Chronic lower limb ischaemia Flashcards
What is PAD?
Peripheral arterial disease
What is PAD due to?
Atherosclerosis of the lower limb vessels due to stenosis of arteries
What is a key feature of PAD?
Intermittent claudication - pain when walking, fine at rest
Describe critical limb ischaemia?
One of the latter stages of PAD, key features are gangrene and ulceration. Pain in foot at rest - common, burning pain in leg at night, relieved by hanging over the bed.
Describe the 4 classifications of PAD?
- asymptomatic
- Intermittent claudication
- Ischamic pain at rest
- Gangrene and ulceration (critical limb ischamia)
What are some of the signs of PAD?
Absent pulses
Cold/white feet/legs
Punched out ulceration (painful)
Colour changes
Give the ranges of ABPI, normal, PAD and Critical limb ischamia?
Normal = 1-1.2
PAD = 0.5-0.9
Critical limb ischamia = <0.5
What is usually 1st and 2nd line in imaging investigations for PAD?
1st = duplex uses 2nd = if considering intervention - MR/CT angiography
What would be the treatment for PAD?
-1. lifestyle
Lifestyle - stop smoking, treat hypertension/cholesterol, anti platelets
What would be the treatment for PAD?
- 2. managing claudicaiton
Exercise programmes
2hrs per week for 3 months
aim to push patient to maximal pain to help improve collateral blood flow
What would be the treatment for PAD?
- 3. vasoactive drugs
Naftodrofuryloxalate
recommended in those who do not want revasuclarisation and did not improve via exercise
What would be the treatment for PAD?
- 4. PTA
Percutanous transluminal angioplasty
Only is only one vessel is affected
Balloon through narrowed artery
+/- stent
What would be the treatment for PAD?
- 5. Surgical reconstruction
If atheromatous disease is extensive but distal run off is good (distal arteries filled with collaterals) then you can reconsturct with a bypass graft
What is the outcome for some patients with PAD worst scenario?
Amputation
What is acute limb ischaemia?
A medical emergency requiring revascularisation within 4-6hrs to save the limb
What might acute limb ischaemia be due to?
Thrombosis in situ, emboli, graft./angioplasty occlusion…; etc
What are the 6 P’s of acute limb ischamia?
Pale Perishingly cold Paralysed Paraesthetic (tingling) Pulseless Painful
What is a post op complication of acute limb ischaemia?
Compartment syndrome, very painful, due to bleeding/swelling causing high pressure, decreasing blood flow and O2 getting to that compartment of muscle.
What might make a patient more susceptible to amputation?
- smoking
- diabetes
Are males or females more prone to PAD?
Males
What is chronic lower limb ischaemia a marker for, and what is it associated with?
It is a marker for atherosclerosis elsewhere and is associated with a large cardiovascular morbidity and mortality.
