LL Arterial Flashcards
Redness with dependency
Chronic ischaemia
Onychogryphosis
Thickened distorted nail
Guttering of superficial veins
Chronic arterial disease
Arterial ulcers
IC, rest pain Foot, toes, ankle-- lateral malleolus Punched out Little exudate Rarely edema Painful Trophic changes and gangrene
Tx arterial ulcers
Conservative
Angioplasty– endo vascular revasc
Bypass-
Aorta femoral graft
Venous ulcers
DVT, varicose veins Medial lower leg gaiter area Sloped edges LOTS EXUDATE painless-- unless ... Usually aw limb edema Aw-- chronic venous insufficiency signs
When do venous ulcers become painful?
Edema
Infection
Increase capillary refill
Ischaemia/PVD
Decrease capillary refill
Dependent blood pooling
Chronic ischaemic limb – colour
Red from venous pooling– goes pale when elevated
Severe ischaemia– capillary refill
15-30sec
Ischaemic burger angle
15-30 degrees
Conclusion LL arterial
Bp Full CVS exam ABI PAD - tar staining, hyperCH Investigations-- Doppler US, MRA
ABI 0.5-1
Intermittent claudication
ABI 0.3-0.5
Rest pain/ critical limb ischaemia
ABI
Gangrene and ulceration
Causes of claudication with normal pulse
Neurogenic claudication– spinal stenosis
Anemia
Beta blockers
Critical ischaemia 6P’s
Pallor Pain Pulse less Paraesthesia Perishingly cold Paralysis
Leriches syndrome
Bilaterally painful buttocks and impotence due to common iliac disease
Diabetic foot
Peripheral neuropathy
Autonomic neuropathy
Large artery disease
Small artery disease
Peripheral neuropathy diabetic
Loss of ankle jerk and vibration sense
Accidental injury/ tissue damage
Charcot joints
Autonomic neuropathy
Decreased sweating
Cracked dry skin
Infection
Pallor and mottling
Acute limb ischaemia
