Peripheral Vascular Disease I - Intermittent claudication & critical limb ischaemia

Question 1

what is intermittent claudication?

Answer 1

occurs when insufficient blood blood reaches exercising muscle.

Question 2

in intermittent claudication, when does the pain go away?

Answer 2

pain free at rest

Question 3

what is another term to describe claudication?

Answer 3

muscle ischaemia ON EXERCISE (oxygen demand on exercise)

Question 4

who is at the greatest risk for developing intermittent claudication?

What is the pathology of limb iscahemia?

Answer 4

• male gender
• age (per 10 years) >55years
• diabetes
• smoking
• hypertension
• hypercholesterolemia
• fibrinogen
• alcohol

atherosclerosis

Question 5

what are 2 non-invasive investigations that can investigate lower-limb ischaemia?

Answer 5

1) measurement of ABPI

2) duplex ultrasound scanning

Question 6

what are 3 invasive investigations that can investigate lower limb ischaemia?

Answer 6

1) magnetic resonance angiography
2) CT angiography
3) catheter angiography

Question 7

how are you able to quantify the pressure in the leg?

Answer 7

ankle brachial pressure index (ABPI)
- listen to posterior tibial pulses and brachial pulse and you take a ratio

ABPI = Ankle pressure / brachial pressure

Question 8

what should the normal ABPI be?
what is the ABPI if there is claudication?
what is the ABPI if it severe?

Answer 8

Normal = 0.9-1.2

Claudication = 0.4-0.85

Severe = 0-0.4

Question 9

what does duplex ultrasound scanning do?

Answer 9

uses sound waves that bounce off blood vessels to create pictures

Question 10

what is MRA (Magnetic resonance angiography)?

Answer 10

techniques based on magnetic resonance imaging to image blood vessels.
= it takes pictures of the inside of your body

Question 11

what is CT angiography?

What is catheter angiography?

Answer 11

= 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

Question 12

how can you treat lower limb ischaemia?

Answer 12

= guardian therapy (slow it down)

• smoking
• lipid lowering
• anti-platelets
• hypertension
• diabetes
• life style issues

Question 13

in lower limb ishaemia, how can you improve claudication symptoms?

Answer 13

• realistic expectations
• consent
• exercise training
• drugs
• angioplasty/stenting
• surgery

Question 14

what is the ideal exercise target that should be done in a week?

Answer 14

30mins, 3 times a week for minimum of 6months

Question 15

Yes or No.

Should you push yours when exercising to beyond pain?

Answer 15

yes - as only then will you feel the benefits

Question 16

what drug is used to treat lower limb ischaemia?

Answer 16

cilostozol

Question 17

how can you treat an angioplasty?

Answer 17

insertion of a stent

Question 18

what are the 2 surgical options?

Answer 18

1) inflow bypass

2) outflow bypass

Question 19

what should you use in a bypass surgery to reduce the chance of infection?

Answer 19

• your own veins rather than a prosthetic device

Question 20

what should you use in a bypass surgery to reduce the chance of infection?

Answer 20

• your own veins rather than a prosthetic device

Question 21

what are the symptoms of critical limb iscahemia?

Answer 21

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

Question 22

when is critical limb ichaemia worst?

Answer 22

at night

Question 23

how is critical limb iscahemia helped?

Answer 23

by sitting and putting leg in a dependent position, and by getting up and walking about

Question 24

what is a risk of critic limb iapchaemia?

Answer 24

amputation

Question 25

what are the risk factors for critical limb ischaemia?

Answer 25

1) smoking

2) diabetes

Question 26

how do you treat critical limb ischaemia?

Answer 26

• realistic expectations
• analgesia
• angioplasty/stenting
• surgical
• reconstruction/amputation

Question 27

what is angioplasty?

Answer 27

surgical repair or unblocking of a blood vessel