Arterial Diseases of the Limbs Flashcards
describe stage one of the fontaine classification
asymptomatic, incomplete blood vessel obstruction
describe stage 2 of the fontaine classification
A: claudication when walking a distance of greater than 200m
B: claudication when walking a distance less than 200m
describe stage 3 of the fontaine classification
rest pain in the feet
describe stage 4 of the fontaine classification
necrosis and/or gangrene
what signs of chronic ischaemia would you see when examining the legs?
> ulceration (tissue loss)
pallor
hair loss
what is an ankle brachial index?
the ankle pressure divided by the brachial pressure
describe the buergers test
the legs are elevated, if they become pale at an angle of less than 20 degrees then there is severe ischaemia.
the feet are hung over the edge of the bed, there is a slow regain of colour creating a dark red colour, hyperaemic.
what do anti-platelets do?
they reduce the risk of requiring revascularisation as well as reducing cardiovascular mortality
what are the effects of statins?
they inhibit antiplatelet activation and thrombosis, endothelial and inflammation activation, and plaque rupture.
what is the management?
> antiplatelet > statins > blood pressure control > smoking cessation > exercise > diabetic control
what imaging investigations would you carry out?
> duplex
CT/MRA
digital subtraction angiogram
what are the pros of a duplex imaging?
> dynamic
> no contrast or radiation needed
what are the problems with duplex imaging?
> not good on the abdomen
operator dependant
time consuming
what are the pros of CTA/MRA imaging?
detailed allows treatment planning
what are the problems the CTA/MRA imaging?
> contrast and radiation
> can overestimate calcification
if an angioplasty has been tried and it has failed what might you try next?
surgical bypass of the occlusion/stenosis
what does a surgical bypass require?
> inflow
conduit: autologous (veins form legs/arms) or synthetic
outflow
what are the technical complications of a surgical bypass?
> damage to nearby vein, artery, nerve
distal emboli
graft fracture
define thrombus
blood clot formed in situ within the vascular system of the body and impeding blood flow
what can cause acute limb ischaemia?
> arterial embolus > thrombosis > trauma > dissection > acute aneurysm thrombosis
what are the 6 p’s in the presentation of acute limb ischaemia?
> pain > pallor > perishingly cold > paraesthesia > paralysis > pulseless
when will irreversibility of acute limb ischaemia start?
after 6 hours
describe compartment syndrome of muscle ischaemia
there is inflammation but the fascia stops expansion resulting in oedema and venous obstruction. this becomes a cycle where the tissue dies. there is a rise in creatinine and a risk of renal failure.
what is the management of acute limb ischaemia?
> analgesia
anticoagulate
pain killer
heparin
