limb ischaemia Flashcards
what is peripheral vascular disease commonly caused by
atherosclerosis
what are the patients most likely to die of
MI or stroke
what are the 2 types of limb ischaemia
acute or chronic
what are risk factors chronic limb ischaemia
- smoking
- diabetes
- hypercholesterolaemia
- hypertension
what do patients with intermittent claudication complain of
exertion discomfort most commonly in the calf that is relieved by rest
what do patients with aorta-iliac disease experience
pain in the buttock, hip or thigh also may have erectile dysfunction
what do patients with rest pain experience
unremitting pain in the foot which stops patient from sleeping
relieved by dangling the foot over the edge of the bed or standing on cold floor
signs
- lower limbs are cold
- dry skin
- lack of hair
- diminished pulses
- ulceration may occur with dark discolouration of the toes
what is severity of disease indicated by
ankle/brachial pressure index
what options are there for imaging
- angiography
- duplex ultrasound using colour doppler
- 3D MR angiography
- CT angiography
what does digital subtraction angiography provide
an arterial map
use immediately prior to intervention
what can duplex ultrasound using colour doppler provide
an accurate anatomical map of the lower limbs
what does 3D MR angiography provide
imaging of both legs with single contrast injection
what should patients be encouraged to do for treatment
stop smoking
what do patients with diabetes need
regular chiropody and diabetic management
what lifestyle measures
- weight loss
- increase exercise
what drugs are given
- cilostazol
- naftidrofuryl
what is cilostazol
phosphodiesterase III inhibitor that increases levels of cAMP
what does cilostazol produce
vasodilatation and inhibits platelet aggregation
what is naftidrofuryl
vasodilator agent that inhibits vascular and platelet 5-HT2 receptors
reduce lactic acid
what drugs are not recommended
Oxpentifylline, inositol nicotinate and cinnarizine
what occurs in severe ischaemia
amputation
symptom of acute limb ischaemia
the 5 P’s
- pain
- pallor legs (white)
- paraesthesia
- paralysis
- perishingly cold
signs of acute limb ischaemia
- limb is cold
- marbling of skin
- pulses are diminished or absent
- movement of leg are reduced
- pain in calf on compression
what are causes of acute limb ischaemia
- embolic disease
- rheumatic fever
- cardiac arrhythmias
- atrial myxoma
what is given first
heparin
what is given to patients with acute limb ischaemia after MI
long term warfarin
what do patients with embolus benefit from
surgical removal = embolectomy
