distal angioplasty/stent or distal bypass
amputation