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Cardiovascular system 16/17 > Arterial disease of the limbs > Flashcards

Arterial disease of the limbs Flashcards

1
Q

Where is the aortic pulse felt?

A

Above umbilicus

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2
Q

Where is the common femoral artery pulse felt?

A

Mid-ingunal point - halfway between pubic symphysis and superior iliac spine

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3
Q

Where is the popliteal artery pulse felt?

A

Deep in popliteal fossa of knee

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4
Q

Where is the posterior tibial pulse felt?

A

halfway between medial malleolus and the achilles tendon

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5
Q

Where is the dorsal is pedis pulse felt?

A

Lateral to the extensor hallucis longus tendon

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6
Q

What can cause critical limb ischaemia?

A

Atherosclerosis
Vasculitis
Buergers disease

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7
Q

What is buergers disease?

A

Inflammation of vessels, which then get blocked with clots

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8
Q

What are the risk factors for critical limb ischaemia?

A 
Male
Age
Smoking
Hypercholesterolaemia
Hypertension
Diabetes
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9
Q

How do we classify critical limb ischaemia?

A

Fontaine classification

I - asymptomatic
IIa - mild claudication walking >200m
IIb - mild claudication <200m
III - pain at rest, mostly in feet
IV - necrosis and/or gangrene
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10
Q

What in a patient history is necessary for CLI diagnosis?

A 
Claudication - leg out of bed at night
Rest pain
Tissue loss
Risk factors
PMH
Drug history - anti platelets, statins, diuretics
SH - smoking
OH - take into account the deciding treatment
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11
Q

What are some physical signs of critical limb ischaemia?

A 
Ulceration
Pale pallor
Hair loss
Cool to touch
Decreased peripheral pulses
Loss of peripheral sensation
Decreased capillary refill times
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12
Q

What special tests can be used to diagnose CLI?

A

Ankle brachial pressure index

Buergers test - elevate and lower legs and note pallor

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13
Q

Why in CLI do patients have hyperaemic sunset foot following the Buerger test?

A

Autoregulation is lost, leading to all capillaries filling rapidly to cause flush

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14
Q

What medical therapy is offered to those with CLI?

A 
Antiplatelets
Statins
BP control <140/85
Smoking cessation
Diabetic control
Angioplasty
CABG
Amputation if too severe
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15
Q

What investigations are used for CLI?

A

Duplex ultrasonography
CTA
MRA
Digital subtraction angiogram (not often used now)

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16
Q

What are the pros of duplex ultrasonography?

A

Dynamic

No radiation/contrast

17
Q

What are the cons of duplex ultrasonography?

A

Not clear in the abdomen
Operator dependent
time consuming

18
Q

What are the pros of MRA/CTA?

A

Detailed

19
Q

What are the cons of MRA/CTA?

A

Contrast and radiation used
Can overestimate calcification
Difficult in low flow states (occlusion)

20
Q

What is potency?

A

Degree of openness of a vessel

21
Q

What is required for a surgical bypass?

A

Adequate inflow
An available conduit/graft
Clear outflow path

22
Q

What are some complications of surgical bypass surgery?

A 
Bleeding
Infection of wound
Pain 
Scar
DVT/PR/MI/CVA
Death
Damage to nearby anatomy
Graft failure
Graft infection
23
Q

How does acute limb ischaemia present?

A

History of CLI and claudication
Onset of symptoms over 6 hours
Compartment syndrome

24
Q

What are the 6 Ps?

A 
Pain
Pallor
Perishingly cold
Paraesthesia (abnormal sensations)
Paralysis 
Pulseless
25
Q

When does acute limb ischaemia damage become irreversible?

A

> 6 hours since onset of symptoms

26
Q

What is compartment syndrome?

A

Increased pressure within one of the bodies compartments which contain muscles and nerves

27
Q

What are the 2 types of compartment syndrome?

A

acute - occur after trauma

chronic external - exercise induced

28
Q

What can cause compartment syndrome?

A

Trauma
Following attempt to revascularise tissue
Muscle cant drain, build up of pressure, feels tight and occluded blood flow, leading to ischaemia and possibly necrosis

29
Q

How do you treat acute limb ischaemia?

A

ECG, blood tests, nil by mouth
Analgesia and anticoagulants

If severe:
Amputation
Embolectomy

30
Q

What % of ALI is caused by emboli?

A

30%

31
Q

What % of ALI is caused by thrombosis?

A

60%

32
Q

What % of DM patients will develop a foot ulcer in their lifetime?

A

15%

33
Q

How can we prevent diabetic foot disease?

A 
Footcare
Glycaemic control
Regular checks
Education
Good wound care
34
Q

What is one of the most common foot deformities seen in diabetic patients?

A

“Rocker bottom foot” - prominent calcaneus (heel bone) and convex sole of the feet

35
Q

What causes diabetic foot disease?

A

Microvascular peripheral artery disease
Peripheral neuropathy
Mechanical imbalance
Infection by commensals

36
Q

What should you also investigate for in suspected cases of diabetic foot disease?

A

Osteomyelitis
Gas gangrene
Necrotizing fascitis

37
Q

How do we treat diabetic foot disease?

A

Revascularization (not very successful)

Amputation

Cardiovascular system 16/17 (40 decks)

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