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CVS Pathology > Arterial Diseases of the Limbs > Flashcards

Arterial Diseases of the Limbs Flashcards

1
Q

What does the aorta split into in the pelvis?

A

Iliac arteries

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2
Q

What does the iliac arteries split into?

A

Common femoral

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3
Q

Branches of the superficial femoral artery

A 
Popliteal 
Anterior tibial 
Peroneal 
Posterior tibial 
Dorsalis pedis
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4
Q

Where do you feel the common femoral artery?

A

Mid inguinal point, half way between anterior superior iliac spine and the pubic symphysis

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5
Q

Where do you feel the popliteal artery?

A

Deep in popliteal fossa

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6
Q

Where do you feel posterior tibial pulse?

A

Half way between the medial malleolus and the achilles tendon

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7
Q

Where do you feel the dorsalis pedis pulse?

A

Lateral to the extensor hallicus longus tendon

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8
Q

Causes of critical limb ischaemia

A

Atherosclerotic disease of arteries supplying lower limb
Vasculitis
Buergers disease

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9
Q

Risk factors for critical limb ischaemia

A 
Male
Age
Smoking
Hypercholesteraemia
HTN
DM
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10
Q

Classification system of critical limb ischaemia

A

Fontaine classification

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11
Q

Stages of Fontaine classification of critical limb ischaemia

A

Stage I - asymptomatic, incomplete blood vessel obstruction
Stage II - mild claudication, pain in the limb
Stage IIA - claudication when walking > 200metres
Stage IIB - claudication when walking < 200metres
Stage III - Rest pain, mostly in feet
Stage IV - Necrosis and/or gangrene of the limb

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12
Q

Why would you get pain in feet at night with critical limb ischaemia?

A

BP drops at night and the way you are sitting - the perfusion would decrease at night and therefore cause the pain

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13
Q

What to ask about the claudication

A 
Exercise tolerance
Effect of incline
Change over time
Relieved by rest
Where in the leg 
Type of pain 
Bilateral or one leg
Distance they walk when it starts 
Rest pain
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14
Q

What type of pain is claudication usually?

A

Burning

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15
Q

Signs of chronic ischaemia in lower limbs

A

Ulceration
Pallor
Hair loss

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16
Q

Investigations for critical limb ischaemia

A 
Examination 
Auscultate (hand held doppler)
Ankle brachial pressure index (pressure)
Buergers test 
Hang feet off edge of bed 
Duplex 
CTA/MRA
Digital subtraction angiogram
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17
Q

ABPI in normal vasculature value

A

equal or > 1

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18
Q

ABPI in intermittent claudication

A

0.95 - 0.5

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19
Q

ABPI in rest pain

A

0.5 - 0.3

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20
Q

What is buergers test?

A

Elevate legs for pallor and beurgers angle, <20 degrees = severe ischaemia

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21
Q

What would you see if the feet are hung off the bed in claudication and what is this called?

A

Slow to regain colour and a dark red colour as the blood rushes in and the feet become red
Hyperaemic sunset foot

22
Q

1st line investigation for critical limb ischaemia

A

CTA/MRA

23
Q

Definition of emboli

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 embolism

24
Q

Definition of thrombus

A

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

25
Q

Sources of arterial embolus

A

MI
AF
Proximal atherosclerosis

26
Q

Causes of acute limb ischaemia

A 
Arterial embolus
Thrombus 
Trauma
Dissection 
Acute aneurysm thrombosis i.e. popliteal
27
Q

Presentation of acute limb ischaemia

A

6 Ps!!!

  • Pain
  • Pallor
  • Perishingly cold
  • Paraesthesia
  • Paralysis
  • Pulseless
28
Q

Irreversibility will occur how long after symptoms present in acute limb ischaemia?

A

> 6 hours

29
Q

Pathology of compartment syndrome

A

Muscle ischaemia
Inflammation
Oedema
Venous obstruction

30
Q

Presentation of compartment syndrome of lower limb

A

Tense, tender calf

31
Q

What is raised in compartment syndrome?

A

Creatinine kinase

32
Q

Management of acute limb ischaemia

A 
ECG
Bloods 
Analgesia
Anticoagulation
Suspicion of embolus - embolectomy 
Suspicion of thrombus - thrombectomy/thrombolysis, open embolectomy +/- bypass 
Amputation
Palliation
33
Q

Mortality of amputation

A

20%

34
Q

What % of acute limb ischaemia is due to emboli and to thrombus?

A

30% emboli

60% thrombosis

35
Q

Mortality of acute limb ischaemia

A

22%

36
Q

What % of patients with DM will develop a foot ulcer?

A

15%

37
Q

What is key in managing diabetic foot ulcers?

A

Prevention

38
Q

Prevention of diabetic foot ulcers

A

Footcare
Glycaemic control
Good wound care
Tracking infection (consider systemic Ax)

39
Q

Pathology of diabetic foot disease

A

Microvascular peripheral artery disease affecting capillary beds - stiffening of capillaries, inflammation etc
Peripheral neuropathy - risk of trauma - standing on things without realising etc
Mechanical imbalance - pressure points in odd places and tissue damage in these areas
Susceptibility to infection (via normal skin commensals)

40
Q

Footcare in DM

A

Always wear shoes
Check fit
Check pressure points / plantar surface of foot regularly
Prompt and regular wound care of skin breaches

41
Q

What should be investigated for in diabetic foot disease?

A

Osteomyelitis
Gas gangrene
Necrotising fasciitis

42
Q

Management of chronic limb ischaemia

A 
Anti-platelet 
Statin 
BP control 
Smoking cessation 
Exercise
Diabetic control 
Angioplasty/stent 
Surgical bypass
Endovascular reconstruction
43
Q

What can be used as a surgical bypass?

A

Femoral popliteal bypass
Femoral distal bypass to calves
Anatomical bypass - aorta to both femorals
Extra anatomical bypass
Axillo anatomical bypass (axilla to femoral))

44
Q

What does a surgical bypass require?

A 
Inflow above the blood flow
A conduit 
- autologous 
- synthetic 
Outflow
45
Q

Complications of surgical bypass

A 
Bleeding
Wound infection 
Pain 
Scar
DVT / PE / MI 
Death (2%)
Damage to nearby structures
Graft failure (stenosis / occlusion)
Distal emboli
46
Q

ABPI in diabetics

A

Higher

47
Q

What may T2DM have to do with their vessels and therefore how does this effect their ABPM?

A

Vessel classification

Abnormally high ABPM readings

48
Q

What is Buergers disease also known as?

A

Thromboangiitis obliterans

49
Q

What is buergers disease?

A

Small and medium vessel vasculitis that is strongly associated with smoking

50
Q

Features of buergers disease

A 
Extremity ischaemia 
- intermittent claudication 
- ischaemic ulcers 
Superficial thrombophlebitis 
Raynauds phenomenon

CVS Pathology (19 decks)

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