Lower Limb Ischaemia Flashcards
What are the main causes of lower limb ischaemia
- endothelial damage to artery wall
- plaque formation
What can damage the endothelium of blood vessels and lead to limb ischaemia?
- smoking
- increased BP
- cholesterol
- high glucose
- free radicals
What causes plaque formation?
- Activated platelets
- LDL cholesterol
- Inflammatory response - foamy macrophages
What is intermittent claudication?
- plaque in lower leg artery causes insufficient blood to reach muscles
What are the symptoms of intermittent claudication?
- patient is pain-free at rest
- after variable periods of exercise develops ischaemic pain in the affected limb
- pain is relieved by rest
How is lower limb ischaemia investigated?
Non-invasive
- Measurement of ABPI
- Duplex ultrasound scanning
Invasive
- Magnetic resonance angiography
- CT angiography
- Catheter angiography
HOw is lower limb ischaemia treated?
Attempt to slow progression of disease
- Stop SMOKING
- lipid lowering
- antiplatelets
- hypertension and diabetes medication
- encourage walking to help develop collateral circulation
What vasodilator drugs can be used in an attempt to help lower limb disease?
Cilostozol / pentoxifyline / naftidrofuryl
How much are patients encouraged to exercise to improve lower limb ischaemia?
30 min 3x per week for 6+ months
exercise beyond pain
What interventions can be used to treat lower limb ischaemia?
- angioplasty + stent
- surgery (bypass graft using vein)
What symptoms indicate CRITICAL limb ischaemia?
Rest pain = toe / foot ischaemia (nerve ending pain)
Ulcers/gangrene = severe ischaemia + damage
due to Trauma/Footwear
Rest pain usually occurs when the patient is lying/ sleeping at night. What can they do to help this pain?
Helped by:
- sitting and putting the leg in a dependent position
- getting up and walking about
- requires strong analgesia as pain is worse at night
What may be seen on examination of a patient with critical limb ischaemia?
- Cool to touch
- Absence of peripheral pulses
- Colour change
- Poor tissue nutrition
- hairless
- thick nails
- shiny skin
- Venous guttering
- Ulcers
- Gangrene
What risk factors increase the probability of amputation?
smoking
diabetes
At what locations can the leg be amputated?
- transtibial
- through the knee
- transfemoral
