Week 3 - Peripheral Artery Disease

Question 1

What is the anatomy of the lower limb arteries?

Answer 1

aorta - external iliac - common femoral - superficial femoral - popliteal artery - anterior tibia becomes dorsalis pedis - posterior tibial supplies ankle

Question 2

What does the presence of a normal palpable pulse imply?

Answer 2

no stenosis or obstruction of arteries

Question 3

What is chronic limb ischaemia?

Answer 3

atherosclerotic disease. limbs in ischaemic state for long period of time.

Question 4

What are risk factors for CLI?

Answer 4

age, male, smoking, hypertension, hypercholesterolaemia, diabetes

Question 5

Why is diabetes a risk factor?

Answer 5

causes hypertension

Question 6

What are the symptoms of CLI by stage?

Answer 6

4 stages.
stage I is asymptomatic
stage II is mild claudication pain
stage III is pain during rest in feet
stage IV is necrosis/gangrene

Question 7

How do you diagnose CLI?

Answer 7

history of claudication, what relieves pain, where, bilateral? during rest? tissue loss? risk factors

Question 8

How do you examine CLI? what findings may you find?

Answer 8

LOOK, FEEL, LISTEN
look for ulceration, pallor and hair loss.
feel for temp, capillary refill, sensation, pulse
listen using doppler

Question 9

How do you investigate and test for CLI?

Answer 9

• compare ankle pressure with brachial pressure. difference shows ischaemia.
• buergers test
• investigate with CT angiogram and MR angiogram
• duplex scan

Question 10

What are benefits and limitations with using duplex scan?

Answer 10

shows flow, width of vessel and blockages.
however hard to see in obese patients, and where tissues cover arteries - aorta or iliac arteries

Question 11

How do you manage CLI?

Answer 11

use antiplatalets and statins. control smoking, diabetes and BP.

revascularise either with endovascular intervention or open surgery

Question 12

What are the endovascular intervention methods for CLI?

Answer 12

stent and baloon or atherectomy if plaque is too hard or blockage still exists

Question 13

What are surgical management options for CLI?

Answer 13

bypass surgery. use veins or superficial vein grafts to reroute blood. different methods depending on which vessel and extent of occlusion

Question 14

What is the preferred revascularisation treatment depending on the patient?

Answer 14

for long term efficiency in viable patient, bypass is pressered.
for short term results, angioplasty is preferred.

Question 15

What conditions are needed for bypass surgery?

Answer 15

good blood flow, inflow vessel, a conduit (vein graft or superficial graft) and an outflow vessel

Question 16

What is acute limb ischaemia?

Answer 16

medical emergency caused by thrombus or embolus obstructing vessels. limb is threatened

Question 17

What are the causes/ types of acute limb ischaemia?

Answer 17

30% are embolic and 60% are thrombosis

Question 18

What is the presentation of ALI?

Answer 18

6 p’s

palor, pain, pulse deficit, paraesthesia, paralysis/paresis and poikilothermia (cold)

Question 19

What is the history of ALI?

Answer 19

chronic limb ischaemia, cardiac history, onset, duration, risk factors,

Question 20

What are 3 categories of acute limb ischaemia?

Answer 20

viable leg, threatened leg and irreversible ischaemia

Question 21

How long until acute limb ischaemia damage is irreversible?

Answer 21

6-8 hours

Question 22

What is compartment syndrome?

Answer 22

increased pressure inside muscle, restricting blood flow and causing pain. tender and tense calf with oedema, inflammation and venous obstruction

Question 23

How do you treat a threatened ischaemic limb?

Answer 23

immediate revascularisation

Question 24

How do you treat acute limb ischaemia?

Answer 24

if limb is salveagable, do embolectomy or thrombolysis depending on cause. bypass may be necassary.

if limb is not salvageable, palliative treatment or amputate

Question 25

What is diabetic foot disease?

Answer 25

peripheral vascular disease and neuropathy may lead to trauma, ulceration, to leg going unseen and becoming infected

Question 26

How do you treat diabetic foot disease?

Answer 26

prevent ulceration and infection in first place with adequate foot care. may need re-vascularise or amputate.

Question 27

Where are arterial ulcers commonly found?

Answer 27

directly above malleoli and over toes

Question 28

What type of pain is typically experienced in CLI?

Answer 28

burning pain

Question 29

Which patients receive angioplasty (endovascular revascularisation surgery)?

Answer 29

only those with critical limb ischaemia - not mild or moderate. these can be managed with BP control, statins, smoking cessation, diabetes control

Question 30

What is acute vs chronic vs critical lung ischaemia?

Answer 30

• acute is like an MI of the leg - emergency, compromises blood flow and leads to mortality and amputation
• chronic is like stable angina - partial occlusion which needs stabilising
• critical is like unstable MI - atherosclerotic plaque rupture is high risk and intervention needed immdiately.

Question 31

What are 3 facts about diabetic foot ulcers?

Answer 31

• 50% of diabetics develop a foot ulcer
• 20% of foot ulcers require amputation
• 50% of foot ulcers become infected

Question 32

How does ankle brachial pressure index reflect disease?

Answer 32

An ABPI of >1.0 is aysmptomatic disease .
An ABPI of >0.5 means only 50% of the blood is reaching the arteries and 50% is being blocked by peripheral arterial disease