FN: Chronic limb ischaemia: Presentation and Classification

Question 1

Incidence

Answer 1

5% of males >50 yrs have intermittent claudication

Question 2

Definition

Answer 2

Ankle artyer pressure

Question 3

Cause

Answer 3

1. Atherosclerosis: typically asymptomatic until 50% stenosis
2. (vasculitis and fibromuscular dysplasa are very rare causes)

Question 4

Atherosclerosis summary

Answer 4

1. Endothelial injury: haemodynamic, HTN, increase lipids
2. Chronic inflammation:
   - lipid laden foam cells produce GFs, cytokines, RO’s and MMPs
   - Lymphocyte and SMC recruitment
3. SM proliferation: conversion of fatty streak to atheroscleroitc plaque

Question 5

Arteriosclerosis

Answer 5

General artery hardening

Question 6

Atherosclerosis

Answer 6

Arterial hardening specifically due to atheroma

Question 7

Atheroma pathology

Answer 7

1. Fibrous cap: SM cells, lymphocytes, collagen

2. Necrotic centre: cell debris, choeslterol, Ca, foam cells

Question 8

risk factors modifiable

Answer 8

Smoking
BP
DM control
Hyperlipidaemia
Reduced excercis

Question 9

Non-modifiable RF

Answer 9

FH and PMH
Male
Increased age
Genetic

Question 10

Associated vascular disease

Answer 10

IHD: 90%
Carotid stenosis: 15%
AAA
Renovascular disease
DM microvascular disease

Question 11

Presentation

Answer 11

Intermittant
Critical lumb ischaem
Leriche syndrome: Aortoilliac Occlusive disease
buergers disease: throboangiitis obliterans

Question 12

Intermittant claudication

Answer 12

Cramping pain after walking a fixed distance

Pain rapidly relieved by rest

Question 13

Buttock pain

Answer 13

Iliac disease

Question 14

Calf pain

Answer 14

Superficial femoral

Question 15

Critical limb ischaemia

Answer 15

Fontaine 3 or 4

1. Rest pain
2. Ulceration
3. Gangrene

Question 16

Describe rest pain in critical limb ischaemia

Answer 16

Especially @ night
Usually felt in the foot
Pt. hangs foot out of bed
- Due to reduced CO and loss of gravity helps

Question 17

Leriches sndrome

Answer 17

Atherosclerotic occlusion of abdominal aort and iliacs

Question 18

Leriches syndrome triad

Answer 18

Buttock claudication and wasting
Erectile dysfunction
Absent femoral pulses

Question 19

Beurgersdisease

Answer 19

Young, male, heavy smoker

Acute inflammation and thrombosis of arteries and veins in the hands and feet - ulceratino and gangrene

Question 20

Signs of limb ischaemia

Answer 20

1. Pulses: pulses and raised CRT (norm

Question 21

Beurgers angle

Answer 21

> 90 normal

20-30 ischaemia

Question 22

+ver beurgers signs

Answer 22

Reactive hyperaemia due to accumulation of deoxygenated blood in dilated capillaries

Question 23

Clinical Classification

Answer 23

Fontaine

Rutherford

Question 24

Fontaine

Answer 24

1. Asympto (subclinical)
2. Intermittant claudication
   a. >200m
   b.

Question 25

Rutherford

Answer 25

1. Mild claudication
2. Moderate cludication
3. Severe claudication
4. Ischaemia rest pain
5. Minor tissue loss
6. Major tissue loss