Peripheral Vascular Disease Flashcards
In chronic lower limb ischaemia how might the legs present?
Legs are cold with dry skin and lack of hair. Pulses may be diminished or absent. Ulceration may occur in association with dark discolouration of toes and gangrene.
Describe the ankle brachial pressure index and what it is used for
Indicates the severity of lower limb ischaemia. Intermittent claudication= 0.5-0.9 and values of less than 0.5 are associated with critical limb ischaemia. Remember it is important to listen to wave forms particularly in diabetic patients.
Treatment of chronic lower limb ischaemia
Prevent more atherosclerosis (ie encourage patient to stop smoking, lower lipids etc.)
Encourage patient to exercise more- continue walking beyond the pain.
Surgery may be required in patients with severe symptoms- angioplasty or bypass.
Drugs- cilostazol and naftidrofuryl
What is acute lower limb ischaemia?
Sudden loss of blood supply to a limb as a result of occlusion of native artery or bypass graft
6Ps patients will complain of in acute lower limb ischaemia?
Pain (usually unbearable) , pallor (skin will change from white to mottled as the deoxygenated blood starts to stagnate), pulseless, perishingly cold, paraesthesia and paralysis.
Acute lower limb ischaemia…
From 0-4 hrs ___________
From 4-12 hours ______
From 12 hours onwards____
The foot is white and salvageable
The foot is mottled and damage is partly reversible
There is fixed mottling on the foot and it is paralysed. The foot is not salvageable.
In acute lower limb ischaemia if the foot is salvageable you could treat with ___1__
If the limb is unsalvageable the two options are ___2____
1 embolectomy, fasciotomies 2 palliation (if patient too frail for amputation) or amputation
Diabetics are particularly prone to foot infections because…
Neuropathy (damage to peripheral nerves) and presence of peripheral vascular disease means that they may not notice infection until there are systemic symptoms.
Diabetic foot infections are usually ______so a ________ spectrum antibiotic is required
polymicrobial
broad spectrum
Presentation of diabetic foot sepsis?
Patient is pyrexic, tachycardia, tachypnoeic, confused and has very laboured breathing. Swollen forefoot and digit Ulcer with pus Erythema which may track up the limb Patches of necrosis Crepitus in soft tissues of the foot
Symptoms of abdominal aortic aneurysm?
Pain mimicking renal colic (kidney stones), trashing (occurs when tiny bits of the aneurysm break off causing small spots of discolouration on the feet) or rupture.
Symptoms of AAA rupture?
Sudden onset epigastric/ central pain, pain radiation to the back, collapse, hypo/hypertensive, pulsatile expansile abdominal mass, transmitted pulses and changes to peripheral pulses.
What other type of aneurysm should you check for in those with AAA?
Popliteal aneurysms.
Intervene with AAA if…
They are fixed with…
Patient is symptomatic- has pain, trashing or rupture.
If more than or equal to 5.5 cm in diameter or expanding at a rate of more than 1cm a year.
Fixed with open repair or endovascular repair.
Distal vein thrombosis refers to DVT of the ____1______ and there is no evidence that you have to _____2______ Proximal vein thrombosis refers to DVT of __3__ or __4____ and these are ___5____
1 Calves 2 treat these 3 popliteal vein 4 femoral vein 5 treated
