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Cardiovascular > Peripheral Arterial Disease > Flashcards

Peripheral Arterial Disease Flashcards

1
Q

Where are the normal palpable pulses?

A

Aorta
Common femoral artery
Popliteal artery
Posterior tibial pulse
Dorsalis pedis pulse

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2
Q

Explain pathophysiology for critical limb ischaemia?

A

Same disease process as coronary and carotid atherosclerotic disease - systemic disease

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3
Q

What is critical limb ischaemia?

A

Atheromatous disease of the arteries supplying the lower limb
Less commonly - vasculitis, Buerger’s disease (inflamed and swollen arteries collect blood clots)

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4
Q

What are the risk factors of critical limb ischaemia?

A

Male, age, smoking, hypercholesterolaemia , hypertension and diabetes

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5
Q

Explain Fontaine classification?

A

Stage I - asymptomatic, incomplete blood vessel obstruction
Stage II - mild claudication pain in the limb
Stage III - rest pain, mostly in feet
Stage IV- Necrosis and or gangrene of the limb

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6
Q

What stages are critical limb ischaemia/

A

3 and 4
Need max. attention

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7
Q

What is involved in history of critical limb ischamia?

A

Claudication - exercise tolerance, change over time, leg, type of pain, bilateral
Rest pain - relieving factors
Tissue loss - duration, trauma and peripheral sensation
Risk factors, PMH, Drug history, Surgical history

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8
Q

What can be seen on clinical examination of critical limb ischaemia?

A

Signs of chronic ischaemia
-ulceration, pallor and hair loss

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9
Q

What can you feel and auscultate on clinical examination of CLI?

A

Feel - Temp., capillary refill time, peripheral sensation, pulses
Auscultate - hand held doppler. Check dorsalis pedia and posterior tibial pulses

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10
Q

Explain ankle brachial pressure index?

A

Ankle pressure (mmHg/ Brachial pressure
Symptom free is 1 or more
Intermittent claudication is 0.95-0.5
Rest pain is 0.5-0.3
Gangrene and ulceration is <0.2

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11
Q

Explain the Buerger’s test

A

Elevate legs - pallor shows ischaemia at buergers angle < 20 which is severe ischaemia
Hang feet over edge of bed and slow regain of colour then dark red as more capillaries are open if ischaemia

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12
Q

What are benefits and negatives of Duplex imaging?

A

Dynamic and no radiation or contrast
Not good in abdomen, operator dependant and time consuming

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13
Q

What are the benefits and negatives of CTA/MRA - angiogram?

A

Detailed and first line according to NICE
Contrast and radiation, can overestimate calcification and difficulty in low flow states

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14
Q

What investigations are used for CLI?

A

Duplex
CTA/MRA
Digital subtraction angioplasty

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15
Q

What medical therapy is given for CLI?

A

Antiplatelet - reduces risk of revascularisation and cardiovascular mortality
Statins - inhibit platelet activation and thrombosis

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16
Q

What are the risk factor controls for CLI?

A

BP control - target 140/85
Smoking cessation
Diabetic control
Exercise

17
Q

What are the options for management for CLI?

A

Medical treatment
Primary amputation
Revascularisation

18
Q

What are the open surgery options for CLI?

A

Bypass and/or endarterectomy

19
Q

What are the endovascular intervention options for CLI?

A

Balloon angioplasty
Stent replacement
Atherectomy

20
Q

What does surgical bypass require?

A

Inflow, a conduit (autologous or synthetic) and outflow

21
Q

What are the risks of complications for surgical bypass/

A

Bleeding, wound infection, pain, scar, DVT, PE, MI, CVA, LRTI and death
Can also have damage to nearby vein, artery, nerve, distal emboli, graft failure - stenosis or occlusion

22
Q

What are the 2 types of surgical bypass graft?

A

Reversed saphenous vein graft
In situ saphenous vein graft

23
Q

Is surgical bypass or angioplasty better?

A

In short term where results matter then angioplasty is likely preferred
In patients with suitable anatomy, vein availability and reasonable life expectancy - surgery may be better

24
Q

What is the pathophysiology for acute limb ischaemia?

A

Arterial embolus, thrombosis, trauma, dissection and acute aneurysm thrombosis i.e. popliteal

25
Q

What is the clinical presentation of acute limb ischaemia?

A

6 Ps - Pain, pallor, pulselessness, paraesthesia, paresis/paralysis and poikilothermic (cold)
Remember to compare to contralateral limb to index limb

26
Q

Explain compartment syndrome

A

Muscle ischaemia leads to inflammation, oedema and venous obstruction
Then get tense and tender calf
Then rise in creatine kinase and risk of renal failure due to myoglobulinaemia

27
Q

When is muscle ischaemia irreversible?

A

After 6-8 hours

28
Q

What happens if there is irreversible ischaemia?

A

Major tissue loss or permanent loss damage, paralysis and profound
No pulse over artery or vein

29
Q

What are the options if the limb salvageable?

A

Suspicion of embolus then embolectomy
Suspicion of thrombus in situ - thrombolysis, thrombectomy or embolectomy and maybe bypass

30
Q

What happens when the limb is not salvageable?

A

Palliate or amputation

31
Q

Describe an embolectomy

A

Catheter passes through clot and balloon collects clot

32
Q

Is acute limb ischaemia a medical emergency?

A

Yes
30% embolic and 60% thrombosis in situ

33
Q

How many diabetic patients will develop ulcer?

A

25%

34
Q

What is the pathophysiology of diabetic foot disease?

A

Microvascular peripheral artery disease, peripheral neuropathy, mechanical imbalance, foot deformity, minor trauma and susceptibility to infection

35
Q

Describe foot care for diabetics in DFU prevention?

A

Always wear shoes
Check fit of footwear
Check pressure points/plantar surface of foot
Wound care of skin breaches
Effective glycaemic control

36
Q

Explain management of DFU

A

Prevention, Diligent wound care, infection and investigate for osteomyelitis, gas gangrene or necrotizing fasciitis (air between bones)

37
Q

Explain surgical management of DFU

A

Revascularization - attempt distal crural angioplasty/stent and distal bypass
Amputation

38
Q

What are adjunctive measures for DFU?

A

Dressings, debridement- larval therapy, negative pressure wound closure and skin grafts

39
Q

What are major amputations?

A

Below knee and above knee as energy energy requirements are much more

Cardiovascular (33 decks)

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