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Cardio 3 > Arterial diseases of the limbs > Flashcards

Arterial diseases of the limbs Flashcards

1
Q

What is the clinical presentation of arterial occlusive disease?

A

Cold, loss of pallor, painful leg.

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2
Q

What is the clinical presentation and progression of venous disorders?

A
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3
Q

What are the surgical interventions available for the treatment of arterial occlusive disease?

A

Stents or bypass

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4
Q

What does aorta divide into?

A

Aorta - illiac - common femoral (-cprofunda femoris) - Superficial femoral artery - popliteal artery - (ant tib - dorsalis pedalis) (Peroneal artery) (Posterior tibial artery)

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5
Q

How to feel aortic pulse?

A

2 hands above umbillicus

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6
Q

Check now you can feel common femoral, popliteal and posterior tibial and dorsalis pedilais

A

hip crease, under knee (relaxed knee), inside of inside ankle, on foot

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7
Q

What is Chronic Limb Ischemia?

A

Long term atherosclerotic disease in leg arteries, causing claudication or some form of ischemia eg on excertion

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8
Q

What are the risk factors for CLI?

A 
Male
Age
Smoking
Hypercholesterolemia
Hypertension
Diabetes
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9
Q

What are the 4 stages of CLI (Fontaine classification)

A

Stage I - No symptoms, incomplete blood vessel occlusion
II = IIa Claudication on walking over 200m, IIb claudication on walking under 200m
III = at rest pain in feet
IV = Gangrene/necreosis

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10
Q

Which stages are critical limb ischemia?

A

Stage III and IV (rest pain and gangrene/necrosis)

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11
Q

What is claudicaition?

A

Cramping/gripping sensation in calfves caused by ischemia

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12
Q

What factors should you ask about claudcation?

A

When, how long, exact location, exacerbating/relievling factors, bilateral, exercise tolerance, pain type.

Also think about Risk factors
Past Medical History
Drug History
Occupational History – Daily Habits
Surgical History
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13
Q

What are claudication relieving factors?

A

Dangling feet off bed

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14
Q

What foot symptoms are signs of chronic limb ischemia? Do you need to look at both legs?

A

Yes need to look at both legs to compare. Think UPH- Chonic limb ischemia!

Ulceration
Pallor
Hair loss

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15
Q

What is the hand held doppler used for?

A

To auscultate the dorsalis pedis and posterior tibial pulses

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16
Q

What do you need to feel for in clinical exam before the doppler exam?

A

Temperature
Capillary refill time
Peripheral sensation
Pulses – start at the aorta

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17
Q

What is ABPI?

A

Arterial Brachial Pressure Index:

Ankle Pressure (mmHg) / Brachial Pressure (mmHg)

A good measurement for the amount of occlusion of the arteries.

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18
Q

WHat is a healthy ABPI?

A

greater than 1

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19
Q

ABPI critical limb ischemia

A

Under 0.5

20
Q

intermittent claudication abpi

A

0.5-0.95

21
Q

Gangrene and ulceration abpi

A

less than 0.2

22
Q

What is Beurger’s test?

A

You lift the legs and thne put them back down, if has limb ischemi, then blood flow retunr will be slow and will turn darker colours

23
Q

Why does foot go to dark red colour?

A

Because it is chronic limb ischemia. usually in healthy leg approx only 1/3 capillaries etc are dilated, but due to hypoxia, all vessels are dilated.

24
Q

What investigations can be used for CLI? Pros and cons

A

Duplex - no contrast or radiation required, produces dynamic image. Not good on abdomen, operator dependant and time consuming.

MRACTA - clearer, requires ratiation/contrast and can overestimate calcification/difficult in low flow states

25
Q

What is first line invesitgation according to NICE?

A

CTA/MRA

26
Q

What usually follows a digital subtraction angiography?

A

Angioplasty (stent)

27
Q

Wgat is angioplasty?

