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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
Q

What measures can be taken in the secondary prevention of peripheral arterial disease?

A

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
Q

What can be done for the symptom improvement of peripheral arterial disease?

A

Pharmacotherapy
Exercise therapy
Angioplasty
Surgery

27
Q

After an acute MI, what is the reduction in mortality caused by cardiovascular rehabilitation?

A

25% reduction

28
Q

What does exercise in peripheral arterial disease improve?

A

BP
Dyslipidaemia
Endothelial function

29
Q

What is severe limb ischaemia?

A

Rest pain in more than 2 weeks per year
Tissue loss
ABPI < 0.5

30
Q

What is critical limb ischaemia?

A

Absolute ankle pressure < 50mmHg

31
Q

What measures can be taken in the modern management of critical limb ischaemia?

A 
Antiplatelet therapy 
Statins
Screen for diabetes
Diabetics achieve HbA1C < 7% 
Smoking cessation
BP < 140/85 mmHg
ACEIs
Surgery 
Angioplasty 
Amputation
32
Q

What is the typical presentation of acute limb ischaemia?

A 
Pain
Pulseless
Paraesthesia 
Pallor 
Paralysis
Cold
33
Q

What are the potential causes of acute limb ischaemia?

A

30% embolus

60% in-situ thrombosis

34
Q

What suggest an in-situ thrombosis as the cause of acute limb ischaemia?

A

History of intermittent claudication

35
Q

What suggests atrial fibrillation and embolus as the cause of acute limb ischaemia?

A

All pulses present in the contralateral limb

36
Q

What are the most important parts of history and examination of a patient with acute limb ischaemia?

A 
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
Q

What are the investigations necessary in acute limb ischaemia?

A 
ECG
CXR
Routine bloods
Cross match 
Angiography for suspected in-situ thrombosis 
Straight to theatre if suspected embolus
38
Q

What are the treatment options for acute limb ischaemia caused by embolus?

A 
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
Q

What are the treatment options for acute limb ischaemia caused by thrombosis?

A

Angiography, thrombolysis and PTA and bypass
or
Angiography and bypass if leg is salvageable

Amputation if leg is unsalvageable

40
Q

What are the contraindications for thrombolysis?

A

Recent stroke
GI bleed
Bleeding diathesis
Age > 80 years

41
Q

What are other causes of acute limb ischaemia?

A 
Transection/ stretched/ compressed/ percussion injury 
Limb fractures/dislocations
Stabbings
Blunt injury from RTA
Iatrogenic injury 
Popliteal aneurysm
Intra-arterial drug administration
Thoracic dissection
42
Q

In what percentage of patients is percutaneous transluminal angiography (PTA) considered?

A

49%

43
Q

What is PTA recommended for?

A

Short occlusions

44
Q

What is the improvement of quality of life achieved by PTA?

A

Improves quality of life until at least 24/12

45
Q

What kind of disease is unsuitable for PTA?

A

Extensive

46
Q

What are the patient requirements for PTA?

A

Well-managed risk factors
Poor quality of life
Acceptably co-morbidity
Clear understanding of mortality and morbidity

47
Q

What are the advantages and disadvantages of angioplasty?

A

Less morbidity
Reduced latency rates
Less durable

48
Q

What is the 5 year patency rate for aortobifemoral angioplasty?

A

90%

49
Q

What is the 5 year patency rate for femoral above knee/popliteal angioplasty?

A

65-70% with vein graft

35% with PTFE graft

50
Q

What is the 5 year patency rate for femoral posterior tibial angioplasty?

A

50% with vein graft

12% with PTFE graft

51
Q

What is the mortality and morbidity of femoral-popliteal bypass?

A

2% mortality

5-12% morbidity

52
Q

What is the amputation rate following femoral-popliteal bypass?

A

30 day 0.6%

future 0.2-3.3%

53
Q

What is the re-intervention rate following femoral-popliteal bypass?

A

18.3-38.8%

54
Q

What is the five year latency rate of a femoral-popliteal bypass?

A

45-73% - depends on conduit

55
Q

What are the amputation options in critical limb ischaemia?

A

Digital
Transmetatarsal
Below knee
Above knee

56
Q

What is the prosthetic mobility following amputation?

A

Unlimited household in;
80% below knee
40% above knee

Outdoor in;
65% below knee
43% above knee

57
Q

What is the energy cost of walking following amputation?

A

63% increase below knee

117% increase above knee

Cardiovascular System (40 decks)

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