Peripheral Arterial Disease Flashcards
Critical limb ischaemia is caused by
Atherosclerosis of arteries supplying lower limbs
Risk factors of critical limb ischaemia
Male Age Smoking Hypercholesterolaemia Hypertension Diabetes
Symptoms of critical limb ischaemia
Rest pain mostly in feet
Claudication
Necrosis/gangrene of limb
Clinical examination findings of critical limb ischaemia
Ulceration, pallor and hair loss of legs and feet
Ankle brachial pressure index <0.5
Buerger’s test - slow to regain colour, dark red colour (hanging feet over edge), pallor, angle<20 degrees (elevated legs)
Imaging for critical limb ischaemia
Duplex
CT/MRA
Digital subtraction angiography
Peripheral artery disease is connected to
Coronary artery disease
Management of critical limb ischaemia
Conservative
Revascularisation - open surgery and endovascuilar intervention
Conservative management of critical limb ischaemia
Best medical therapy
Risk factors control
Exercise
Best medical therapy of critical limb ischaemia
Combination of anti-platelet and statin
Risk factor control of critical limb ischaemia
Blood pressure control
Smoking cessation
Diabetic control
Open surgery options for critical limb ischaemia
Bypass
Endarterectomy
Endovascular intervention options for critical limb ischaemia
Balloon angioplasty
Stent placement
Atherectomy
Surgical bypass requires
Inflow artery
A conduit
Outflow artery
General complications of surgical bypass
Bleeding Wound infection Pain Scar Deep vein thrombosis Pulmonary embolism MI Stroke
Technical complications of surgical bypass
Damage to nearby vein, artery, nerve
Distal emboli
Graft failure
Acute limb ischaemia is caused by
Arterial embolus Thrombosis Trauma Dissection Acute aneurysm thrombosis
Clinical presentation of acute limb ischaemia
Pain Pallor Pulse deficit Paraesthesia Paresis/paralysis Poikilothermia
Muscle ischaemia is irreversible after how much time
6-8 hours
Compartment syndrome results in
Muscle ischaemia Inflammation, oedema, venous obstruction Tense, tender calf Rise in creatinine kinase Risk of renal failure (myoglobulinaemia)
Management of acute limb ischaemia if limb salvageable
Open embolectomy
Bypass
Mechanical thrombectomy
Thrombolysis
Management of acute limb ischaemia if limb unsalvageable
Palliate
Amputate
What percentage of diabetic patients will develop a foot ulcer in their lifetime
25%
Diabetic foot diseases
Microvascular peripheral artery disease Peripheral neuropathy Mechanical imbalance Foot deformity Minor trauma Susceptibility to infection
Diabetic foot disease presentation
Pressure ulcers
Foot care
Always wear shoes
Check fit of footwear
Check pressure points/plantar (bottom) surface of foot regularly
Prompt and regular wound care of skin breaches
Diabetic foot disease prevention
Foot care
Effective glycaemic control
Management of diabetic foot disease
Prevention Diligent wound care Infection - antibiotics Investigate for other problems Revascularisation Amputation Adjunctive measures
Revascularisation options for diabetic foot disease
Distal crural angioplasty/stent
Distal bypass
Adjunctive measures for diabetic foot disease
Dressing
Debridement
Negative pressure wound closure
Skin grafts
