Arterial occlusive disease

Question 1

What are the classic symptoms of acute limb ischaemia?

Answer 1

✅ The 6 P’s:
👉 “Painful Pale Patients Prefer Paralysis Prevention”

Pain (sudden, severe).
Pallor (pale limb due to lack of blood).
Pulselessness (no palpable pulses distal to occlusion).
Paraesthesia (numbness, tingling).
Paralysis (late stage → poor prognosis!).
Poikilothermia (cold limb).

💡 Urgent emergency! Needs immediate vascular intervention.

Question 2

What are the symptoms of chronic limb-threatening ischaemia?

Answer 2

✅ CLTI Symptoms:

Rest pain (worse at night, relieved by hanging foot over edge).
Non-healing ulcers (typically on toes, heels).
Gangrene (blackened, necrotic tissue).

💡 Timeframe: Unlike ALI (sudden onset), CLTI develops over weeks to months.

🦵 Mnemonic: “URGENT” for CLTI

Ulcers (non-healing, on toes/heels)
Rest pain (worse at night, improves with leg hanging down)
Gangrene (blackened, necrotic tissue)
Edema (chronic swelling, in some cases)
Numbness (due to nerve ischemia)
Tissue loss (severe cases)

Question 3

What causes acute limb ischaemia?

Answer 3

✅ ALI (Acute Limb Ischaemia):

Sudden onset.
Caused by embolism (e.g., atrial fibrillation), thrombosis, or trauma.
Risk factors: Atrial fibrillation, recent MI, aneurysm, trauma.

💡 ALI is a sudden arterial blockage,

Question 4

What causes chronic limb ischaemia?

Answer 4

✅ CLTI (Chronic Limb-Threatening Ischaemia):

Gradual onset.
Caused by atherosclerosis leading to progressive narrowing of arteries.
Risk factors: Smoking, diabetes, hypertension, hyperlipidaemia.

💡 CLTI is a slow, progressive narrowing of blood vessels.

Question 5

What are the treatment options for CLTI? (Critical Limb-Threatening Ischaemia)

Answer 5

What are the treatment options for CLTI?

✅ Conservative Management (for mild cases):

Stop smoking to slow disease progression.
Supervised exercise therapy to improve circulation.
Antiplatelet therapy (aspirin, clopidogrel) to reduce clot risk.
✅ Endovascular Treatment (for moderate cases):

Angioplasty + Stenting to reopen blocked arteries.
Atherectomy to remove plaques.
✅ Open Surgical Treatment (for severe cases):

Arterial bypass surgery to reroute blood flow.
Amputation as a last resort for non-viable limbs.
💡 Endovascular approaches are preferred initially, but severe cases may require open surgery.

🩺 Mnemonic: “BASICS” for PAD Management

BP control (ACE inhibitors, beta-blockers)
Antiplatelets (aspirin, clopidogrel)
Statin therapy (lowers LDL, stabilizes plaques)
Intervention (angioplasty, bypass, stenting)
Cessation of smoking (most effective intervention!)
Supervised exercise therapy

Question 6

How is symptomatic carotid stenosis treated?

Answer 6

✅ Carotid Endarterectomy (CEA):

Preferred for high-grade stenosis (>70%).
Open surgery to remove plaque from the carotid artery.
✅ Carotid Artery Stenting (CAS):

Used for patients at high surgical risk.
Less invasive but associated with a slightly higher stroke risk compared to CEA.
💡 Carotid endarterectomy is more effective for most patients, but stenting is an option when surgery is too risky.

Question 7

How can PAD progression be prevented?

Answer 7

✅ Lifestyle Modifications:

Quit smoking (most effective intervention!).
Regular exercise to improve circulation.
✅ Medical Therapy:

Antiplatelets (aspirin, clopidogrel) to reduce clot formation.
Statins (e.g., atorvastatin) to slow atherosclerosis progression.
Blood pressure control (ACE inhibitors, beta-blockers if needed).
Diabetes management to prevent vascular complications.

💡 The best approach is aggressive cardiovascular risk reduction, including smoking cessation and medication therapy.