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Cardiovascular > Arterial Disease of the Limbs > Flashcards

Arterial Disease of the Limbs Flashcards

1
Q

What are the 5 pulses in this lecture?

A 
Aorta 
Common femoral artery 
Popliteal artery 
Posterior tibial pulse 
Dorsalis pedis pulse
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2
Q

Where and how is the pulse of the aorta palpated?

A

Above the umbilicus

Use two hands to fell for the pulsation compared to the expansion

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3
Q

Where and how is the pulse of the common femoral artery palpated?

A

Mid-inguinal point, half way between the anterior superior iliac spine and the pubic symphysis

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4
Q

Where and how is the pulse of the popliteal artery palpated?

A

Use both hands to feel deep in the popliteal fossa

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5
Q

Where and how is the pulse of the posterior tibial pulse palpated?

A

Half way between the medial malleolus and the achilles tendon

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6
Q

Where and how is the pulse of the dorsals pedis pulse palpated?

A

Lateral to the extensor hallucis longs tendon

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7
Q

What causes critical limb ischaemia?

A

Atherosclerotic disease of the arteries supplying the lower limbs
Vasculitis
Burger’s disease

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8
Q

What are the risk factors for CLI?

A 
Male 
Age 
Smoking 
Hypercholesterolaemia 
Hypertension 
Diabetes
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9
Q

What symptoms are associated with stage 1 CLI?

A

Asymptomatic, incomplete vessel obstruction

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10
Q

What symptoms are associated with stage 2 CLI?

A

Mild claudication
A- claudication when walking a distance greater than 200 meters
B - claudication when walking a distance less than 200 meters

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11
Q

What is claudication?

A

Pain in the calves that is usually bilateral

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12
Q

What symptoms are associated with stage 3 CLI?

A

Pain at rest, mostly in the feet

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13
Q

What symptoms are associated with stage 4 CLI?

A

Necrosis and/or gangrene of the limbs

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14
Q

What are you looking for in the history and examination to diagnose CLI?

A

Claudication
Rest pain
Tissue loss

Examine the legs for:
Ulceration
Pallor
Hair loss

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15
Q

What should be done during the examination?

A 
Capillary refill times 
Temp 
Pulses starting at the aorta 
Peripheral sensation 
Auscultate, using a hand held doppler, the dorsalis pedis and posterior tibial pulses 
Ankle brachial pressure index
Buerger's test
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16
Q

How is the ankle brachial pressure index calculated?

A

Ankle pressure decided by brachial pressure in mmHg

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17
Q

What is the scaling system for the ankle brachial pressure index?

A

1 or more - symptom free
0.5-0.95 - intermittent claudication
0.3-0.5 - rest pain
<0.2 - gangrene and ulceration

18
Q

How is the Buerger’s test carried out?

A

Lift up leg of patient lying flat and observe for colour change
If there is a colour change before the leg is lifted to 20 degrees then there is severe ischamea
Let the leg down and ask the patient to sit on the side of the bed and observe how long it takes for the leg to return to normal colour

19
Q

How is peripheral vascular disease managed?

A 
Antiplatelets 
Statins 
Blood pressure control to get to 140/85 or less 
Aim for 150% improvement in walking time
Diabetic control
20
Q

What can be done to treat severe CLI?

A

Angioplasty/stent
Surgical bypass
BMT

21
Q

What can be done to treat critical CLI?

A

BMT
Angioplasty/stent
Endovascular reconstruction
Surgical bypass

22
Q

What imaging is used to investigate for CLI?

A

Duplex
CTA/MRA
Digital subtraction angiogram

23
Q

What does surgical bypass require?

A

Inflow
Outflow
A conduit - autologous or synthetic

24
Q

What are the risks of surgical bypass?

A 
Bleeding 
Wound infection 
Pain 
Scar 
Deep vein thrombosis 
Pulmonary embolism
MI 
CVA/stroke 
Lower respiratory tract infection 
Death 
Damage to nearby vein, artery or nerve
Distal emboli 
Graft failure
25
Q

What is acute limb ischaemia?

A

It is when there is a sudden lack of blood flow to a limb

26
Q

What causes acute limb ischaemia?

A 
Arterial emboli 
Thrombosis
Trauma 
Dissection 
Acute aneurysm thrombosis
27
Q

What Is the presentation of acute limb ischaemia?

A 
Pain 
Pallor 
Perishingly cold 
Paraesthesia 
Paralysis 
Pulseless
28
Q

What is the management of ALI if the limb is salvageable and it is caused only by an embolus?

A

Embolectomy

29
Q

What is the management of ALI if the limb is salvageable and a thrombus in situ is suspected?

A

Mechanical thrombectomy/thrombolysis

Open embolectomy and possibly surgical bypass

30
Q

What is the management of ALI if the limb is not salvageable?

A

If it can be amputated amputate, if not then palliate

31
Q

In ALI what happens after 6-8 hours?

A

Irreversible muscle ischaemia

32
Q

What is compartment syndrome?

A

Increased pressure in one compartment of the body which can cause muscle ischaemia, inflammation, oedema and venous obstruction

33
Q

How does compartment syndrome affect a person?

A

Makes the compartment tense and tender

34
Q

What is there an increased level of in compartment syndrome?

A

Kinase

35
Q

What is there a risk of with compartment syndrome?

A

Renal failure

36
Q

What is diabetic foot disease?

A

A foot that exhibits any pathology due to diabetes

37
Q

What is the pathophysiology of diabetic foot disease?

A

Microvascular peripheral artery disease
Peripheral neuropathy
Mechanical imbalance
Susceptibility to infection

38
Q

What can be done in terms of foot care?

A

Always wear shoes
Check fit of footwear
Check feet regularly
Prompt and regular wound care of skin breaches

39
Q

How is diabetic foot disease managed?

A

Good wound care
Tracking infection - possibly systemic antibiotics
Investigate for osteomyelitis, gas gangrene and necrotising fasciitis

40
Q

What is the surgical treatment of diabetic foot disease?

A

Revascularisation

Amputation

41
Q

What are the results of diabetic foot disease?

A

Infection
Diabetic foot ulcers
Neuropathic osteoarthropathy

Cardiovascular (34 decks)

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