Limb conditions

Question 1

What is acute limb ischaemia?

Answer 1

Sudden decrease in limb perfusion due to:
- Thrombosis (60%)
- Embolus (30%)
- Trauma
- Dissection

Question 2

How does acute limb ischaemia present?

Answer 2

Pain
Pallor
Pulse deficit
Paraesthesia
Paresis/paralysis
Poikilothermic (cold)

Question 3

What are the categories of acute limb ischaemia?

Answer 3

I. Viable
II. Threatened
rginally or immediately)
III- Irreversible

Question 4

What are the categories of acute limb ischaemia?

Answer 4

I. Viable
II. Threatened
a. Marginally threatened
b. Immediately threatened
III- Irreversible

Question 5

What investigations are done for acute limb ischaemia?

Answer 5

Duplex ultrasound/doppler scan
ECG- AF
Bloods
CT angiography

Question 6

What is management of acute limb ischaemia?

Answer 6

Initial- anticoagulation with heparin, analgesia
Surgical- endovascular revascularisation
- Thrombolysis
- Embolectomy

Question 7

What are complications of acute limb ischaemia?

Answer 7

Reperfusion injury:
- Compartment syndrome
- Hypovolaemic shock
- Hyperkalaemia
- Systemic acidosis
- Peripheral nerve injury

Question 8

What is compartment syndrome?

Answer 8

Oedema causing increased pressure in a muscle compartment causing muscle/nerve damage and pain

Question 9

What is chronic limb ischaemia?

Answer 9

Advanced stage of peripheral artery disease (PAD)

Question 10

What is the clinical definition of chronic limb ischaemia?

Answer 10

Ischaemic pain at rest
Arterial insufficiency ulcers
Gangrne

Question 11

What are the signs of chronic limb ischaemia?

Answer 11

Atrophic skin
Ulceration
Gangrene
Pallor
Hair loss
Cold limbs
Increased cap. refill time
Decreased peripheral sensations
Reduced peripheral pulses

Question 12

What is the classification of chronic limb ischaemia?

Answer 12

Fontaine classification

Question 13

What is stage 1 of CLI?

Answer 13

Asymptomatic

Question 14

What is stage 2 of CLI?

Answer 14

Intermittent claudication pain
a. Walking>200m
Walking<200m

Question 15

What is stage 3 of CLI?

Answer 15

Ischaemic rest pain

Question 16

What is stage 4 of CLI?

Answer 16

Ulceration and gangrene

Question 17

What is Buerger’s test?

Answer 17

Patient lies supine and raises legs until they go pale and lowers them until the colour returns
The angle where the limb goes pale is termed Buerger’s angle
Angle<20 indicates severe ischaemia

Question 18

What is the medical management of CLI?

Answer 18

Lifestyle advice- smoking cessation, exercise, weight reduction
Statin therapy- atorvastatin
Antiplatelet therapy- clopidogrel
Diabetes control

Question 19

What is the surgical management of CLI?

Answer 19

Open surgery- bypass + endarterectomy
Endovascular- angioplasty + stenting

Question 20

What is chronic venous insufficiency?

Answer 20

Malfunction of venous walls/valves in the legs causing peripheral pooling of blood

Question 21

What are the signs and symptoms of chronic venous insufficiency?

Answer 21

Discolouration
Venous eczema
Hardening of skin
Cellulitis
Skin ulcers
Pain

Question 22

What is the management of chronic venous insufficiency?

Answer 22

Keep skin healthy
Weight loss
Exercise
Compression stockings
Antibiotics for infection
Analgesia for pain
Wound care for ulceration

Question 23

What are varicose veins?

Answer 23

Veins enlarge due to malfunction of valves

Question 24

What are the symptoms of varicose veins?

Answer 24

Blue/purple prominent veins
Swollen/twisted veins
Clustering of veins
Bleeding from veins
Leg pain
Itching/burning

Question 25

What is the management of varicose veins?

Answer 25

Sclerotherapy- inject vein with irritant foam to cause closure
Endothermal ablation- insert catheter into vein to apply radiofrequency ablation
Stripping- veins ligated and pulled out of leg

Question 26

What are the complications of varicose veins?

Answer 26

Prolonged, heavy bleeding after trauma
Superficial thrombophlebitis
DVT
Skin changes
Ulcers