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Year 4: Vascular Surgery > Lower Limb Ischaemia > Flashcards

Lower Limb Ischaemia Flashcards

1
Q

what is acute limb ischaemia defined as

A

sudden decrease in limb perfusion that threatens the viability of the limb

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2
Q

what are the 3 main classifications that can cause acute limb ischaemia

A
  1. Embolisation
    - thrombus from proximal source travels distally to occlude artery e.g. AF, post MI, prosthetic valve, AAA.
  2. Thrombus in Situ
    - atheroma plaque ruptures and thrombus is formed
  3. Trauma
    - e.g. compartment syndrome, least common
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3
Q

signs + symptoms of acute limb ischaemia

A

the 6 P’s:

PAIN

PALLOR

PULSELESSNESS

PARATHESIA

PERISHINLGY COLD

PARALYSIS

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4
Q

Investigations for patient with acute limb ischaemia

A

Routine bloods including serum lactate to assess level of ischaemia

ECG

Doppler USS of both limbs followed by CT angiography

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5
Q

is acute limb ischaemia an emergency?

A

YES

-Complete occlusion will lead to irreversible tissue damage within 6 hours

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6
Q

surgical options for embolic cause of acute limb ischaemia

A
  • embelectomy via fogarty catheter
  • local intra-arterial thrombolysis
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7
Q

surgical options for thrombotic cause of acute limb ischaemia

A
  • angioplasty +/- stent
  • bypass
  • local intra-arterial thrombolysis
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8
Q

what drug should be initiated in acute limb ischaemia

A

heparin

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9
Q

appearance of irreversible limb ischaemia

A

mottled non-blanching appearance with hard woody muscles

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10
Q

management of irreversible limb ischaemia

A

amputation

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11
Q

what is an important complication of acute limb ischaemia

A

reperfusion injury – a sudden increase in capillary permeability can result in:

  • compartment syndrome
  • release of substances from damaged muscle cells:
    • K+ ions cause hyperkalaemia
    • H+ ions causing acidosis
    • Myoglobin – significant AKI
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12
Q

what is chronic limb ishaemia

A

peripheral arterial disease that results in symptomatic reduced blood supply to the limbs

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13
Q

most common cause of chronic limb ischaemia

A

atherosclerosis

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14
Q

risk factors for chronic limb ischaemia

A

smoking

diabetes

HTN

hyperlipidaemia

family hx

obesity

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15
Q

how does chronic limb ischaemia typically present

A

intermittent claudication - cramping pain in calf/thigh/buttock after walking a fixed distance and relieved by rest

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16
Q

what is Buergers test

A

involves lying the patient supine and raising their legs until they go pale, then lowering them until the colour returns

  • the angle at which the limb goes pale is termed Buergers angle
  • angle of <20 degress indiacates severe ischaemia
17
Q

what is Leriche syndrome

A

form of peripheral arterial disease that affect the aoritc bifurcation

typically presents as buttock claudication + erectile dysfunction

18
Q

what is ABPI

A

ABPI = ankle brachial pressure index

  • measured bu taking BP from ankle + arm and calculating ratio
  • usually BP is higher in the leg than the arm
  • if blood flow to the leg is impaired, leg BP drops below arm BP
  • the greater the drop the worse the blood flow
19
Q

what ABPI score is normal

A

1-1.2

20
Q

what ABPI indicates claudication

A

0.9-0.6

21
Q

what ABPI indicates ischaemic rest pain

A

0.6-0.3

22
Q

what ABPI score indicates critical ischaemia

A

<0.3

23
Q

what is critical limb ischaemia?

how can is be clinically defined?

A

advanced form of chronic limb ischaemia.

Can be clinically defined in 3 ways:

  • ischaemic rest pain > 2 weeks duration
  • presence of ischaemic lesions/gangrene
  • ABPI <0.3
24
Q

how is diagnosis of chronic limb ischaemia made

A

clinical, with ABPI to confirm and quantify severity

25
Q

what tests should be done as part of cardiovascular risk assessment for patients with chronic limb ischaemia

A

BP

blood glucose

lipid profile

ECG

26
Q

What additional tests should be done in a patient <50 years old with no risk factors presenting with chronic limb ischaemia

A

thrombophilia screen

homocysteine levels

27
Q

medical management of chronic limb ischaemia

A

lifesytle advice - smoking cessation, weight loss, exercise

statin - atorvastatin 80mg

anti-platelet - clopidogrel 75mg

diabetes control

28
Q

management of critical limb ischaemia

A

urgent referral for surgical intervention

  • angioplasty +/- stenting
  • bypass grafting
29
Q

what can cause a raised ABPI >1.2

A

Vessel calcification

  • common in diabetes
30
Q

In claudication affecting the buttocks, which artery is likely to be affected

A

iliac stenosis

Year 4: Vascular Surgery (7 decks)

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