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