Chronic limb ischaemia Flashcards
What is chronic limb ischaemia?
peripheral arterial disease that results in a symptomatic reduced blood supply to the limbs
What usually causes chronic limb ischaemia?
atherosclerosis and rarely vasculitis
Where can be affected in chronic limb ischaemia?
the leg usually but can also be the upper and gluteals
What are the risk factors for chronic limb ischaemia?
smoking, diabetes mellitus, hypertension, hyperlipidaema, increasing age, family, history, obesity and physical inactivity
What is one of the earlier symptoms of chronic limb ischaemia?
intermittent claudication which is cramping like pain after walking a fixed distance which is relieved by rest within minutes
What are the 4 stages of Fontaines chronic leg ischaemia?
Asymptomatic, intermittent claudication, ischaemic rest pain, ulceration or gangrene or both
What is Buergers tests?
lying the patient supine and raising their legs until they go pale, and then lowering them until the colour returns, the angle at which the limb goes pale is termed Burgers angle an angle of less than 20 degree indicated severe ischaemia
What is Leriche syndrome?
peripheral arterial disease affecting the aortic bifurcation, presents with buttock or thigh pain and associated erectile dysfunction
What is critical limb ischaemia?
Advanced form of chronic limb ischaemia
What are the three ways to clinically define critical limb ischaemia?
Ischaemic rest pain for greater than 2 weeks duration requiring opiate analgesia, presence of ischaemic lesions or gangrene objectively attributable to the arterial occlusive disease, or ABPI of less than 0.5
With critical limb ischaemia what will be seen on examination?
Pale and cold with weak or absent pulses, may have limb hair loss, skin changes (atrophic skin, ulceration or gangrene) and thickened nails
What are the two differential diagnosis for patient presenting with limb ischaemia?
Spinal stenosis or acute limb ischaemia
What is spinal stenosis?
Typically pain from the back radiating to the lateral aspects of the legs and symptoms on initial movement that are relieved by sitting rather than standing
What investigation would you do for chronic limb ischaemia?
Ankle-brachial pressure index, doppler ultrasound, CT angiography, Cardiovascular risk assessment, thrombopihilia screen and homocysteine levels
How is ABPI measured?
Take the blood pressure in the arm and of the ankle and compare, if its above 0.9 then is normal, 0.8-0.9 is milk, 0.5-08 is moderate and if below 0.5 then is severe
