Vascular Conditions Flashcards
What is acute limb ischaemia?
Sudden decrease in limb perfusion that threatens the viability of the limb
What can vascular occlusion lead to?
Rapid ischaemia of the affected limb and poor outcomes
What are the potential causes of acute limb ischaemia?
Embolisation
Thrombosis in Situ
Trauma
How can embolisation lead to acute limb ischaemia
Thrombus from a proximal source travels distally to occlude an artery
How does a Thrombosis in Situ lead to acute limb ischaemia?
Atheroma within the artery ruptures, and a thrombus forms on the plaque cap
What are the clinical features of acute limb ischaemia?
The 6 P’s
What are the 6 P’s
Pallor Pain Pulseless Perishingly Cold Paralysis Paraesthesia
Which score can be used to determine prognosis in acute limb ischaemia?
Rutherford score
Which investigations are appropriate with suspected acute limb ischaemia?
Doppler USS
CT Angio
Bloods inc Lactate - ?Ischaemia
What is the initial management for suspected acute limb ischaemia?
High flow O2 and IV Access
Therapeutic Heparin infusion
What are the surgical management options for acute limb ischaemia?
Embolectomy
Thrombolysis
Bypass surgery
What is Chronic Limb Ischaemia?
Peripheral arterial disease that gives symptomatic reduced blood supply to the limbs
What is usually the cause of Chronic Limb Ischaemia?
Atherosclerosis
Which limbs are usually affected by Chronic Limb Ischaemia?
Lower limbs
What are some risk factors of Chronic Limb Ischaemia?
Smoking Diabetes Mellitus Hypertension Hyperlipidaemia Increasing age Family Hx Obesity and Physical Inactivity
What score can be used to classify degree of chronic limb ischaemia?
Fontaine classification
What is the Fontaine Classification of Chronic Limb Ischaemia?
Stage 1 - Asymptomatic
Stage 2 - Intermittent Claudication
Stage 3 - Ischaemic Rest Pain
Stage 4 - Ulceration/Gangrene
What is Critical Limb Ischaemia?
Advanced form of chronic limb ischaemia defined by three criteria:
- Ischaemic rest pain of >2/52 duration
- Presence of Ischaemic lesions
- ABPI <0.5
What is ABPI and what does it measure?
Ankle-Brachial Pressure Index
Measures the difference in arterial BP between the arm and leg
Which value of ABPI is considered significant?
<0.9
Which investigations are appropriate for suspected Chronic Limb Ischaemia?
Doppler USS
CT Angio
What management options are there for Chronic Limb Ischaemia?
Lifestyle advice Statin therapy Antiplatelet therapy Optimise diabetes control Supervised exercise program
When should surgical intervention be offered with Chronic Limb Ischaemia?
If the conservative management options have failed to reduce symptoms
What are the surgical management options for Chronic Limb Ischaemia?
Angioplasty
Bypass surgery
Amputation
