Chronic Arterial Insufficiency Flashcards
Assessment of vascular system
- Golden 5 - consent, chaperone, privacy, exposure, confidentiality
- Observations - calculate NEWS score
- Radial pulse - peripheral pulse, rate rhythm, volume, character, delay + capillary refill
- Carotid pulse - central pulse, not at same time, check peripheral and central at same time
- CVS exam - listen to heart sounds
- Lower limbs - inspection (standing) and palpation
- Inspect - hair changes, swelling, assymetry, skin changes
- Palpation - examine normal side first
- Pulses - distal to proximal (dorsalis pedis first)
What happens in CAI?
- Collateral vessels form
- Allow blood supply to go past blockage
- Body does not have time to do this in acute cases
What is AI?
- Anything that hinders blood flow in arteries
- More common in men than women
- Increased prevalace with age
- Presents with intermittent claudication usually
- Atherosclerosis common cause
Composition of arteries vessels
- Tunica adventitia
- Tunica media
- Tunica intima (inside) - this is what atherosclerosis affects
Large plaques can affect nutrition to tunica media from tunica intima = apoptosis = damage to wall = aneurysms
Lower limb vasculature
- L4 = level of common iliac
- Then external and internal iliac
- As external iliac crosses inguinal ligament = femoral artery
- Femoral triangle
- Profunda femoris and superficial femoral artery branch
- Knee - superficial artery –> Popliteal artery
- –> anterior and posterior tibial artery (posterior) and peroneal artery (lateral)
Arteriosclerosis
- Hardening of arteries due to thickening of BV wall, medium and large arteries
- Can be split into atherosclerosis (intima), arteriolosclerosis (small arteries hyaline) Monkeberg medial calcific sclerosis (calcium in media)
What is atherosclerosis and atheromatous plaques
- Hardening of arteries due to intimal atheromatous plaque
- Has necrotic lipid core (cholesterol) with fibromuscular cap - can rupture
- Damage endothelium = lipid moves into intima
- Lipids oxidised and consumed by macrophages = foam cells
- = inflammation, SM proliferation, deposition of ECM
- = turbulant blood flow
Consequence of turbulant blood flow in arteries
- Arterial thrombus
- As can cause endothelial injury and stasis of blood
RF for CAI
Same as CVS
* Age
* Smoking
* Hypertension
* Smoking etc etc
Classification of PAD
- Fontaine classification
Fontaine classification
1 - Asymptomatic
2 - intermittent claudication (2a is more than 200m, 2b is within 200m)
3 - rest pain
4 - ulceration, gangrene or both
What is intermittent claudication?
- Cramp like pain felt in muscles
- Commonest site = calf
- As superficial femoral artery most commonly affected
- Brought on by walking, relieved by standing still (unlike neuropathy) not present on first step (like OA)
Classifcation of IC
- Boyds Classification
- I-IV
Claudication distance?
- Relative - Distance a person can walk before the onset of pain
- Absolute - distance person can walk before they cannot walk anymore
What is rest pain?
- Pain in limb at rest
- Classically at night time - felt in foot most common
- Exacerbated by lying down/elevating foot
- May improve by hanging foot out of bed
- Due to involvement of vasa nervorum (nerves in tunica adventitia)
- Pressure of enviroment on foot makes it worse - even touching can hurt with duvet
Management of rest pain
- Analgesia - need to help sleep