Arterial disease of the limbs Flashcards
Rough anatomy down the leg for arteries from aorta
Aorta Iliac arteries Common femoral Superficial femoral Popliteal Anterior tibial, dorsalis pedis Peroneal artery, posterior tibial
Chronic limb ischaemia pathophysiology
Atherosclerosis
vasculitis, Buerger’s disease
Risk factors
male age smoking hypercholesterolaemia hypertension diabetes
What classification system for chronic limb ischaemia
Fontaine Classification
Symptoms at each stage of Fontaine Classification
- asymptomatic
- mild claudication when walking (a - >200m, b- <200m)
3 Rest pain - Necrosis and/or gangrene of the limb
- rest
Signs of chronic limb ischaemia
Ulceration
Pallor
Hair loss
Investigation
Hand held Doppler
Ankle Brachial pressure index
Buerger’s test (elevate legs, hang feet over edge of bed)
Duplex (ultrasound)
CT
Digital subtraction angiogram
Best medical therapy (6 things - think atherosclerosis)
Antiplatelet Statin BP control Smoking cessation Exercise Diabetic control
Surgical options for chronic limb ischaemia
Angioplasty
Surgical bypass
Amputation
Acute limb ischaemia pathophysiology
Arterial embolus Thrombosis Trauma Dissection Acute aneurysm thrombosis
6 Ps for what the leg would be like in acute limb ishaemia
Pain Pallor Perishingly cold Paraesthesia Paralysis Pulseless
What is compartment syndrome
When there’s bleeding or swelling in enclosed bundle of muscle
What enzyme levels rise in compartment syndrome
creatinine kinase
What management if limb is salvagable
embolectomy thrombolysis endovascular mechanical thrombolectomy open embolectomy bypass
What management is limb is not salvagable
Palliation
Amputation
