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Year 1-Cardiovascular System > Arterial Diseases of the Limbs > Flashcards

Arterial Diseases of the Limbs Flashcards

1
Q

What does the aorta divide into?

A

Two iliac arteries

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2
Q

What does the detection of a normal pulse confirm?

A

There is no significant stenosis or occlusion within the lumen of an artery

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3
Q

What is chronic limb ischaemia?

A

Atherosclerotic disease of the arteries supplying the lower limb

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4
Q

What are the risk factors for chronic limb ischaemia?

A

Male
Age
Smoking
Hypercholesterolemia
Hypertension
Diabetes

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5
Q

In which decade of life can atheromatous disease form?

A

3rd decade

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6
Q

In which decade of life can complicated plaques start to develop?

A

4th decade

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7
Q

Which classification system can be used to classify symptoms?

A

Fontaines Classification

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8
Q

What is stage one of Fontaines Classification?

A

Asymptomatic, incomplete blood vessel obstruction

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9
Q

What is stage 2A of Fontaines Classification?

A

Mild claudication pain in limb
Claudication when walking a distance of greater than 200 meters

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10
Q

What is stage 2B of Fontaines Classification?

A

Mild claudication pain in limb
Claudication when walking a distance of less than 200 meters

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11
Q

What is stage three of Fontaines Classification?

A

Rest pain, mostly in the feet

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12
Q

What is stage four of Fontaines Classification?

A

Necrosis and/or gangrene of the limb

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13
Q

Which stages of Fostaines Classification indicate critical limb ischaemia?

A

Stage III or IV

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14
Q

Which questions would you ask in a history if a patient has claudification?

A

Level of exercise tolerance, effect of incline, change over time, relieved by rest? Where in the leg, type of pain. Bilateral?

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15
Q

Upon examination, what are some of the signs of chronic ischaemia?

A

Ulceration
Pallor
Hair loss

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16
Q

What are the types of imaging you might use with someone with chronic limb ischaemia?

A

Duplex ultrasonography
MRA/CTA
Digital subtraction angiography

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17
Q

What is the first line imaging investigation for those with chronic limb ischaemia?

A

Duplex ultrasonography

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18
Q

What are the pros/cons for duplex ultrasonography?

A

Pros- dynamic, no radiation/contrast
Cons- Not good in the abdomen, operator dependant time consuming

19
Q

What are the pros/cons for MRA/CTA (MRI/CT angio)?

A

Pros- detailed so help with planning next steps
Cons- contrast and radiation

20
Q

Which types of drug make up the best medical therapy to manage chronic limb ischaemia?

A

Antiplatelet and a stain

21
Q

Discuss how control of risk factors can reduce risks of chronic limb ischaemia.

A

Reduction of BP to <140/85 can help
Smoking cessation
Diabetic control
More exercise

22
Q

What are the two revascularization procedures which can be done in patients with chronic limb ischaemia?

A

Open surgery
Endovascular intervention

23
Q

What are some of the open revascularisation surgeries used for management of chronic limb ischaemia?

A

Bypass and/or endarterectomy

24
Q

What are some of the endovascular revascularisation surgeries used for management of chronic limb ischaemia?

A

Balloon angioplasty
Stent placement
Atherectomy

25
Q

Define embolus.

A

A blood clot, air bubble, piece of fatty deposit, or other object which has been carried in the bloodstream to lodge in a vessel and cause an obstruction.

26
Q

Define thrombus.

A

A blood clot formed in situ within the vascular system of the body and impeding blood flow.

27
Q

What can cause acute limb ischaemia?

A

Embolus or a thrombus

28
Q

What is the clinical presentation for a patient with acute limb ischaemia?

A

6 Pā€™s :)

Pain
Pallor
Pulse deficit
Paraesthesia
Paresis/Paralysis
Poikilothermia (cold)

29
Q

What does paraesthesia mean?

A

A burning/prickly feeling

30
Q

After how much time is muscle ischaemia irreversible?

A

6-8 hours

31
Q

What can irreversible muscle ischemia cause to happen?

A

Inflammation, oedema, venous obstruction

All those cause calve tenderness

32
Q

Describe the findings of someone with marginally threatening limb ischaemia.

A

Minimal sensory loss- sometimes toes
No muscle weakness
Inaudible doppler signals
Audible doppler signals

33
Q

Describe the findings of someone with immediately threatening limb ischaemia.

A

Some sensory loss- more than toes
Mild/ moderate muscle weakness
Inaudible doppler signals
Audible doppler signals

34
Q

Describe the findings of someone with marginally threatened limb ischaemia.

A

Profound sensory loss
Profound muscle loss/ paralysis
Inaudible arterial doppler signals
Inaudible venous doppler signals

35
Q

In acute limb ischaemia, if the limb is salvageable and there is a suspicion of embolus, what can be done?

A

Embolectomy

36
Q

In acute limb ischaemia, if the limb is salvageable and there is a suspicion of thrombosis, what can be done?

A

Endovascular: mechanical thrombectomy / thrombolysis

OR

Open embolectomy +/- bypass

37
Q

In acute limb ischaemia, what are the management options if the limb is not salvageable?

A

If the patient is willing, amputate it.
If not, palliative management.

38
Q

What % of diabetic patients will develop foot disease?

A

25%

39
Q

What % of diabetic foot ulcers become infected?

A

50%

40
Q

Aetiology of diabetic food disease is usually multifactorial.

Therefore, list some of the causes of diabetic foot disease.

A

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

41
Q

Prevention is always better than cure :)

What preventative measures can reduce risks of diabetic foot ulcers?

A

Avoid walking barefoot
Ensure footwear are good fit
Check pressure points of the foot regularly
Prompt, regular wound care of any skin breaches

42
Q

If you notice infection of a foot ulcer, what should the immediate treatment be?

A

Antibiotics

43
Q

What are some of the management options for individuals with diabetic foot ulcers/disease?

A

Revascularisation
Amputation

44
Q

What are some adjunctive* measures for foot ulcers?

*supplement

A

Dressings

Debridement ā€“ Larval therapy

Negative Pressure Wound Closure

Skin grafts

Year 1-Cardiovascular System (41 decks)

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