arterial disease of the limbs Flashcards
how would you diagnose peripheral arterial disease
history
examination
ankle brachial pressure index
if intervention is planned for PAD what tests/imaging would you do
Duplex
MRA
Angiography
what does ankle brachial pressure give information about
the ratio of the blood pressure at the ankle to the blood pressure in the upper arm, therefore an indication of limb ischaemia
what treatment would be given for secondary management of claudication
lifestyle advice
aspirin
statin
ACE inhibitor
what is it important to screen for in those presenting with claudication
diabetes - 10% attending clinic for PAD are undiagnosed diabetics
what could you do to improve the symptoms of PAD
pharmacotherapy
exercise therapy
angioplasty
surgery
what claudication patients wouldnt be suitable for surgery
those with extensive disease -angioplasty suitable for only 15%
surgery is infrequently preformed
how long is angioplasty effective for
2 years average
what type of patients with PAD would be suitable for surgery
in patients where risk factors are well managed
in patients with poor QOL
if a patient has critical limb ischaemia what are the treatment options
secondary prevention medical treatment
in advanced cases surgery, angioplasty or amputation
what are warning symptoms of critical limb ischaemia
presence of rest pain
ulcer
gangrene
what are the 6 Ps of acute limb ischaemia
pain pulseless paraethesia pallor paralysis perishing cold
what is the cause of acute limb ischaemia
embolus 30%
in-situ thrombosis-60%
what are the treatment options in acute limb ischaemia if an embolus is the cause
if in immediate danger-straight to theater
if there is time- thrombolysis
leg not salvageable- amputation
what are the treatment options if acute limb ischaemia is due to a thrombus
salvageable-angiography then throbolysis or bypass
not salvageable- amputation
