Arterial Disorders Flashcards
Chronic arterial stenosis and occlusion of the leg
1- intermittent claudication
2- rest pain
3- ulceration/gangrene
Intermittent claudication
Brought on by exercise
Relieved by standing still
Usually felt in the calf in superficial femoral artery stenosis.
In aortoiliac disease in both buttocks. Thighs and calves. Along with sexual impotence.
Leriches syndrome
Rest pain
Brought on by lying flat or leg elevation.
Lessened by hanging foot out of bed.
Chronic vs acute arterial ischemia
In acute limb becomes cold. Paralysis. Numbness.
In chronic no such changes. However dependent rubor or sunset foot sign is present. And capillary refill time may become 10 seconds.
Arterial pulses can be diminished in chronic due to collateral.
Absent in acute.
Arterial bruit is present in chronic due to stenosis.
Risk factors
Smoking
Hypertension
Diabetes
Hyperlipidemia
Investigations
Doppler ultrasound blood flow and ankle brachial pressure index.
Duplex scanning.
Angiography.
Conservative management in intermittent claudication
Drugs like statins and antiplatelet aspirin 75 mg/day.
Percutaneous transluminal angioplasty (by a balloon catheter) and subintimal angioplasty(creation of a new lumen)
Done under local anesthesia
And for patients who cannot undergo major bypass surgery
Surgical options in rest pain
Aortofemoral bypass in aortoiliac disease. Or axillofemoral bypass. Axillobifemoral is better than axillounifemoral.
In Iliac disease. Ileofemoral bypass or femorofemoral bypass.
In profunda or common femoral artery disease. Endarterectomy.
Femorodistal bypass.
Types of grafts in bypass
Dacron
Autogenous saphenous vein. Long or short. Or arm veins. Reversed or in situ after valve disruption. Minimum 3 mm diameter.
Polytetrafluoroethylene (PFTE) graft with a small cuff of vein called Millers cuff.
