Limb Claudication & Gangrene Flashcards
What are the symptoms of peripheral arterial disease?
What are the symptoms of critical ischaemia?
Cramping pain in the calf, thigh or buttock after walking for a given distance, relieved by rest. (6P’s: pale, pulseless, painful, paralysed, paraesthetic, perishingly cold)
Critical ischaemia = ulceration, gangrene and foot pain at rest (burning pain at night relieved by hanging legs over side of bed)
What does calf claudication and buttock claudication suggest?
Calf = femoral artery
Buttock = iliac disease
What do buttock claudication and impotence suggest?
Leriche’s syndrome
Outline the Fontaine classification for PAD
1) Asymptomatic
2) Intermittent claudication
3) Ischaemic rest pain
4) Ulceration/gangrene (critical ischaemia)
What are the signs of PAD?
Absent femoral, popliteal and foot pulses
Cold, white legs
Punched out ulcers or non-healing ulcers
Erectile dysfunction
What are the tests used for PAD?
Exclude DM Exclude arteritis (ESR/CRP) FBC (exclude anaemia/polycythaemia) ECG (cardiac ischaemia) ABPI
What are the possible outcomes of a ABPI?
Normal = 1-1.2
PAD = 0.5-0.9
Critical limb ischaemia = <0.5 or ankle systolic pressure <50mmHg
What imaging studies can be used in PAD?
Colour duplex US = first line
MR/CT angiography if considering intervention
What is the preventative management strategies for PAD?
Stop smoking
Treat HTN and hyperlipidaemia
Give clopidogrel to ALL PATIENTS unless CI
What is the management of PAD?
Conservative: exercise programmes, 2h per week for 3m
Surgical:
Percutaneous transluminal angioplasty: when the disease is limited to a certain section
Surgical reconstruction: when disease is extensive
Surgical embolectomy or alteplase: may be used if
occlusion is embolic. Give heparin before this.
What are the indications for amputation in patients with PAD?
If attempts at revascularisation fail
If the limb is non-viable
If the limb is septic or gangrenous
Outline the Well’s Criteria for DVT
All are +1 apart from ‘alternative diagnosis’ which is -2
Active cancer Localised tenderness Entire leg swollen Pitting oedema Paralysis Previously documented DVT Calf swelling >3cm compared to the other leg Alternative diagnosis more likely Bedridden >3 days or major surgery >4 weeks
What medication should be given to a patient who experiences phantom limb pain?
Gabapentin
What is the management of a DVT?
Rivaroxaban (if pregnant, use enoxaparin)
Early ambulation
Gradient stockings
Maintain anticoagulation for a minimum of three months
