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MS4 - Vascular > Limb Ischaemia, Ulcers, Gangrene > Flashcards

Limb Ischaemia, Ulcers, Gangrene Flashcards

1
Q

Definition of chronic limb ischaemia

A

Ankle artery pressure <50mmHg (toe <30mmHg)

AND either:

  • Persistent rest pain requiring analgesia for ≥2wks
  • Ulceration or gangrenes
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2
Q

Causes of chronic limb ischaemia

A

Atherosclerosis

Rarely vasculitis

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3
Q

Spectrum of chronic limb ischaemia

A

1) Intermittent claudication
2) Critical limb ischaemia (fontaine 3/4)
3) Leriche’s syndrome
4) Buerger’s syndrome

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4
Q

Intermittent claudication sx

A

Cramping pain after walking set distance

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5
Q

Vessel responisble for intermittent claudication in calf

A

superficial femoral disease

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6
Q

Vessel responsible for intermittent claudication in buttock

A

iliac disease

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7
Q

Critical limb ischaemian sx

A

Rest pain (night)

ulceration

gangrene

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8
Q

Leriche’s syndrome

A

Aortoiliac occlusive disease

Triad:

  • Buttock claudication/wasting
  • Erectile dysfunction
  • Absent femoral pulses
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9
Q

Buerger’s disease aka

A

Thromboangiitis Obliterans

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10
Q

Buerger’s disease risk factors

A

Young, male, smoker

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11
Q

Buerger’s disease pathology

A

Acute inflammation and thrombosis of arteries/veins in hands and feet –> ulceration and gangrene

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12
Q

Buergers test

A

lift leg until pale

≥90: normal

20-30: ischaemia

<20: severe ischaemia

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13
Q

Signs of chronic limb ischaemia

A

Pallor

Pulseless

Pain

Perishingly cold

Parasthesia/paralysis

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14
Q

Fontaine classification of chronic limb ischaemia

A

1) Assymptomatic
2) Intermittent claudication: a. >200m b.<200m
3) Ischaemic rest pain
4) Ulceration/gangrene

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15
Q

Rutherford classification of chronic limb ischaemia

A

1) Mild claudication
2) Moderate claudication
3) Severe claudication
4) Ischaemic rest pain
5) Minor tissue loss
6) Major tissue loss

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16
Q

Investigations for chronic limb ischaemia

A

Doppler waveforms

ABPI

Walk test

Imaging

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17
Q

Imaging Ix for chronic limb ischaemia

A

colour duplex US

CT/MR angiogram with gadolinium contrast

Digital subtraction angiography

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18
Q

Doppler waveforms

A

Normal: triphasic

Mild stenosis: biphasic

Severe stenosis: monophasic

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19
Q

Medical mx of chronic limb ischaemia

A

RFs mx

Beta Blockers in intermittent (NOT critical limb ischaemia)

antiplatelets

analgaesia

20
Q

Interventional mx of chronic limb ischaemia

A

Endovascular: percutaneous transluminal angioplasty/stenting

Surgical reconstruction

21
Q

Acute ischaemia definition

A

< 14 days

22
Q

Severity of acute limb ischaemia

A

Incomplete: limb not threatened

Complete: limb threatened: Loss of limb unless intervention within 6hrs

Irreversible: requires amputation

23
Q

Causes of acute limb ischaemia

A

1) Thrombosis in situ (60%)
2) Embolus (30%)
3) Others: graft occlusion, trauma, aortic dissection

24
Q

Where do majority of emboli causing limb ischaemia form?

A

left atria in AF (80%)

25
Q

Where do majority of emboli causing limb ischaemia get stuck

A

femoral bifurcation

26
Q

Investigations of acute limb ischaemia

A

ECG

CXR

Duplex doppler

27
Q

General treatment of acute limb ischaemia

A

NBM + Rehydration

Analgaesia

Antibiotics

Unfractionated heparin IV infusion

28
Q

Mx of incomplete limb ischaemia

A

angiogram and observe

29
Q

Mx of complete limb ischaemia

A

urgent surgery (embolectomy/bypass)

30
Q

Embolus treatment

A

Wire fed through embolus

Fogarty catheter fed over the top, balloon inflated and catheter withdrawn

31
Q

Causes of leg ulcers

A
  1. Venous: commonest
  2. Arterial
  3. Neuropathic
  4. Pressure/trauma
  5. Systemic disease: e.g. pyoderma gangrenosum
  6. SCC
32
Q

Features of venous leg ulcers

A

Painless

Shallow ulcers

33
Q

Risk factors for venous leg ulcers

A

Venous insufficiency

Varicosities

DVT

Obesity

34
Q

Common place for venous ulcers

A

medial malleolus: “gaiter area”

35
Q

Features of arterial leg ulcers

A

Painful

Deep

Punched

36
Q

Common place for arterial ulcers

A

Heal

Tips of and between toes

Metatarsal heads esp. 5th

37
Q

Features of neuropathic leg ulcers

A

Painless with insensate surrounding skin

Warm foot with good pulses

38
Q

Complications of leg ulcers

A

Osteomyelitis

Development of SCC in the ulcer (Marjolin’s ulcer)

39
Q

Investigations of leg ulcers

A

ABPI

Duplex ultrasonography

Biopsy may be necessary (Look for malignant change: Marjolin’s ulcer)

40
Q

Management of leg ulcers

A

Graduated compression stockings

RFs eg smoking

Analgesia

Bed rest + elevate leg

Pentoxyfylline PO

41
Q

Classication of gangrene?

A

Wet: tissue death + infection

Dry: tissue death only

42
Q

Gas Gangrene microorganism?

A

Clostridium perfringes myositis

43
Q

Treatment of gas gangrene?

A

Debridement (may need amputation)

Benzylpenicillin + metronidazole

Hyperbaric O2

44
Q

Synergistic Gangrene microorganism?

A

Involves aerobes + anaerobes

45
Q

Management of synergistic gangrene?

A

Debridement

Benzylpenicillin ± clindamycin

MS4 - Vascular (4 decks)

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