Vascular - Peripheral Vascular Disease

Question 1

Define Acute Limb Ischaemia

Answer 1

Sudden decrease in limb perfusion that threatens viability

Question 2

What are the three groups of causes of acute limb ischaemia?

Answer 2

Embolism e.g. AF, AAA
Thrombosis in situ
Trauma e.g. compartment syndrome

Question 3

What is the typical presentation of acute limb ischaemia?

Answer 3

6PS 
Pain 
Pallor 
Pulselessness
Paraesthesia 
Perishingly cold 
Paralysis

Question 4

What investigation is diagnostic in acute limb ischaemia?

Answer 4

Doppler USS (both limbs)

Question 5

How many hours is it before damage in acute limb ischaemia is considered irreversible?

Answer 5

6

Question 6

What initial management is required in acute limb ischaemia?

Answer 6

High flow O2
IV access
Therapeutic dose heparin - IV bolus then infusion

Question 7

What is the surgical management in acute limb ischaemia?

Answer 7

Embolic disease - embolectomy, thrombolysis or bypass
Thrombotic disease - thrombolysis, angioplasty, or bypass
Irreversible disease - urgent amputation

Question 8

What are signs of irreversible acute limb ischaemia?

Answer 8

Mottling
Non-blanching
Woody muscles

Question 9

Release of myoglobin in reperfusion puts patients at risk for…

Answer 9

AKI

Question 10

What is released in reperfusion syndrome which should be monitored in patients following acute limb ischaemia treatment?

Answer 10

K+
H+
Myoglobin

Question 11

Define chronic limb ischaemia

Answer 11

Peripheral artery disease that results in symptomatic reduced blood supply to the limbs

Question 12

What are the two main causes of chronic limb iscaemia?

Answer 12

Atherosclerosis - common

Vasculitis - rarer

Question 13

How is chronic limb ischaemia staged?

Answer 13

I-IV

I - asymptomatic
II - intermittent claudication
III - ischaemia pain at rest
IV - gangrene or ulceration

Question 14

What special test is useful in examination of chronic limb ischaemia?

Answer 14

Buerger’s test

Lying down, raise leg until goes pale, then lower until colour returns

Question 15

What is the value of “Beuger’s angle” which is indicative of severe ischaemia?

Answer 15

<20 degrees

Question 16

Define critical limb ischaemia

Answer 16

advanced chronic limb ischaemia whereby there is:
Pain at rest for > 2 weeks requiring opiates,
Gangrene or ischaemic lesions
ABPI <0.5

Question 17

What examination findings would you expect for critical limb ischaemia?

Answer 17

Pale, cold limb
Pulseless or weak pulse
Limb hair loss or skin changes

Question 18

What investigations are used in chronic limb ischaemia?

Answer 18

ABPI
Doppler

also assess CV risk factors e.g. lipids, glucose

Question 19

What medical management is used in chronic limb ischaemia?

Answer 19

Lifestyle advice
Statin - 80mg atorvastatin OD
Antiplatelet - 75mg clopidogrel OD
Optimise diabetes control if required

Question 20

What are the surgical options for chronic limb ischaemia?

Answer 20

Angioplasty
Bypass
Amputation

Question 21

What are the indications for surgery in chronic limb ischaemia?

Answer 21

Any critical limb ischaemia

Non-critical but no improving with medical management