Peripheral Vascular Conditions Flashcards
What is Intermittent Claudication?
= pain in limb brought on by exertion, relieved at rest, and reoccurs on similar effort
Usually measured by how far someone can walk on flat
What is critical limb ischaemia?
= pain at rest +/- tissue loss
<50mmHg at ankle
How is CLI managed?
Stop smoking Exercise more Good diet Lose weight Diabetes control —> reduce HbA1c by 1-21%
What is the mortality and morbidity rate of CLI?
25% amputation rate
50% of which die within 5 years
What medications might you prescribe to treat IC or CLI?
Statins - simvastatin 40mg (HDL protective + 24% revascularisation)
Antiplatelets - aspirin or clopidogrel 75mg
Anti hypertensives
Antioxidants - omega 3
Cilostazol/Pletal - phosphodiesterase inhibitor
How can CLI be treated with angioplasty? What are the benefits and risk factors?
Angioplasty =
use balloon +/- stent
Good: minimally invasive, short stay, quick recovery
Bad: failure to dilate, re-stenosis, amputation, death
When is a surgical bypass used to treat CLI? What are the risks and benefits?
= conduit
Can be autologous - femoral vein
Or synthetic - PFTE/Dacron
Reserved for patients with CLI +/- life altering claudication
Good: save limb, retain independence, wound healing, don’t need multiple visits
Bad: graft failure, MI, infection, limb loss, death
What are varicose veins?
Diseased valves or refluxing valves —> blood flows back —> vein stretches —> back pressure —> varicose veins
What are the symptoms of varicose veins?
Dilated, tortuous, incompetence, reflux = aching veins
Hypertension in veins
Swelling of ankles
What are some complications of varicose veins?
Swelling Discomfort Itching Haemosiderin Eczema Lipodermatosclerosis Ulceration Thrombophlebitis
How are varicose veins managed?
Conservative:
Leg elevation
Compression stockings
Activity
Medical:
Topical relief
Surgery:
Open ligation + stripping
Foam scleropathy
Endovenous solutions
What is chronic limb ischaemia?
pain at rest +/- tissue loss
<50mmHg at ankle
What is the ABPI? What are its classifications?
>1.4 = calcification might be present >1 = likely normal 0.8 - 1 = no significant disease 0.5 - 0.8 = moderate disease 0.3 - 0.5 = severe disease <0.3 = critical ishaemia
What is Buerger’s test?
The vascular angle, which is also called Buerger’s angle, is the angle to which the leg has to be raised before it becomes pale, whilst lying down.
In a limb with a normal circulation the toes and sole of the foot, stay pink, even when the limb is raised by 90 degrees.
In an ischaemic leg, elevation to 15 degrees or 30 degrees for 30 to 60 seconds may cause pallor.
A vascular angle of less than 20 degrees indicates severe ischaemia.
When is surgery considered as a treatment for limb ischaemia? When might amputation be considered?
bypass graft if chronic limb ischaemia +/- life-altering claudication
amputation is considered when there is tissue loss/death or claudication persists despite bypass graft
What medication could be involved in palliative care of intractable limb ischaemia?
opiates
gabapentin
antidepressants
When is an amputee’s stitches removed post-op?
after 10-21 days
What are the 6 signs of Acute Limb Ischaemia?
Pain Pallor Pulselessness Polar Paralysis Paresthesia
How can limb ischaemia cause AKI?
ischaemia –> increased lactate –> rhabdomyolysis –> AKI
What is reperfusion syndrome?
tissue damage caused when blood supply returns to tissue after a period of ischemia.
The absence of oxygen and nutrients from blood during the ischemic period creates a condition in which the restoration of circulation results in inflammation and oxidative damage through the induction of oxidative stress.
treat with prophylactic fasciotomy
What are the common causes of leg ulcers? What are the different types?
chronic venous hypertension - venous
ischaemia - arterial
diabetes - diabetic ulcer
prolonged soft tissue compression - pressure sore/decubitus ulcer
How do you treat leg ulcers?
primary = treat cause
secondary compression stockings elevate legs above heart vitamin supplement if needed review medication