A

Stent

28
Q

What is best medical therapy for Chronic Limb Ishemia?

A

combination of antiplatelet and statin

Antiplatelet: Reduces risk of requiring revascularization as well as cardiovascular and all-cause mortality
Statin: Inhibits platelet activation and thrombosis, endothelial and inflammation activation, plaque rupture by lowering LDL cholesterol in blood.

29
Q

How can we control risk factors in CLI?

A

Stop smoking, increasing walking 150%, controlling diabetes (10% peeps are unknown diabetes), managing bp (ideally 140/85)

30
Q

What are the 2 options for revasularisation

A

Endovascular intervention (balloon angioplasty/stent/atherectomy) and open surgery (bypass/endarterectomy)

31
Q

What is required for a surgical bypass?

A

In and out flows and something to put in the middle (ocnduit) eg synthetic or vein

32
Q

Give examples of General and Technical risks of complications arising from surgical bypass

A

General : Bleeding, wound infection, pain, scar, DVT, PE, MI, CVA, LRTI, death (2%)

Technical :Damage to nearby vein, artery, nerve, distal emboli, graft failure (stenosis, occlusion)

33
Q

Which options are better short/long term?

A

Short term endothelial (stent) long term is bypass

34
Q

What is acute limb ischemia? And causes?

A

Medical emergency - usually as a result of throbus or embolism. Severe limb ischemia, limb will die within 6-8h.

Pathophysiology:Arterial embolus: MI, AF, proximal atherosclerosis (NOT DVT/PE)
Thrombosis: Usually thrombosis of a previously diseased artery.
Trauma
Dissection
Acute aneurysm thrombosis i.e. popliteal

35
Q

What are the 6Ps of acute limb ischemia? What do you have to compare?

A 
Pain
Pallor
Pulse deficit
Poikilothermia (cold)
Paralysis/Paresis (muscular weakness)
Paraethesia (abnormal sensatino eg pins and needles)
36
Q

What is compartmet symdrome?

A

When an area is shut off for more than 6-8 hours, swelling, blocks weins, tender calf, Creatinine kinase increase, increased risk of renal failure.

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

37
Q

What are the 3 stages of acut limb ischemia?

A

I - Viable (audible art and venous doppler)
II - Threatened (inaudible art doppler, audible venous)
III - Irreversiable (inaudible art and venous doppler)

38
Q

Treatment options:
Salvagable limb - ebulus? Thrombus?
Non-Salvagable? Fit/willing for amputation?

A 
Salavagavgle :
Embolus - embolectomy
Thrombus - consider endovascular (thrombectomy/thrombolysis) or open embolectomy (w/wo bypass)
Non salvageable:
Fit/willing for amputation - amputation 
Not - palliate
39
Q

What % ALI embolic/thrombotic?

A

30% embolic, 60% thrombosis

40
Q

How long does it take for irreversiable muscle ischemia?

A

6-8h

41
Q

Is ALI a medical emergency?

A

Yes

42
Q

What is Diabetic foot disease? How prevelent? What % require amputation?

A

Ulcers on foot as result of diabetes. 25% all diabetics will get ulcers, 50% become infected, 20% require amputation

43
Q

What are the major contributing factor to ulcers? How best to prevent?

A 
Microvascular peripheral artery disease
Peripheral neuropathy
Mechanical imbalance
Foot deformity
Minor trauma 
Susceptibility to infection

Prevent:
Always wear shoes – avoid minor injuries
Check fit of footwear
Check pressure points/plantar surface of foot regularly
Prompt and regular wound care of skin breaches

Effective glycaemic control

44
Q

Management of diabetic foot disease?

A 
Antibiotics asap
Maggots (larvae therapy)
Negative pressure (shown to be best)
skin grafts
dressings
Amputation/revascularisation
45
Q

Where are 2 major sites of amputation?

A

Above and below the knee

Cardio 3 (5 decks)

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