ARTERIAL OCCLUSIVE DISEASES Flashcards
signs of intermittent claudication
worsening cramping pain on exertion
presence of pulses
difference in pulses
location of the pain is in the calf
what is the pathophysiology of intermittent claudication
there is formation of an atheroma on the artery , causes blockage of the artery , there is supply and demand mismatch with that leading to cramping on exertion as
anaerobic metabolites are released which causes pain
investigation of intermittent claudication
full lower limb investigation
doppler machine
ankle brachial pressure index
interpretation of ABPI
0.8-1.3 there is no evidence of significant peripheral arterial disease
less than 0.5 severe arterial disease which includes pain at rest
0.5-0.7 mild or moderate arterial disease typically presenting features include claudication
management of intermittent claudication
improve collateral supply by exercising
improve pain free walking distance
secondary prevention measures - by preventing cardiovascular risk factors
risk factors for intermittent claudication
smoking
diabetes type 1 and type 2
hypercholesterolaemia
what is critical limb threatening ischaemia
pain at rest and tissue loss that is there is ulcerations
what is the pathophysiology of critical limb ischaemia
there is progressive atherosclerosis which causes narrowing , gravity has to contribute to the supply and demand of the leg anaerobic metabolites are released which causes pain , legs hanging down which leads to oedema . skin breaks down and there is an ulceration which does not heal
buergers test
test done to asses the arterial peripheral supply of the legs
step 1 - elevate the legs to 45 degrees note if there is pallor
step 2 - swing the legs at 45 degrees and note if the color returns to normal .
management of critical limb ischaemia
full blood count
urea and electrolytes
coagulation
arterial blood gas
antiplatelet
statins analgesia for the pain
ECG for heart failure
decision making in vascular diseases
mdt meeting
operative management of critical limb ischaemia
angioplasty and a stent
open surgery to repair the artery
aims of an open arterial surgery
bypass
interposition graft
endaretectomy
embolectomy
examples of arterial bypass
femero-popliteal that is fem pop
what are the signs of acute limb ischaemia
pain
pallor
pulseless
cold
paralysis
paraesthesia
pathophysiology of acute limb ischaemia
sudden blockage of the artery - tissue ischemia - cell death through necrosis
relation to clinical appearance
acute arterial spasms which causes pallor
deoxygenated blood fills the skin which causes mottling
stagnant blood coagulates which causes fixed staining
management of acute limb ischaemia
analgesia
IV heparin
full blood count
urea and electrolytes
arterial blood gas
coagulopathy screen
ECG screenings
embolectomy
fogarty catheter passed beyond embolus , balloon inflated ,clot being withdrawn through arteriotomy
post embolectomy
amputation
Carotid endarterectomy
symptomatic carotid stenosis
- > 50% ICA stenosis on US
- good neurological recovery
- within 2 weeks from event
carotid endarterectomy
acute limb ischemia pathophysiology
Sudden occlusion to blood supply to limb (leg or arm)
- embolic (typically cardiac origin)
- thrombotic (plaque rupture – can be acute-on-chronic)
