Chronic lower limb ischemia Flashcards
What is intermittent claudication?
muscle ischemia on exercise
What are the features of intermittent claudication?
the patient is pain free at rest but after variable periods of exercise develops ischemic pain in the affected limb, relieved at rest
In what age group is intermittent claudication most common?
elderly (over 70)
What are non-invasive investigations for lower limb ischemia?
- measurement of ABPI
- duplex ultrasound scanning
What are invasive investigations for lower limb ischemia?
- Magnetic resonance angiography
- CT angiography
- catheter angiography
What is ABPI?
Ankle brachial pressure index.
ABPI = ankle BP/brachial BP
What is the normal range for ABPI?
0.9-1.2
What is the severe range for ABPI?
0-0.5
When can false results be given?
Diabetes and kidney failure can cause calcification of arteries so when BP cuff increases in pressure to say 180mmHG it wont actually pressure the artery to that degree therefore can give false results.
Why is duplex ultrasound scanning important?
- can see the artery so can assess the flow
- The artery shows upa s red and the vein blue
- Can see turbulent flow clearly
- can assess the speed of the flow and assess the ratio of normal flow to turbulent flow
What are the pros and cons of Magnetic resonance angiography?
pro- complex imaging but really good detailed pictures
cons- patients dont like them
What are the pros and cons of CT angiography?
pro- quick, good images
conns- contrast can affect people with kidney problems
can give a lot of radiation
How does a catheter angiography work?
- 4 or 5 xrays before adding contrast
- Contrast is injected
- X rays taken
- The similarities between the two pictures is removed ie pictures of bones removed so you can only see vessels
How do you slow the progression of lower limb ischemia?
- Stop smoking
- lower lipids
- antiplatelet
- lower BP
- control diabetes
- make lifestyle changes
How do you improve the symptoms of claudication?
- realistic expectations
- exercise training
- drugs
- angioplasty/stenting
- surgery
What is the recommendation for exercise in lower limb ischemia?
1 hour per day - 30 mins 3 times per week for a minimum of 6 months
What is the drug of choice for lower limb ischemia?
cilostozol
How is exercise beneficial in lower limb ischemia?
if exercise then vessels dilate. Blood can then bypass the claudication point
How is an angioplasty performed?
- tiny holes in arteries
- insert balloon
- some balloons can have drugs intertwined
- stents can also be used and they can also have drugs within them
Where is the most common artery for occlusions?
iliac artery
What’s the most common site for a stenosis to be inserted?
common iliac artery
What surgery can be performed for lower limb ischemia?
endarterectomy
What are the symptoms of critical limb ischemia?
- pain at rest
- worse at night
- requires strong analgesia
- cool to touch
- absent of peripheral pulses
- colour changes
- poor tissue nutrition ie hair loss
What are the risk factors associated with needing amputation in critical leg ischemia?
- smoking
- diabetes
What is the treatment for critical limb ischemia?
- realistic expectations
- analgesia
- angioplasty/stenting
- surgical reconstruction/ amputation
What is the dilemma when considering lower limb amputation?
- the lower you go on an amputation, the higher the risk it wont heal
- 1/3 of patients with lower limb amputations will be dead after 2 years
What is an endarterectomy?
Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of deposits. It is carried out by separating the plaque from the arterial wall
