Vascular disease of LL

Question 1

Describe the process of atherosclerosis:

Answer 1

Endothelial damage.
Monocytes differentiate into macrophages.
Platelets adhere to endothelium + release cytokines.
LDL is oxidised + scavenged by macrophages - becoming foam cells.
Foam cells die, releasing lipid into plaque.

Question 2

How do statins act to prevent atherosclerosis?

Answer 2

Lipid lowering.
Antiplatelet.
Stabilise plaques.

Question 3

What happens in plaque rupture?

Answer 3

Thrombogenic inside is exposed.

Triggers platelet activation + coagulation cascade.

Question 4

Where does atherosclerosis occur?

Answer 4

Large/medium arteries, at bifurcations.

Coronary, carotid, lower limb and aorta.

Question 5

Describe chronic limb ischaemia: (4).

Answer 5

Secondary to atherosclerosis.
Usually bilateral.
Collateral circulation develops.
May become critically ischaemic.

Question 6

What is the Fontaine classification of critical limb ischaemia?

Answer 6

Asymptomatic.
Intermittent claudication.
Ischaemic rest pain.
Ulceration/gangrene (critical ischaemia).

Question 7

What are the signs of critical ischaemia? (3).

Answer 7

Pain at rest.
Ulceration.
Gangrene.

Question 8

Where does dry gangrene occur?

Answer 8

Places with minimal blood supply to drive infection. E.g. toes.

Question 9

Who gets acute limb ischaemia?

Answer 9

Atherosclerotic rupture.
Embolus in AF.
Angioplasty.
Recent grafting of occlusion.

Question 10

What are the signs of a critically ischaemic limb?

Answer 10

Painful.
Pulselessness.
Perishingly cold.
Pallor.
Paraesthesia.
Paralysis.