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ICC1 > chronic arterial ischaemia > Flashcards

chronic arterial ischaemia Flashcards

1
Q

what are the three disorders of arteries ?

A

arterial occlusive disease
aneurysmal disorders
injuries

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2
Q

what are the causes of acute arterial ischaemia ?

A

embolic
thrombotic
traumatic

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3
Q

what are the causes of chronic arterial ischaemia ?

A

atherosclerotic or otherwise

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4
Q

what are the common causes of peripheral arterial occlusive disease?

A

atherosclerosis
burgers disease
SLE

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5
Q

what are the rare causes of peripheral arterial occlusive disease ?

A

external compression
popliteal entrapment
thoracic outlet syndrome
coartication of the aorta

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6
Q

what are the risk factors for atherosclerosis ?

A

hypercholesteremia
smoking
diabetes mellitus
hypertension

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7
Q

what are the determinants of the clinical presentation of chronic ischaemia ?

A

downstream organ
degree of stenosis
chronicity of obstruction
availability of collateral circulation

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8
Q

what does the proposed arterial adaptation suggest ?

A

initially the artery enlarges to maintain its luminal diameter despite the enlarging plaque , after the plaque creates a stenosis of more than 40%the artery can no longer adapt

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9
Q

what are the subdivisions of the anatomic sections affected by chronic occlusive disease in the LL ?

A
  • Aortoilliac (inflow disease)
  • femoral-popliteal (outflow disease)
  • tibial-peroneal (runoff disease)
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10
Q

which arteries are involved in the aorto-iliac area ?

A

infrarenal aorta , common iliac and external iliac arteries

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11
Q

which arteries are involved the femoral popliteal area ?

A

common femoral
superficial femoral
popliteal arteries

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12
Q

which arteries are involved with the tibial-peroneal area ?

A

distal to popliteal artery

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13
Q

what are the distal aorta and iliac arteries mostly affected byu ?

A

atherosclerosis

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14
Q

which collateral circulation is present in the aorto-illiac area ?

A

pelvic and groin collaterals

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15
Q

what are the classifications of aorto-iliac disease ?

A

type 1- focal disease affecting the distal aorta and proximal common iliac artery
type 2- represents diffuse aortoiliac disease above the inguinal ligament
type 3- represents multisegment occlusive diseases involving aortoilliac and infra inguinal

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16
Q

which artery passes deep to the adductor canal ?

A

superficial femoral artery

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17
Q

why may the occlusion of the distal SFA be asymptomatic ?

A

because of the development of collaterals from the proximal SFA

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18
Q

which area is more likley to be affected by smokers and Buergers disease ?

A

infrapopliteal or the tibioperoneal area

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19
Q

why is ischaemia in the infrapopliteal area limb threatning ?

A

because the collaterals are less developed than the other two regions

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20
Q

what are the most common causes of occlusive arterial disease in Egypt ?

A

atherosclerosis and Buerger’s disease

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21
Q

what is buerger’s disease ?

A

a form of vasculitis, inflammatory occlusive disease affecting small and medium sized vessels affecting male smokers below
40

22
Q

what is the clinical triad of buerger’s disease ?

A
  • claudication of affected extremities
  • raynauds phenomenon
  • migratory superficial thrombophlebitis
23
Q

how would you make a diagnosis of Buergers disease ?

A

angiography of all four limbs but pathological examination is necessary for confirmation

24
Q

what would be the treatment for buergers disease ?

A

no specific treatment except abstinence from smoking q

25
Q

what are the clinical presentation of chronic limb ischaemia

A

intermittent claudications
rest pain
ulcerations and gangrene

26
Q

how is claudication pain relieved?

A

on cessation of walking

27
Q

what is the clinical presentation if the aorto-illiac is blocked ?

A

buttock, thigh and calf claudication known as Leriche syndrome

28
Q

what is the clinical presentation if the common femoral disease is blocked ?

A

thigh and calf claudication

29
Q

what is the clinical presentation if the SFA is blocked ?

A

calf claudication

30
Q

what is the clinical presentation if the if the popliteal artery is blocked ?

A

calf claudication

31
Q

what is the clinical presentation if the infra popliteal artery is blocked ?

A

calf and maybe sole claudication

32
Q

what could be the differential diagnosis of vascular claudication?

A

neurogenic pseudoclaudication

33
Q

what is ischemic rest pain caused by?

A

ischaemic neuritis

34
Q

what is rest pain aggravated by ?

A

horizontal position or elevation of the extremity

35
Q

what is rest pain relieved by ?

A

hanging leg over the side of the bed

36
Q

where are arterial insufficiency ulcers mostly located ?

A

lateral surface of the ankle or the distal digits

37
Q

how do you diagnose an arterial ulcer ?

A

arterial doppler

38
Q

why may radiograph be necessary when suspecting arterial ulcers ?

A

to rule out osteomyelitis

39
Q

what pressures suggest critical limb ischaemia ?

A

ankle pressure less than 70 mmhg

or a toe systolic pressure of less than 50 mmhg

40
Q

what are the investigations of chronic ischaemia ?

A

doppler/duplex

ankle brachial index

41
Q

what is the normal shape of the duplex wave ?

A

triphasic

42
Q

why might CTA be an inappropriate method of investigation for diabetics ?

A

due to calcifications

43
Q

what is the fontaine classification?

A 
stage I - asymptomatic
stage IIa -mild claudication
stage IIb - moderate to severe claudication
stage III-ischemic rest pain 
stage IV- ulceration or gangrene
44
Q

what is the Rutherford classification ?

A 
category 
0 - asymptomatic
1- mild claudication 
2-moderate claudication
3- severe claudication
4-ischemic rest pain
5- minor tissue loss 
6- major tissue loss
45
Q

what can symptomatic peripheral chronic arterial disease be broadly managed as ?

A

intermittent claudication

critical limb ischaemia

46
Q

what would the treatment be for chronic limb ischaemia ?

A

conservative treatment including risk factor modification along with exercise rehabilitation

47
Q

what are the types of vascular grafts

A

bio-prosthetic

synthetic

48
Q

what is the normal ABI ?

A

1.0-1.2

49
Q

what does an ABI of more thann 1.2 indicate ?

A

non-compressible, severely classified vessel in DM

50
Q

what does an ABI of 0.5-0.9 indicate ?

A

intermittent claudication ( mild to moderate ischaemia )

51
Q

what does an ABI of 0.1-0.4 indicate ?

A

critical limb ischaemia ( ischaemic ulceration and gangrene)

ICC1 (50 decks)

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