Vascular Conditions

Question 1

What is acute limb ischaemia?

Answer 1

Sudden decrease in limb perfusion that threatens the viability of the limb

Question 2

What can vascular occlusion lead to?

Answer 2

Rapid ischaemia of the affected limb and poor outcomes

Question 3

What are the potential causes of acute limb ischaemia?

Answer 3

Embolisation
Thrombosis in Situ
Trauma

Question 4

How can embolisation lead to acute limb ischaemia

Answer 4

Thrombus from a proximal source travels distally to occlude an artery

Question 5

How does a Thrombosis in Situ lead to acute limb ischaemia?

Answer 5

Atheroma within the artery ruptures, and a thrombus forms on the plaque cap

Question 6

What are the clinical features of acute limb ischaemia?

Answer 6

The 6 P’s

Question 7

What are the 6 P’s

Answer 7

Pallor
Pain
Pulseless
Perishingly Cold
Paralysis
Paraesthesia

Question 8

Which score can be used to determine prognosis in acute limb ischaemia?

Answer 8

Rutherford score

Question 9

Which investigations are appropriate with suspected acute limb ischaemia?

Answer 9

Doppler USS
CT Angio
Bloods inc Lactate - ?Ischaemia

Question 10

What is the initial management for suspected acute limb ischaemia?

Answer 10

High flow O2 and IV Access

Therapeutic Heparin infusion

Question 11

What are the surgical management options for acute limb ischaemia?

Answer 11

Embolectomy
Thrombolysis
Bypass surgery

Question 12

What is Chronic Limb Ischaemia?

Answer 12

Peripheral arterial disease that gives symptomatic reduced blood supply to the limbs

Question 13

What is usually the cause of Chronic Limb Ischaemia?

Answer 13

Atherosclerosis

Question 14

Which limbs are usually affected by Chronic Limb Ischaemia?

Answer 14

Lower limbs

Question 15

What are some risk factors of Chronic Limb Ischaemia?

Answer 15

Smoking
Diabetes Mellitus
Hypertension
Hyperlipidaemia
Increasing age
Family Hx
Obesity and Physical Inactivity

Question 16

What score can be used to classify degree of chronic limb ischaemia?

Answer 16

Fontaine classification

Question 17

What is the Fontaine Classification of Chronic Limb Ischaemia?

Answer 17

Stage 1 - Asymptomatic
Stage 2 - Intermittent Claudication
Stage 3 - Ischaemic Rest Pain
Stage 4 - Ulceration/Gangrene

Question 18

What is Critical Limb Ischaemia?

Answer 18

Advanced form of chronic limb ischaemia defined by three criteria:

1. Ischaemic rest pain of >2/52 duration
2. Presence of Ischaemic lesions
3. ABPI <0.5

Question 19

What is ABPI and what does it measure?

Answer 19

Ankle-Brachial Pressure Index

Measures the difference in arterial BP between the arm and leg

Question 20

Which value of ABPI is considered significant?

Answer 20

<0.9

Question 21

Which investigations are appropriate for suspected Chronic Limb Ischaemia?

Answer 21

Doppler USS

CT Angio

Question 22

What management options are there for Chronic Limb Ischaemia?

Answer 22

Lifestyle advice
Statin therapy
Antiplatelet therapy
Optimise diabetes control
Supervised exercise program

Question 23

When should surgical intervention be offered with Chronic Limb Ischaemia?

Answer 23

If the conservative management options have failed to reduce symptoms

Question 24

What are the surgical management options for Chronic Limb Ischaemia?

Answer 24

Angioplasty
Bypass surgery
Amputation