Peripheral Vasc Disease + Limb Ischemia

Question 1

What is acute limb ischemia?

Answer 1

Quickly developing or sudden decrease in limb perfusion, usually produce new or worsening S+S

Question 2

What is chronic limb ischemia?

Answer 2

Intermittent claudication or critical limb ischemia

Question 3

What is the most common, and other causes of, acute limb ischemia?

Answer 3

Common: thrombosis at site of atherosclerotic stenosis
Other: cardiac embolization, aortic dissection or embolization, graft thrombosis, thrombosis of a popliteal aneurysm, and trauma

Question 4

RF for peripheral artery disease

Answer 4

Greater with age, people with CVD or DM

Smoking

Question 5

S+S of acute limb ischemia

Answer 5

Pain, pale, pulseless, paralysis, paraesthesia, perishingly cold

Question 6

Management of acute limb ischemia

Answer 6

Immediate admission to vascular surgery

Question 7

When should chronic limb ischemia be suspected?

Answer 7

Progressive development of intermittent claudication 
Rest pain (usually at night) 
Gangrenous wounds 
Non healing wounds 
Peripheral pulses hard to feel

Question 8

How is chronic limb ischemia diagnosed?

Answer 8

Presence of features + ABPI ratio of <0.9 (peripheral artery disease) + <0.5 (critical limb ischemia)

Question 9

Management of critical leg ischaemia

Answer 9

Management of CV risk
Referral to vascular MDT
Management of pain
Foot care

Question 10

Management of intermittent claudication

Answer 10

Manage CV risk
Exercise programme
Referral for angioplasty or bypass surgery
Naftidrofuryl oxalate 2nd line

Question 11

What is intermittent claudication?

Answer 11

Pain in a group of muscles, brought on by exercise, relieved with rest

Question 12

What is rest pain?

Answer 12

Pain in toes at rest - typically when horizontal due to gravity not helping blood flow