Vascular - Peripheral Vascular Disease Flashcards
Define Acute Limb Ischaemia
Sudden decrease in limb perfusion that threatens viability
What are the three groups of causes of acute limb ischaemia?
Embolism e.g. AF, AAA
Thrombosis in situ
Trauma e.g. compartment syndrome
What is the typical presentation of acute limb ischaemia?
6PS Pain Pallor Pulselessness Paraesthesia Perishingly cold Paralysis
What investigation is diagnostic in acute limb ischaemia?
Doppler USS (both limbs)
How many hours is it before damage in acute limb ischaemia is considered irreversible?
6
What initial management is required in acute limb ischaemia?
High flow O2
IV access
Therapeutic dose heparin - IV bolus then infusion
What is the surgical management in acute limb ischaemia?
Embolic disease - embolectomy, thrombolysis or bypass
Thrombotic disease - thrombolysis, angioplasty, or bypass
Irreversible disease - urgent amputation
What are signs of irreversible acute limb ischaemia?
Mottling
Non-blanching
Woody muscles
Release of myoglobin in reperfusion puts patients at risk for…
AKI
What is released in reperfusion syndrome which should be monitored in patients following acute limb ischaemia treatment?
K+
H+
Myoglobin
Define chronic limb ischaemia
Peripheral artery disease that results in symptomatic reduced blood supply to the limbs
What are the two main causes of chronic limb iscaemia?
Atherosclerosis - common
Vasculitis - rarer
How is chronic limb ischaemia staged?
I-IV
I - asymptomatic
II - intermittent claudication
III - ischaemia pain at rest
IV - gangrene or ulceration
What special test is useful in examination of chronic limb ischaemia?
Buerger’s test
Lying down, raise leg until goes pale, then lower until colour returns
What is the value of “Beuger’s angle” which is indicative of severe ischaemia?
<20 degrees
Define critical limb ischaemia
advanced chronic limb ischaemia whereby there is:
Pain at rest for > 2 weeks requiring opiates,
Gangrene or ischaemic lesions
ABPI <0.5
What examination findings would you expect for critical limb ischaemia?
Pale, cold limb
Pulseless or weak pulse
Limb hair loss or skin changes
What investigations are used in chronic limb ischaemia?
ABPI
Doppler
also assess CV risk factors e.g. lipids, glucose
What medical management is used in chronic limb ischaemia?
Lifestyle advice
Statin - 80mg atorvastatin OD
Antiplatelet - 75mg clopidogrel OD
Optimise diabetes control if required
What are the surgical options for chronic limb ischaemia?
Angioplasty
Bypass
Amputation
What are the indications for surgery in chronic limb ischaemia?
Any critical limb ischaemia
Non-critical but no improving with medical management
