peripheral vascular disease Flashcards
1
Q
what is intermittent claudication?
A
- when insufficient blood reaches exercising muscle
- the patient is pain free at rest but after variable periods of exercise develops ischaemic pain in the affected limb, which is relieved by further rest
2
Q
what are the risk factors for intermittent claudication?
A
- male
- age
- diabetes
- smoking
- hypertension
- hypercholesterolaemia
- fibrinogen
- alcohol
3
Q
what are the non invasive investigations of lower limb ischaemia?
A
- measurement of ABPI
- duplex ultrasound scanning
4
Q
what are the invasive investigations of lower limb ischaemia?
A
- magnetic resonance angiography
- CT angiography
- catheter angiography
5
Q
how do you measure ABPI?
A
- ankle pressure/brachial pressure
6
Q
what are the normal values for ABPI?
A
- normal = 0.9-0.12
- claudiaction = 0.4-0.85
- severe = 0-4.5
7
Q
what are the different ways to treat lower limb ischaemia?
A
- guardian therapy
- improvement of claudiaction symptoms
- exercise training and drugs
- angioplasty/stent
- surgery
8
Q
what is the guardian therapy?
A
- smoking cessation
- lipid lowering
- antiplatelets
- hypertension Rx
- diabetes Rc
- life style issues
- information
9
Q
what exercise should be recommended for lower limb ischaemia?
A
- 1 hour per day - 30 mins 3 times per week for minimum of 6 months
- 20-200% improvment in walking distance
10
Q
what drugs should be given for lower limb ischaemia?
A
- cliostozol
11
Q
what surgery would be given to treat lower limb ischaemia?
A
- endarterectomy
- bypass
12
Q
what is critical limb ischaemia?
A
- at rest there is pain in toe/foot
- occurs when sleeping and lying down
- can be ulcers/ gangrene
- severe ischaemia + damage (trauma/footwear)
13
Q
what are the symptoms of critical limb ischaemia?
A
- pain at rest
- toes and forefoot
- requires strong analgesia
- worse at night
- helped by sitting and putting led in a dependent possition
- helped by getting up and walking about
14
Q
what are the critical limb ischaemia risk factors for amputation?
A
- smoking
- diabetes
15
Q
what is an aneurysm?
A
- dilation of a vessel by more than 50% of its normal diameter
- normal aortic diameter is 1.2-2cm
16
Q
what is a true aneurysm?
A
- all 3 vessel walls are intact
17
Q
what is a false aneurysm?
A
- there is a breach in the vessel wall (surrounding structure act as vessel wall)
18
Q
what are the morphologies or aneurysms?
A
- saccular
- fusiform
- mycotic - arteries secondary to an infection process, involving all 3 layers of the artery
19
Q
what happens in an abdomial aortic aneurysm?
A
- medial degeneration
- regulatin of elastin/collagen in aortic wall
- aneyrysmal dilation
- increase in aortic wall stress
- progressive dilation
20
Q
what increases chance of abdominal aortic aneurysm?
A
- male
- increases with age >65
21
Q
symptoms of AAA?
A
- mostly asymptomatic
- identified by imaging for other pathology
- surveillance programme
- symptoms may be trashing pain
- may mimic renal colic
22
Q
what happens in an AAA rupture?
A
- sudden onset epigastric /central pain
- may radiate through to back
- may minic renal colic
- collapse
23
Q
what would you find on examination of a ruptured AAA?
A
- may look well
- hypo/hypertensive
- pulsatile, expansile mass +- tender
- transmitted pulse
- peripheral pulses
24
Q
what are the outcomes of a ruptured AAA?
A
- 75% will not make it to hospital
- more retroperitoneal, contained rupture
- free intra-peritoneal rupture is rapidly fatal
- 50% operative mortality
25
how do you manage AAA?
operation may cause more harm than doing nothing
| - intervention should be offered at 5.5cm small ones - should just be watched or if it grown 1cm/year
26
how to duplex ultrasound?
- aP diameter
- involvement of iliac arteries
- but it only tells us there is an aneurysm and its AP diameter
27
what does a CT scan allow us to see?
- shape, size and iliac involvement
- allows for management planning
- only imagine method to identify ruptured AAA
28
how do you manage AAA?
- laparotomy
- clamp aorta + iliacs
- dacron graft
- tube vs bifurcated graft
- endovascular aneurysm repair (EVAR) = exclude AAA from insde the vessel
29
what is acute limb iscahemia?
- sudden loss of blood supply to a limb = occlusion of native artery or bypass graft
30
what are the causes of sudden occlusion (acute limb ischaemia)?
- embolism
- atheroembolism
- arterial dissection
- trauma
- extrinsic compression
31
clinical features of acute limb ischaemia?
- pain
- pallor
- pulseless
- perishingly cold
- paraesthesia
- paralysis
32
how can you ddescribe the pain for acute limb ischaemia?
- severe, sudden onset, resistant to angina
| - calcification tenderness with tight compartment intricate muscle necrosis
33
how can you describe the pallor for acute limb ischaemia?
- limb initally white with empty veins
| - later capilaries fill with stagnated de oxygenated blood
34
what is the time line for acute limb ischaemia clinical features?
- 0-4 hours = white foot, painful, sensorimotor deficit
- 4-12 hours = mottles, blaches on pressure
- >12 hours = fixed mottling, non blanching, compartments tender/red
- paralysis
35
what is the management of acute limb ischaemia?
```
ABC = resusitate and investigate
FBC = U/Es, CK Coag +-troponin
ECG = MI, dysrhythmia
CXR = underlying malignancy
arterial imagine
```
36
what is diabetic foot sepsis?
```
encompasses
- diabetic neuropathy
- peripheral vascular disease
- infection
this leads to tissue ulcertaion, necrosis and gangrene which may lead to limb amputation
```
37
what can diabetic foot sepsis come from?
- small punctured wound
- infection from the nail plate
- from a neuro-ischaemic ulcer
38
why is diabetic foot sepsis a problem?
- the pressure of pus builds up in this rigid compartment rapidly leading to impairment of capillary blood flow and further ischaemia and further tissue damage
39
what are the clinical findings of diabetic foot sepsis?
- pyrexia
- tachcardic
- tachypnoeic
- confused
- kassmauls breathing
