atrial disease of the limbs Flashcards
what is the disease process the same as
coronary and carotid atherosclerotic disease
what are the risk factors
male
age
smoking
hypercholesterolemia
hypertension
diabetes
what are the classifications of limb ischemia
stage 1 - asymptomatic
stage 2 (a and b) - claudication’s
stage 3 - resting pain
stage 4 - necrosis
when is it critical lib ischemia
stage 3,4
what are the sings of chronic ischaemia to look at
ulceration
pallor
hair loss
what are the sings of chronic ischemia to feel
temperature
capillary refill time
what do you auscultate
hand held dopler
dorsal pedis and posterior tibial pulses
what imaging can you use
CT angiogram
MR angiogram
what is the management of peripheral arterial disease like
managed the same ways as with CAD
what are people with PAD more susceptible to
developing or dying from coronary artery disease
what actually is the conservative management of PLD
antiplatelet therapy
statins
BP control
smoking cessation
diabetic control
what are the revascularisation options for peripheral arterial disease
open surgery
endovascular intervention
what are the open surgery options
bypass and or endarterectomy
what are the endovascular interventions
balloon angioplasty
stent placement
atherectomy
what dies surgical bypass require
inflow
a conduit (synthetic or a vein from leg/arm)
outflow
what causes Acute limb ischaemia
an arterial embolus, MI, AF or proximal thrombosis
what is proximal atherosclerosis is not often a cause
DVT and PE
what are the 6 Ps of clinical presentation of acute limb ischemia
pain
pallor
pulse deficit
paraesthesia (tingling sensation)
paralysis
poikilothermia (cold)
COMPARE TO OTHER LIMB
what is compartment syndrome
a condition resulting from increased pressure within a confined body space like the leg
when does muscle ischaemia become irreversible
after 6-8 hours
what does compartment syndrome cause
inflammation
oedema
venous obstruction
rise in creatine kinase
risk of renal failure
what is the management of compartment syndrome
if limb is salvageable then either embolectomy, thrombectomy, bypass
if not palliate or amputate
what is the % break down of embolus to thrombus for acute limb ischemia
30% embolic
60% thrombosis
what is the peri-operative mortality of acute limb ischaemia
22%
what % of diabetic patients develop a foot ulcer
25%
what % of Diabetic foot ulcers become infected and what % require amputation
50% become infected
20% require amputation
what is the pathophysiology of diabetic foot ulcers
microvascular peripheral artery disease
peripheral neuropathy
minor trauma
how are diabetic foot ulcers prevents
always wear shoes
check pressure points on
feet regularly
effective glycaemic control
what is the management of diabetic foot ulcers
prevention
diligent wound care
infection - antibiotics
possible amputation
revascularisation - very distal disease
what wound care would you used for diabetic foot ulcers
dressing
debridement
negative pressure sound closures
skin grafts
