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Cardiovascular > Chronic Lower Limb Ischaemia > Flashcards

Chronic Lower Limb Ischaemia Flashcards

1
Q

when does intermittent claudication occur?

A

when insufficient blood reaches exercising muscle

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2
Q

describe the symptoms of intermittent claudication

A

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

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3
Q

what is intermittent claudication?

A

muscle ischaemia on exercise

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4
Q

how is ankle brachial pressure index calculated?

A

ankle pressure/ brachial pressure

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5
Q

what is normal ABPI?

A

0.9-1.2

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6
Q

what is the ABPI for someone with claudication?

A

0.4-0.85 (-1)

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7
Q

what is the ABPI for someone with severe disease?

A

0-0.04

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8
Q

what non invasive investigations can be used?

A

measurement of ABPI

duplex ultrasound scanning

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9
Q

what invasive investigations can be used?

A

CT angiography
magnetic reasonance angiography
catheter angiography

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10
Q

what is the treatment of lower limb ischaemia?

A 
slowing progression
smoking
lipid lowering
antiplatelets 
hypertension 
diabetes 
life style issue
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11
Q

what is used for the improvement of claudication symptoms?

A 
realistic expectations
consent
exercise training
drugs
angioplasty/stenting
surgery
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12
Q

when can surgery can be used?

A 
inflow bypass
-anatomic/extra-anatomic 
-prosthetic vein
outflow bypass
-autolgous (vein)
-prosthetic (dacron, ePTFE)
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13
Q

what is critical limb ischaemia?

A

rest pain

toe/foot iscahemia (nerve ending pain)

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14
Q

what are the symptoms of critical limb ischaemia?

A 
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
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15
Q

what are the risk factors for amputation?

A

smoking

diabetes

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16
Q

what is the treatment of critical limb ischaemia?

A

realistic expectations
analgesia
angioplasty/stenting
surgical reconstruction/amputation

17
Q

how is blood taken out of the legs?

A

a vessel
valves which create a one way system
a pump to deliver energy to the system (calf muscle)

18
Q

what are varicose veins?

A

dilated tortuous superficial veins due to abnormal transmission of deep vein pressure

19
Q

why do you get varicose veins following a DVT?

A

conditions that can increase the deep vein pressure can cause deep vein obstruction and deep vein incompetence

20
Q

why are varicose veins more common in woman?

A

pressure of child bearing

hormonal changes

21
Q

what is the difference between primary and secondary varicose veins?

A 
primary= no change in vein pressure
secondary= change in vein pressure
22
Q

what are the risk factors for varicose veins?

A 
pregnancy 
obesity 
age
sex
family history
standing or sitting for long periods of time
23
Q

when are varicose veins worrying?

A

bleeding

  • venules
  • significant
  • recurrent
  • first aid elevation and pressure
24
Q

what is a thrombophelbitis?

A

inflammation of a vein caused by a blood clot

  • sore
  • significant
  • scarring
25
Q

what are the clinical features of chronic venous insufficiency?

A

haemosiderin deposits

  • red cells leakage
  • red cell breakdown
  • little black dots
26
Q

what is lipodermatosclerosis?

A
  • white cells
  • inflammation
  • fibrosis
27
Q

what does a duplex scan focus on?

A

state of the deep veins
(occlusions or incompetence)
saphenofemoral or sephenopopliteal incompetence

28
Q

what is the management of ulcers?

A

information
graduated compression
- 4 layer bandaging
- stockings

29
Q

when is compression contraindicated?

A

low ABPI

30
Q

how can veins be treated?

A

endovenous foam sclerotherapy

endovenous ablation

31
Q

what are the complications of intervention with veins?

A 
thrombophlebitis
skin staining
local ulceration
wound infection
nerve damage 
recurrence

Cardiovascular (31 decks)

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