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Cardiovascular System > Arterial Disease of the Limbs > Flashcards

Arterial Disease of the Limbs Flashcards

1
Q

What is intermittent claudication?

A

Cramp like pain in the muscles of the buttock, thigh and calf which occurs on exercise and is relieved by rest

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2
Q

What is critical limb ischaemia?

A

A more severe disease than intermittent claudication

Rest pain, ulceration and gangrene which starts peripherally and moves centrally

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3
Q

What are the potential causes of peripheral arterial disease?

A

Atherosclerosis
Diabetes mellitus
Less common vasculitis e.g. Beurger’s disease, hyperhomocysteinaemia, thromboangiitis obliterans

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4
Q

How is peripheral arterial disease diagnosed?

A

History
Examination
Ankle brachial pressure index (ABPI)

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5
Q

What investigations are needed if surgery or angioplasty is planned to treat peripheral arterial disease?

A

Duplex scan
MRA
Angiography

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6
Q

What is the prevalence of intermittent claudication in patients > 55 years?

A

4-7?

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7
Q

What percentage of people with intermittent claudication require intervention to prevent limb loss?

A

10%

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8
Q

What percentage of people with intermittent claudication require amputation?

A

1% per year

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9
Q

What are the important aspects to consider in amputation/treatment of perisperhal vascular disease?

A

Quality of life

Survival

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10
Q

What is the reduction in functional capacity in people with intermittent claudication compared to a healthy population?

A

50% reduced functional capacity

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11
Q

What are the risk factors of peripheral arterial disease?

A 
Smoking 
Lack of exercise
Diabetes
Hypertension
Hyperlipidaemia
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12
Q

What drugs can be prescribed for peripheral arterial disease prevention/secondary prevention?

A

Aspirin
Statins
ACEIs

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13
Q

What is the single most powerful risk factor associated with the aetiology and clinical progression of peripheral arterial disease?

A

Smoking

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14
Q

Within how long does the excess risk of cardiovascular disease diminish following smoking cessation?

A

4-6 years

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15
Q

What should be screened for in peripheral arterial disease? Why?

A

Diabetes

10% of those attending clinic will have undiagnosed diabetes

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16
Q

What effect does diabetes have on peripheral arterial disease?

A

Associated with more severe peripheral arterial disease

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17
Q

What will tight glycaemic control help the prevention of in peripheral arterial disease?

A

Microangiopathy

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18
Q

What will tight blood pressure control lead to in peripheral arterial disease?

A

Reduction in macrovascular complications and mortality rates

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19
Q

When is lipid lowering therapy with a statin recommended (according to SIGN)?

A

For patients with peripheral arterial disease and total cholesterol > 3.5 mmol/l

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20
Q

What do statins decrease the 5 year incidence of?

A

Major coronary events, coronary revascularisation and stroke by 1/5th per mmol/l reduction in LDL cholesterol

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21
Q

What are the kinds of statins?

A

Cholesterol lowering

Pleiotrophic

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22
Q

How do statins work?

A

Inhibit platelet activation, thrombosis, plaque rupture, inflammatory activation and endothelial activation

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23
Q

According to SIGN, what is the current BP target for hypertensive patients with peripheral arterial disease?

A

< 140/85mmHg

24
Q

According to SIGN/TASC II, what patients with peripheral arterial disease should be prescribed anti-platelet therapy?

