Week 3 - Peripheral Artery Disease Flashcards
What is the anatomy of the lower limb arteries?
aorta - external iliac - common femoral - superficial femoral - popliteal artery - anterior tibia becomes dorsalis pedis - posterior tibial supplies ankle
What does the presence of a normal palpable pulse imply?
no stenosis or obstruction of arteries
What is chronic limb ischaemia?
atherosclerotic disease. limbs in ischaemic state for long period of time.
What are risk factors for CLI?
age, male, smoking, hypertension, hypercholesterolaemia, diabetes
Why is diabetes a risk factor?
causes hypertension
What are the symptoms of CLI by stage?
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
How do you diagnose CLI?
history of claudication, what relieves pain, where, bilateral? during rest? tissue loss? risk factors
How do you examine CLI? what findings may you find?
LOOK, FEEL, LISTEN
look for ulceration, pallor and hair loss.
feel for temp, capillary refill, sensation, pulse
listen using doppler
How do you investigate and test for CLI?
- compare ankle pressure with brachial pressure. difference shows ischaemia.
- buergers test
- investigate with CT angiogram and MR angiogram
- duplex scan
What are benefits and limitations with using duplex scan?
shows flow, width of vessel and blockages.
however hard to see in obese patients, and where tissues cover arteries - aorta or iliac arteries
How do you manage CLI?
use antiplatalets and statins. control smoking, diabetes and BP.
revascularise either with endovascular intervention or open surgery
What are the endovascular intervention methods for CLI?
stent and baloon or atherectomy if plaque is too hard or blockage still exists
What are surgical management options for CLI?
bypass surgery. use veins or superficial vein grafts to reroute blood. different methods depending on which vessel and extent of occlusion
What is the preferred revascularisation treatment depending on the patient?
for long term efficiency in viable patient, bypass is pressered.
for short term results, angioplasty is preferred.
What conditions are needed for bypass surgery?
good blood flow, inflow vessel, a conduit (vein graft or superficial graft) and an outflow vessel
What is acute limb ischaemia?
medical emergency caused by thrombus or embolus obstructing vessels. limb is threatened
What are the causes/ types of acute limb ischaemia?
30% are embolic and 60% are thrombosis
What is the presentation of ALI?
6 p’s
palor, pain, pulse deficit, paraesthesia, paralysis/paresis and poikilothermia (cold)
What is the history of ALI?
chronic limb ischaemia, cardiac history, onset, duration, risk factors,
What are 3 categories of acute limb ischaemia?
viable leg, threatened leg and irreversible ischaemia
How long until acute limb ischaemia damage is irreversible?
6-8 hours
What is compartment syndrome?
increased pressure inside muscle, restricting blood flow and causing pain. tender and tense calf with oedema, inflammation and venous obstruction
How do you treat a threatened ischaemic limb?
immediate revascularisation
How do you treat acute limb ischaemia?
if limb is salveagable, do embolectomy or thrombolysis depending on cause. bypass may be necassary.
if limb is not salvageable, palliative treatment or amputate
What is diabetic foot disease?
peripheral vascular disease and neuropathy may lead to trauma, ulceration, to leg going unseen and becoming infected
How do you treat diabetic foot disease?
prevent ulceration and infection in first place with adequate foot care. may need re-vascularise or amputate.
Where are arterial ulcers commonly found?
directly above malleoli and over toes
What type of pain is typically experienced in CLI?
burning pain
Which patients receive angioplasty (endovascular revascularisation surgery)?
only those with critical limb ischaemia - not mild or moderate. these can be managed with BP control, statins, smoking cessation, diabetes control
What is acute vs chronic vs critical lung ischaemia?
- 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.
What are 3 facts about diabetic foot ulcers?
- 50% of diabetics develop a foot ulcer
- 20% of foot ulcers require amputation
- 50% of foot ulcers become infected
How does ankle brachial pressure index reflect disease?
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
