Peripheral Vascular Disease I - Intermittent claudication & critical limb ischaemia Flashcards
what is intermittent claudication?
occurs when insufficient blood blood reaches exercising muscle.
in intermittent claudication, when does the pain go away?
pain free at rest
what is another term to describe claudication?
muscle ischaemia ON EXERCISE (oxygen demand on exercise)
who is at the greatest risk for developing intermittent claudication?
What is the pathology of limb iscahemia?
- male gender
- age (per 10 years) >55years
- diabetes
- smoking
- hypertension
- hypercholesterolemia
- fibrinogen
- alcohol
atherosclerosis
what are 2 non-invasive investigations that can investigate lower-limb ischaemia?
1) measurement of ABPI
2) duplex ultrasound scanning
what are 3 invasive investigations that can investigate lower limb ischaemia?
1) magnetic resonance angiography
2) CT angiography
3) catheter angiography
how are you able to quantify the pressure in the leg?
ankle brachial pressure index (ABPI)
- listen to posterior tibial pulses and brachial pulse and you take a ratio
ABPI = Ankle pressure / brachial pressure
what should the normal ABPI be?
what is the ABPI if there is claudication?
what is the ABPI if it severe?
Normal = 0.9-1.2
Claudication = 0.4-0.85
Severe = 0-0.4
what does duplex ultrasound scanning do?
uses sound waves that bounce off blood vessels to create pictures
what is MRA (Magnetic resonance angiography)?
techniques based on magnetic resonance imaging to image blood vessels.
= it takes pictures of the inside of your body
what is CT angiography?
What is catheter angiography?
= visualizes arterial and venous vessels throughout the body. Using contrast injected into the blood vessels
= catheter is inserted into an artery through a small incision. Once the catheter is guided to the area, a contrast material is injected through the tube and images are captured using a small dose of ionizing radiation
how can you treat lower limb ischaemia?
= guardian therapy (slow it down)
- smoking
- lipid lowering
- anti-platelets
- hypertension
- diabetes
- life style issues
in lower limb ishaemia, how can you improve claudication symptoms?
- realistic expectations
- consent
- exercise training
- drugs
- angioplasty/stenting
- surgery
what is the ideal exercise target that should be done in a week?
30mins, 3 times a week for minimum of 6months
Yes or No.
Should you push yours when exercising to beyond pain?
yes - as only then will you feel the benefits
what drug is used to treat lower limb ischaemia?
cilostozol
how can you treat an angioplasty?
insertion of a stent
what are the 2 surgical options?
1) inflow bypass
2) outflow bypass
what should you use in a bypass surgery to reduce the chance of infection?
- your own veins rather than a prosthetic device
what should you use in a bypass surgery to reduce the chance of infection?
- your own veins rather than a prosthetic device
what are the symptoms of critical limb iscahemia?
1) pain at rest = toe/foot ischaemia (nerve ending pan)
- lying/sleeping
2) ulcers/gangrene
= severe iscahemia + damage
- trauma
- footwear
3) toes and forefoot
4) strong analgesia
when is critical limb ichaemia worst?
at night
how is critical limb iscahemia helped?
by sitting and putting leg in a dependent position, and by getting up and walking about
what is a risk of critic limb iapchaemia?
amputation
what are the risk factors for critical limb ischaemia?
1) smoking
2) diabetes
how do you treat critical limb ischaemia?
- realistic expectations
- analgesia
- angioplasty/stenting
- surgical
- reconstruction/amputation
what is angioplasty?
surgical repair or unblocking of a blood vessel
