Peripheral Arterial Disease/Chronic Limb Ischaemia (1*) Flashcards
What is it?
What are its risk factors?
What are its complications?
What are its differentials?
➊ Significant atherosclerotic narrowing of arteries distal to the aortic arch
➋ Elderly, Smoking, Alcohol, Hyperlipidaemia, HTN, DM, Diet, Obesity, Family hx
➌ • Acute limb ischaemia
• Arterial ulcers (small, punched-out, painful ulcers)
➍ • Neuropathic ulcers (e.g. in diabetes) - painless, warm foot with sensory loss
• Venous ulcers
• Nerve root compression - sharp, shooting pain, radiating down the leg
• Spinal stenosis - bilateral pain and weakness in buttocks and posterior leg, worse on extension (standing), and relieved by flexion (bending)
How does it present?
What may be found O/E?
What is Critical Limb ischaemia?
→ How does it present?
→ How is the pain relieved?
→ What is there a high risk of here?
What is Leriche syndrome?
→ How does it present?
➊ • Intermittent Claudication - Crampy calf/thigh/buttock pain on walking, and relieved by rest
• Buttock and thigh pain
➋ • Pale, cold leg
• Ulcers
• Poorly healing wounds
• Weak or absent pulses
➌ Severe PAD, where there’s severely impaired limb perfusion
→ Burning pain at rest, ulcers and gangrene
→ Dangling feet over edge of bed
→ Needing to amputate
➍ Bilateral common iliac stenosis
→ Triad of Buttock/thigh/calf pain + Absent femoral pulses + Erectile dysfunction
Investigations:
What’s the 1st line thing to do?
→ How can this be interpreted?
→ What does a score > 1.3 indicate?
What other investigations may be done?
How is Buerger’s Test carried out?
➊ ABPI (Ankle-Brachial Pressure Index)
→ • 0.8 - 1.3 = Normal
• 0.5 - 0.8 = Mild/moderate PAD
• < 0.5 = Severe PAD
→ Arterial calcification, which makes it harder to compress, therefore giving a misleadingly high ABPI e.g. in Diabetics
➋ • Full CVS risk assessment - FBC, BP, glucose, lipids, ECG
• Duplex USS (for site and severity of stenosis)
• MR/CT Angiogram
➌ 1. Lie pt supine and slowly raise their leg. The angle at which their sole goes pale is Buerger’s angle (smaller the angle, the worse the ischaemia)
2. Dangle pt’s legs off the bed and there’ll be reactive hyperaemia, making the limb very red and hot
Management:
What are the conservative options?
How is it managed medically?
What are the last options?
→ When would this be done?
➊ Supervised exercise, Smoking cessation, HTN/DM control
➋ • Antiplatelets, Statins
• Naftidrofuryl oxalate (vasodilator) as symptomatic relief if supervised exercise not effective and pt doesn’t want surgery
➌ • Angioplasty (Endovascular stenting)
• Surgical bypass
• Amputation if revascularisation isn’t possible
→ When conservative and medical options are no longer effective
