CL4: Vascular Interventional Radiology

Question 1

What is the main difference between acute ischaemia and chronic ischaemia?

Answer 1

Collateral systems have been able to develop in chronic ischaemia and so you may not see pain at rest even with a big occlusion. In acute ischaemia, there isn’t time of the collateral systems to have developed.

Question 2

Where is the blockage likely to be in calf pain?

Answer 2

If she has calf pain, the blockage is likely in the superficial femoral artery. In common iliac, you would expect buttock claudication. In external iliac you would get thigh symptoms, as well as in the femoral. You can get multi-focal disease that causes the same symptoms.

Question 3

What is contrast angiography?

Answer 3

This is the gold standard and is comprehensive. It is an invasive procedure and so there can be complications in where you puncture - bleeding, damage to the vessel and so a risk of surgery to the common femoral, infection, dissection (forms an alternative pathway to the blood between the layers of the artery, the intima/media comes away usually, in a balloon stent, allergy to dye, fresh clot can embolise, rupture the vessel etc.

Question 4

What is a PSA?

Answer 4

PSA - Pseudoaneurysms - a collection of blood between the outer layers of the artery or the tissues in the artery. The are likely to rupture as they are not contained by all the walls of the artery, may even just by the fibrous tissue. Can treat it by injecting thrombin.

Question 5

What are the 6 p’s seen in ischaemia?

Answer 5

• Pain
• Pallor - Pale
• Paraesthesia
• Perishingly cold
• Pulseless
• Paralysis

    Loss of sensation and the ability to move indicates ischemia of the muscle and the nerves. This is associated with a high mortality.

Initially the foot will be white and painful. From 6-12 hours you get a mottled appearance that when you put pressure on disappears. This is due to the stagnant blood. If not fixed you can get irreversible ischemia which is seen as fixed blue staining. They have lost the leg and at high risk of mortality.

Question 6

What are treatment options for ischaemia of the limbs?

Answer 6

Endovascular:

• Thrombolysis
• Aspiration/Mechanical thrombectomy
• Angioplasty and stenting

Surgical options

• Surgical thrombectomy/embolectomy
• Bypass