W8: Arterial Diseases of the Limbs

Question 1

Chronic Limb Ischaemia

Answer 1

• VASCULITIS
• BUERGER’S DISEASE: vessel welling leading to occlusion, tobacco exacerbating factor
  => BUERGER’S TEST: elevate legs, visible signs less than 20º
• Caudication, pain+ Hx., Hair loss, Pallor

Question 2

FONTAINE CLASSIFICATION for CHRONIC LIMB ISCHAEMIA

Answer 2

1. asympt. incomplete occl.
2. mild claudication: 200m+ or less
3. rest
4. NECROSIS/GANGRENE - CRITICAL

Question 3

Investigations for Chronic Limb Ischaemia

Answer 3

1. CTA/MRA STANDARD
   detail+++ = Tx planning, calfication overestimation, low flow states difficult
2. DUPLEX SCAN
   unsuitable in abdo.; time consuming
3. DIGITAL SUBTRACTION ANGIO.
   invasive. followed by angioplasty

Question 4

MGMT OF PERIPH. ART. DISEASE

Answer 4

CONSERVATIVE
=> a-PT + statin combo; RF control, exrcise

REVASC
=> open surgery
=> endovascular tx: balloon angio, stent

SURGICAL BYPASS
=> conduit, achieve inflow and outflow

Question 5

6 Ps of ACUTE LIMB ISCHAEMIA

Answer 5

PAIN
PALLOR
PULSE DEFICIT
PARATHESIA
PARESIS: musc. weakness and partial paralysis
POIKILOTHERMIA

Question 6

ACUTE LIMB ISCH. PLANNING

Answer 6

embolus: endovasc., thromboectomy, thrombolysis
thrombosis: open embolectomy

non-salvg.: palliate or amputate

Question 7

DIABETIC FOOT DISEASE MGMT

Answer 7

=> foot care + prophylaxis

=> DISTAL REVASC.

=> AMPUTATION => rehab.

=> ADJUNCTIVE MEASURES: debridement, dressing, wound closure, skin grafts