chronic arterial ischaemia Flashcards
what are the three disorders of arteries ?
arterial occlusive disease
aneurysmal disorders
injuries
what are the causes of acute arterial ischaemia ?
embolic
thrombotic
traumatic
what are the causes of chronic arterial ischaemia ?
atherosclerotic or otherwise
what are the common causes of peripheral arterial occlusive disease?
atherosclerosis
burgers disease
SLE
what are the rare causes of peripheral arterial occlusive disease ?
external compression
popliteal entrapment
thoracic outlet syndrome
coartication of the aorta
what are the risk factors for atherosclerosis ?
hypercholesteremia
smoking
diabetes mellitus
hypertension
what are the determinants of the clinical presentation of chronic ischaemia ?
downstream organ
degree of stenosis
chronicity of obstruction
availability of collateral circulation
what does the proposed arterial adaptation suggest ?
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
what are the subdivisions of the anatomic sections affected by chronic occlusive disease in the LL ?
- Aortoilliac (inflow disease)
- femoral-popliteal (outflow disease)
- tibial-peroneal (runoff disease)
which arteries are involved in the aorto-iliac area ?
infrarenal aorta , common iliac and external iliac arteries
which arteries are involved the femoral popliteal area ?
common femoral
superficial femoral
popliteal arteries
which arteries are involved with the tibial-peroneal area ?
distal to popliteal artery
what are the distal aorta and iliac arteries mostly affected byu ?
atherosclerosis
which collateral circulation is present in the aorto-illiac area ?
pelvic and groin collaterals
what are the classifications of aorto-iliac disease ?
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
which artery passes deep to the adductor canal ?
superficial femoral artery
why may the occlusion of the distal SFA be asymptomatic ?
because of the development of collaterals from the proximal SFA
which area is more likley to be affected by smokers and Buergers disease ?
infrapopliteal or the tibioperoneal area
why is ischaemia in the infrapopliteal area limb threatning ?
because the collaterals are less developed than the other two regions
what are the most common causes of occlusive arterial disease in Egypt ?
atherosclerosis and Buerger’s disease
what is buerger’s disease ?
a form of vasculitis, inflammatory occlusive disease affecting small and medium sized vessels affecting male smokers below
40
what is the clinical triad of buerger’s disease ?
- claudication of affected extremities
- raynauds phenomenon
- migratory superficial thrombophlebitis
how would you make a diagnosis of Buergers disease ?
angiography of all four limbs but pathological examination is necessary for confirmation
what would be the treatment for buergers disease ?
no specific treatment except abstinence from smoking q
what are the clinical presentation of chronic limb ischaemia
intermittent claudications
rest pain
ulcerations and gangrene
how is claudication pain relieved?
on cessation of walking
what is the clinical presentation if the aorto-illiac is blocked ?
buttock, thigh and calf claudication known as Leriche syndrome
what is the clinical presentation if the common femoral disease is blocked ?
thigh and calf claudication
what is the clinical presentation if the SFA is blocked ?
calf claudication
what is the clinical presentation if the if the popliteal artery is blocked ?
calf claudication
what is the clinical presentation if the infra popliteal artery is blocked ?
calf and maybe sole claudication
what could be the differential diagnosis of vascular claudication?
neurogenic pseudoclaudication
what is ischemic rest pain caused by?
ischaemic neuritis
what is rest pain aggravated by ?
horizontal position or elevation of the extremity
what is rest pain relieved by ?
hanging leg over the side of the bed
where are arterial insufficiency ulcers mostly located ?
lateral surface of the ankle or the distal digits
how do you diagnose an arterial ulcer ?
arterial doppler
why may radiograph be necessary when suspecting arterial ulcers ?
to rule out osteomyelitis
what pressures suggest critical limb ischaemia ?
ankle pressure less than 70 mmhg
or a toe systolic pressure of less than 50 mmhg
what are the investigations of chronic ischaemia ?
doppler/duplex
ankle brachial index
what is the normal shape of the duplex wave ?
triphasic
why might CTA be an inappropriate method of investigation for diabetics ?
due to calcifications
what is the fontaine classification?
stage I - asymptomatic stage IIa -mild claudication stage IIb - moderate to severe claudication stage III-ischemic rest pain stage IV- ulceration or gangrene
what is the Rutherford classification ?
category 0 - asymptomatic 1- mild claudication 2-moderate claudication 3- severe claudication 4-ischemic rest pain 5- minor tissue loss 6- major tissue loss
what can symptomatic peripheral chronic arterial disease be broadly managed as ?
intermittent claudication
critical limb ischaemia
what would the treatment be for chronic limb ischaemia ?
conservative treatment including risk factor modification along with exercise rehabilitation
what are the types of vascular grafts
bio-prosthetic
synthetic
what is the normal ABI ?
1.0-1.2
what does an ABI of more thann 1.2 indicate ?
non-compressible, severely classified vessel in DM
what does an ABI of 0.5-0.9 indicate ?
intermittent claudication ( mild to moderate ischaemia )
what does an ABI of 0.1-0.4 indicate ?
critical limb ischaemia ( ischaemic ulceration and gangrene)
