Arterial Limb Disease Flashcards

1
Q

What are the 3 types of Arterial Limb Disease (Peripheral Arterial Disease)?

A

Critical Limb Ischaemia (CLI)
Acute Limb Ischaemia (ALI)
Diabetic Foot Disease

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2
Q

What is CLI?

A

Long term loss of blood flow to limb tissue due to stenosis/occlusion of peripheral arteries

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3
Q

What commonly causes CLI?

A

Atheroma
Vasculitis
Beurger’s

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4
Q

What are the risk factors for CLI/ALI?

A

Male - Old - Smoker - Hypertension - Hypercholesterolaemia - Diabetes - History of CLI

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5
Q

What are the symptoms of CLI?

A

Claudication
Rest Pain
Tissue Loss
Ulceration
Pallor
Hair Loss
Slow Capillary Refill
Reduced Pulses
Loss of peripheral sensation
Gangrene

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6
Q

How can we investigate a case of CLI?

A

Duplex Ultrasound
CT angiography/MR angiography - First approach
Ankle/Brachial Pressure Index (ABPI)
Beurger’s Test

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7
Q

What is the ABPI?

A

Ankle BP/Brachial BP
A value below 1 indicates loss of blood flow to lower limb

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8
Q

What is the beurger’s test?

A

Unsurprisingly a test for beurger’s disease (occlusion of multiple medium & small arteries thanks to emboli)

Elevate legs - Pallor & severe ischaemic pain at any point below 20 degrees indicates beurger’s
Then hang feet over the bed - Should be slow to regain colour and turn a dark red colour due to hyperaemia

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9
Q

Why do feet turn dark red in the beurger’s test?

A

Normally only 1/3 of capillaries are open.
However in CLI, autoregulation is lost and they all open and so your feet get hyperaemic.

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10
Q

How do we treat varying levels of CLI?

A

A mild case gets Best Medical Treatment (BMT)
A severe case gets BMT & surgical bypass/angioplasty
A critical case adds endovascular reconstruction

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11
Q

What is the Best Medical Treatment for CLI?

A

Antiplatelets
Statins
Anti-Hypertensives
Smoking Cessation
Exercise
Diabetic Control

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12
Q

What is ALI?

A

Sudden onset loss of blood flow to limb tissue due to stenosis/occlusion of peripheral arteries

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13
Q

What causes ALI?

A

Mainly Thrombus in Situ or Arterial Embolus
Uncommonly Trauma, dissection or Acute Aneurysm Thrombosis

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14
Q

What are the symptoms of ALI?

A

Sudden onset 6Ps:
Pallor - Pain - Perishing cold - Paresthesia - Paralysis - Pulseless
If possible compare to contralateral limb

Onset of Gangrene if left too long

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15
Q

What is paresthesia?

A

Abnormal sensation
e.g. tingling, burning, tickling, numbness etc

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16
Q

What kind of tests would you do for ALI?

A

ECG
Bloods
Creatine Kinase levels to indicate muscle damage
Check for myoglobulinuria before it causes renal failure

17
Q

What injury can occur after treating ALI?

A

Repurfusion injury which can lead to compartment syndrome

18
Q

What treatment can we give for ALI?

A

Analgesia
Anti-coagulants - heparin
Palliative Care
Embolectomy under GA/LA
Thrombolysis or Thrombectomy

19
Q

What is diabetic foot disease?

A

The high glucose levels of diabetes damage the endothelium (microvascular PAD) and sensation (peripheral Neuropathy) particularly in the feet.
This leads to easy development and missing of ulcers/infections

20
Q

What are the symptoms of Diabetic Foot Disease?

A

Ulcers
Bleeding
Swelling
Pus

21
Q

What particularly bad infections should be check for in Diabetic Foot disease?

A

Osteomyelitis (Bone infection/inflammation)
Gas Gangrene (Bacterial infection producing gas in tisses)
Necrotizing Fasciitis - Infection killing soft tissue

22
Q

How is diabetic foot disease prevented?

A

Always wearing shoes
Making sure they’re well fitted
Check pressure points on the foot regularly
Promptly treat any skin breaks

23
Q

How do we treat diabetic foot disease?

A

Wound Care
Systemic Antibiotics
Revascularisation (by distal bypas or distal crural angioplasty)

24
Q

What do we do if we fail to save the limb in any PAD?

A

Amputate that fucker,
Many spots to do it but Above knee (AKA) and below Knee (BKA) most common.
Also hindquarter, hip disarticulartion, through knee, symes (ankle), transmetatarsal and digit.

25
Q

How does rehab compare in AKA/BKA?

A

BKA gives better mobility and requires a lot less energy to walk after.

26
Q

What are the fontaine classes of PAD?

A

4 stages:
1) minor obstruction so asymptomatic
2a) Mild claudication >200m
2b) mild Claudication <200m
3) Foot pain at rest
4) Necrosis/Gangrene set in