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Systems: Cardiovascular > Arterial disease of the limbs > Flashcards

Arterial disease of the limbs Flashcards

1
Q

\what causes normally causes critical limb ischaemia ?

A

Atherosclerotic disease of the arteries supplying the lower limb

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2
Q

What are some less common causes of critical limb ischaemia?

A

Vasculitis

Buerger`s disease

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3
Q

What is the classification of CLI?

A

Fontaine Classification

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4
Q

What is stage 1 CLI?

A

Asymptomatic, incomplete blood vessel obstruction

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5
Q

What is stage 2 CLI?

A

Mild claudication pain in limb

a) when walking greater than 200m
b) When walking a distance of less than 200m

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6
Q

What is stage 3 CLI?

A

Rest pain, mostly in feet

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7
Q

Stage 4 CLI?

A

Necrosis and/or gangrene of the limbs

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8
Q

What are the signs of chronic iscahemia in the limbs?

A

Ulceration
Pallor
Hair loss

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9
Q

What should be done when examining for CLI?

A

(Start at toes and compare)

  • Capillary refill times
  • Temperature
  • Pulses-start at aorta
  • Peripheral sensation
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10
Q

What pulses should be auscultated?

A
  • Dorsalis pedis

- Posterior tibial

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11
Q

What are the two special tests used when examining for CLI?

A
  1. Ankle Brachial pressure Index

2. Buerger`s test

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12
Q

How do you measure the ankle brachial pressure?

A

Ankle pressure
divided by
Brachial pressure

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13
Q

How do you carry out Buergers test?

A

elevate legs
-pallor
in less than 20 degrees= severe ischaemia

Hang feet over bed
-Slow to regain colour
-Dark red colour
(hyperaemic sunset foot)

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14
Q

What fraction of capillaries are normally open in the leg?

A

1/3

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15
Q

How should patients with Peripheral vascular disease be managed?

A

The same way as those with CHD

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16
Q

What is the best medical therapy for PVD?

A
  • Anti-platelets
  • Statin
  • Bp control
  • Smoking cessation
  • Exercise
  • Diabetic control
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17
Q

How do antiplatelets help PVD?

A

Reduce risk of requiring re-vascularisation as well as reducing cardio and all cause mortality

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18
Q

How do Statins help PVD?

A

inhibits platelet activation and thrombosis, endothelial and inflammation activation, plaque rupture

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19
Q

What is the target for BP?

A

<140/85

20
Q

When does excess risk of cardiovascular disease diminish after smoking cessation?

A

4-6 yrs

21
Q

What percentage of Peripheral artery disease patients are undiagnosed diabetics?

A

10%

22
Q

What is added to BMT when symptoms are severe?

A

Angioplasty/stent/surgical bypass

23
Q

What is added to BMT when symptoms are critical?

A

Angioplasty/stent/endovascular reconstruction/surgical bypass/stent

24
Q

What are the advantages of Ultrasound?

A
  • No radiation

- Dynamic

25
Q

What are the disadvatages of ultrasound?

A
  • Not good in abdomen

- Operator dependant

26
Q

What are the advantages of CT/MRI?

A
  • Detailed- allows treatment

- First line according to NICE

27
Q

What are the disadvantages of CT/MRI?

A
  • Contrast radiation

- Can overestimate calcification, difficulty in low flow states

28
Q

What happens in a digital subtraction angiogram?

A

needle is placed in artery and fluorescent dye is deposited

29
Q

what does surgical bypass require?

A

-Inflow
A conduit (autologous,synthetc)
-Outflow

30
Q

What is the risk of complications with surgical bypass?

A
  • General; bleeding, infection,pain,scar DVT,PE,MI,CVA,LRTI,Death (2%)
  • Technical :damage to nearby vein,artery, nerve,distal emboli,graft failure
31
Q

Define an emboli?

A

A blood clot, air bubble, peice of fatty deposit, or other object which has been carried in the bloodstream to lodge in a vessel and cause embolism?

32
Q

Define a thrombus?

A

A blod clot formed in situ within the vascular system of the body and impeding flow

33
Q

What causes an arterial embolus?

A

-MI,AF,proximal atherosclerosis

34
Q

What causes thrombosis?

A

usually thrombosis of a previously deceased artery

35
Q

What are the six Ps of CLI?

A
  • Pain
  • Pallor
  • Perishingly cold
  • Paraesthesia
  • Paralysis
  • Pulseless
36
Q

What is paraesthesia?

A

abnormal sensation, typically tingling or pricking (‘pins and needles’), caused chiefly by pressure on or damage to peripheral nerves.

37
Q

What happens in muscle compartment syndrome?

A
  • Muscle ischaemia
  • inflammation
  • oedema
  • Venous obstruction

Tense and tender calf

rise increatine kinase
Risk of renal failure

38
Q

When oedema occurs what happens?

A

venous system will not be able to drain

Amputation

39
Q

How do you manage ALI?

A

ECG bloods, nil by mouth

-analgesia anticoagulants

40
Q

What percentage of acute limb ischaemia is embolic and thrombosis in situ?

A
  • 30%

- 60%

41
Q

What is the mortality rate of acute limb ischaemia?

A

22%

42
Q

How many diabetics will develop a foot ulcer in their lifetime?

A

15%

43
Q

What is the pathophysiology of a foot ulcer?

A
  • Microvascular peripheral artery disease
  • Peripheral neuropathy
  • Mechanical imbalance
  • Suceptibility to infection
44
Q

What foot care should be adhered to when foot ulcers can develop?

A
  • Always wear shoes
  • Check fit of footwear
  • Check pressure points/plantar surface of foot regularly
  • prompt and regular woundcare of skin breaches
45
Q

What is the management of diabetic foot disease?

A

-revascularisation
=Disease is very distal
=distal bypass

-Amputation

Systems: Cardiovascular (31 decks)

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