Arterial Disease of the Limbs - Presentation, Investigation and Therapy

Question 1

Describe the clinical presentation of arterial occlusive disease

Answer 1

• Claudication
• Rest pain
• Tissue loss
• Ulceration, pallor, hair loss
• Temp, CRT, sensation, pulse

Question 2

Identify the possible surgical interventions for the treatment of arterial occlusive disease

Answer 2

• Open surgery: bypass, endarterectomy

- Endovascular intervention: balloon angioplasty, stent placement

Question 3

Describe the staging of arterial occlusive disease

Answer 3

1) Asymptomatic
2) Mild claudication
a. >200 meters
b. <200 meters
3) rest pain
4) necrosis and/or gangrene
(3 and 4 are CLI)

Question 4

Describe the special examination tests of arterial occlusive disease

Answer 4

• Hand-held doppler
• Ankle brachial pressure index
  Buerger’s test;
• Raise legs, pallor indicate severe ischaemia
• Hang legs off of bed: slow to regain colour, dark red colour (hyperaemic sunset foot)

Question 5

Describe the investigations of arterial occlusive disease

Answer 5

• Duplex: combines USS and doppler
• CTA/MRA: first line according to NICE
• Digital subtraction angiography

Question 6

Describe the causes of acute limb ischaemia

Answer 6

• Thrombosis
• Arterial embolus
• Trauma
• Dissection
• Aortic aneurysm thrombosis

Question 7

What are the 6 P’s of acute limb ischaemia

Answer 7

• Pain
• Pallor
• Pulse deficit
• Parasthesia
• Paresis/paralysis
• Poikilothermia
  (Compare to contralateral limb)

Question 8

Describe compartment syndrome

Answer 8

• Muscle ischaemia (irreversible after 6-8 hours)
• Inflammation, oedema, venous obstruction
• Tense, tender calf
• Elevation in creatinine kinase
• Rise in renal failure (myoglubinaemia)

Question 9

Describe diabetic foot disease

Answer 9

• 25% of diabetics get foot ulcers, 50% of which become infected, 20% of which need amputated
• Microvascular PAD
• Peripheral neuropathy
• Mechanical imbalance
• Foot deformity
• Minor trauma
• Susceptibility to infection

Question 10

Describe the prevention of diabetic foot disease

Answer 10

• Always wear shoes, avoid minor injuries
• Check foot regularly
• Effectively treat any wounds
• Effective glycemic control

Question 11

Describe the management of diabetic foot disease

Answer 11

• Prevention
• Infection: systemic antibiotics
• Investigate for osteomyelitis, gas gangrene, necrotising fasciitis
• Revascualrisation/amputation
• Debridement: larval therapy
• Dressings/skin grafts