Chronic Lower Limb Ischaemia Flashcards
when does intermittent claudication occur?
when insufficient blood reaches exercising muscle
describe the symptoms of intermittent claudication
the patient is pain free at rest, but after variable periods of exercise develops ischaemic pain in the affected limb, which is relieved by rest
what is intermittent claudication?
muscle ischaemia on exercise
how is ankle brachial pressure index calculated?
ankle pressure/ brachial pressure
what is normal ABPI?
0.9-1.2
what is the ABPI for someone with claudication?
0.4-0.85 (-1)
what is the ABPI for someone with severe disease?
0-0.04
what non invasive investigations can be used?
measurement of ABPI
duplex ultrasound scanning
what invasive investigations can be used?
CT angiography
magnetic reasonance angiography
catheter angiography
what is the treatment of lower limb ischaemia?
slowing progression smoking lipid lowering antiplatelets hypertension diabetes life style issue
what is used for the improvement of claudication symptoms?
realistic expectations consent exercise training drugs angioplasty/stenting surgery
when can surgery can be used?
inflow bypass -anatomic/extra-anatomic -prosthetic vein outflow bypass -autolgous (vein) -prosthetic (dacron, ePTFE)
what is critical limb ischaemia?
rest pain
toe/foot iscahemia (nerve ending pain)
what are the symptoms of critical limb ischaemia?
pain at rest toes and forefoot requires strong analgesia worse at night helped by siting and putting the leg in a dependant position helped by getting up and walking about
what are the risk factors for amputation?
smoking
diabetes
what is the treatment of critical limb ischaemia?
realistic expectations
analgesia
angioplasty/stenting
surgical reconstruction/amputation
how is blood taken out of the legs?
a vessel
valves which create a one way system
a pump to deliver energy to the system (calf muscle)
what are varicose veins?
dilated tortuous superficial veins due to abnormal transmission of deep vein pressure
why do you get varicose veins following a DVT?
conditions that can increase the deep vein pressure can cause deep vein obstruction and deep vein incompetence
why are varicose veins more common in woman?
pressure of child bearing
hormonal changes
what is the difference between primary and secondary varicose veins?
primary= no change in vein pressure secondary= change in vein pressure
what are the risk factors for varicose veins?
pregnancy obesity age sex family history standing or sitting for long periods of time
when are varicose veins worrying?
bleeding
- venules
- significant
- recurrent
- first aid elevation and pressure
what is a thrombophelbitis?
inflammation of a vein caused by a blood clot
- sore
- significant
- scarring
what are the clinical features of chronic venous insufficiency?
haemosiderin deposits
- red cells leakage
- red cell breakdown
- little black dots
what is lipodermatosclerosis?
- white cells
- inflammation
- fibrosis
what does a duplex scan focus on?
state of the deep veins
(occlusions or incompetence)
saphenofemoral or sephenopopliteal incompetence
what is the management of ulcers?
information
graduated compression
- 4 layer bandaging
- stockings
when is compression contraindicated?
low ABPI
how can veins be treated?
endovenous foam sclerotherapy
endovenous ablation
what are the complications of intervention with veins?
thrombophlebitis skin staining local ulceration wound infection nerve damage recurrence