A

All patients

25
What measures can be taken in the secondary prevention of peripheral arterial disease?
Anti-platelet therapy with aspirin (or clopidogrel 2nd line) Statins Screen for diabetes Diabetics achieve HbA1C < 7% and reassess at 3-6 months for exercise and PTA Smoking cessation BP control, to < 140/85 mmHg
26
What can be done for the symptom improvement of peripheral arterial disease?
Pharmacotherapy Exercise therapy Angioplasty Surgery
27
After an acute MI, what is the reduction in mortality caused by cardiovascular rehabilitation?
25% reduction
28
What does exercise in peripheral arterial disease improve?
BP Dyslipidaemia Endothelial function
29
What is severe limb ischaemia?
Rest pain in more than 2 weeks per year Tissue loss ABPI < 0.5
30
What is critical limb ischaemia?
Absolute ankle pressure < 50mmHg
31
What measures can be taken in the modern management of critical limb ischaemia?
``` Antiplatelet therapy Statins Screen for diabetes Diabetics achieve HbA1C < 7% Smoking cessation BP < 140/85 mmHg ACEIs Surgery Angioplasty Amputation ```
32
What is the typical presentation of acute limb ischaemia?
``` Pain Pulseless Paraesthesia Pallor Paralysis Cold ```
33
What are the potential causes of acute limb ischaemia?
30% embolus | 60% in-situ thrombosis
34
What suggest an in-situ thrombosis as the cause of acute limb ischaemia?
History of intermittent claudication
35
What suggests atrial fibrillation and embolus as the cause of acute limb ischaemia?
All pulses present in the contralateral limb
36
What are the most important parts of history and examination of a patient with acute limb ischaemia?
``` Intermittent claudication history MI history Co-morbidities Examination to determine severity of ischaemia Absent sensation or movement Duration Pulses present - above or below femoral Atrial fibrillation ```
37
What are the investigations necessary in acute limb ischaemia?
``` ECG CXR Routine bloods Cross match Angiography for suspected in-situ thrombosis Straight to theatre if suspected embolus ```
38
What are the treatment options for acute limb ischaemia caused by embolus?
``` Analgesia and heparin first line Embolectomy if immediate danger Thrombolysis if time available Amputation if leg is un-salvageable and patient is fit May require fasciotomy ```
39
What are the treatment options for acute limb ischaemia caused by thrombosis?
Angiography, thrombolysis and PTA and bypass or Angiography and bypass if leg is salvageable Amputation if leg is unsalvageable
40
What are the contraindications for thrombolysis?
Recent stroke GI bleed Bleeding diathesis Age > 80 years
41
What are other causes of acute limb ischaemia?
``` Transection/ stretched/ compressed/ percussion injury Limb fractures/dislocations Stabbings Blunt injury from RTA Iatrogenic injury Popliteal aneurysm Intra-arterial drug administration Thoracic dissection ```
42
In what percentage of patients is percutaneous transluminal angiography (PTA) considered?
49%
43
What is PTA recommended for?
Short occlusions
44
What is the improvement of quality of life achieved by PTA?
Improves quality of life until at least 24/12
45
What kind of disease is unsuitable for PTA?
Extensive
46
What are the patient requirements for PTA?
Well-managed risk factors Poor quality of life Acceptably co-morbidity Clear understanding of mortality and morbidity
47
What are the advantages and disadvantages of angioplasty?
Less morbidity Reduced latency rates Less durable
48
What is the 5 year patency rate for aortobifemoral angioplasty?
90%
49
What is the 5 year patency rate for femoral above knee/popliteal angioplasty?
65-70% with vein graft | 35% with PTFE graft
50
What is the 5 year patency rate for femoral posterior tibial angioplasty?
50% with vein graft | 12% with PTFE graft
51
What is the mortality and morbidity of femoral-popliteal bypass?
2% mortality | 5-12% morbidity
52
What is the amputation rate following femoral-popliteal bypass?
30 day 0.6% | future 0.2-3.3%
53
What is the re-intervention rate following femoral-popliteal bypass?
18.3-38.8%
54
What is the five year latency rate of a femoral-popliteal bypass?
45-73% - depends on conduit
55
What are the amputation options in critical limb ischaemia?
Digital Transmetatarsal Below knee Above knee
56
What is the prosthetic mobility following amputation?
Unlimited household in; 80% below knee 40% above knee Outdoor in; 65% below knee 43% above knee
57
What is the energy cost of walking following amputation?
63% increase below knee | 117% increase above knee

Cardiovascular System (40 decks)

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