PAD Flashcards
What is chronic limb ischaemia
A condition ehre blood supply to the limbs deteriorates with time as a consequence of progressive atherosclerotic disease, with symptoms initially on exertion but eventually at rest where it is called “critical limb ischaemia”
What is critical limb ischaemia
WHen chronic limb ischaemia progresses to constant pain
WHat are the risk factors for critica limb ischaemia
Agem Male, smoking, hyperlipidaemia, hypertension, family history of atherosclerosis
What is the most common cause of chronic limb ischaemia?
Atherosclerosis
Describe the pathophysiology of chronic limbIntermittent ischaemia
Mismatch between circulatory supply and metabolic/nutrient fdemand of skin and skeletal muscle, most commonly due to an atherosclerotic, flow limiting lesion.
As disease progresses, intermittent claudication occurs as oxygen demand on exertion cannot be met
As progresses further, lesions occlude supply so metabolic demands cant be met at rest (critical limb ischaemia)
WHat are the clinical features of chronic limb ischaemia
Intermittent claudication/rest pain determined by severity. 2/3 asymptomatic.
How does intermittent claudication present
Buttock/thigh pain (aorta, iliac vessels)
Calf pain (femoral/popliteal vessels)
Ankle/foot pain (tibial/peroneal vessels)
How does critical limb ischaemia present
Rest pain often accompanied by paraesthesia of foot or toes, ulceration, necrosis, gangrene
Pain exacerbated by leg elevation, relieved with leg dependency. Diabetic neuropathy may experience little pain
What are the examination findings of critical limb ischaemia
Absent/decreased peripheral pulses, bruits in aorta and groin, positive buergers test, rubor on dependency
WHat are the investigations for chronic limb ischaemia?
First line: Blood tests (renal, cardiovascular RFs like lipids, glucose, and lastly anaemia)
Ultrasound doppler and ABPI
Second line are duplex ultrasound, CT/MR angiography
WHat are the ABPI ranges
> 1.4 means stiffened arteries in DM, normal is 0.9-1.1, claudication is 0.75-0.9, short distance claudication is 0.75-0.5
Critical limb ischaemia is <0.5
How is chronic limb ischaemia managed
Lifestyle change,
Medical: Lipids statins, BP control, diabetic control and antiplatelet therapy
Symptomatic relief of claudication (Cilostazol and naftidrofuryl)
Angioplasty/stenting
Vascular surgery/bypass
Amputation
What is acute limb ischaemia
Sudden reduction in arterial blood flow to an arm
WHat causes acute limb ischaemia
Thrommbosis in situ, or arterial emboli most commonly
