2: Acute and Chronic Limb Ischaemia Flashcards by Grace Poole

What causes peripheral arterial disease

atherosclerosis of arteries resulting in decreased limb perfusion

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What are the 3 patterns of peripheral arterial disease

Intermittent claudication
Chronic limb ischaemia
Peripheral limb ischaemia

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What is critical limb ischaemia

Advanced limb-threatening form of chronic limb ischaemia

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In which population is peripheral arterial disease more common

60-80y

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What causes peripheral arterial disease

Atherosclerosis of the arteries, reducing limb perfusion

2. Arterial clot from heart travels to occlude arteries

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Why is there claudication in peripheral arterial disease

Stenosis of arteries results in decreased blood supply and oxygen to tissues. This causes ischaemia and release of adenosine which stimulates nociceptors causing pain sensation.

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What are the two non-modifiable risk factors for peripheral arterial disease

Age

Family History

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What is the most important factor for peripheral arterial disease

Smoking

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What are 5 other modifiable risk factors of peripheral arterial disease

HTN
Diabetes
Hyperlipidaemia
Coronary artery disease
Obesity

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What is intermittent claudication

buttock, calf or leg pain on walking a certain distance

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Which artery is affected if claudication of the buttock

iliac

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Which artery is affected if claudication of upper 2/3 of the calf

femoral

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Which artery is affected if claudication of lower 1/3 of the calf

popliteal

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What is leriche’s syndrome

occlusion at the aortic bifurcation of bilateral occlusion of common iliac arteries

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What is the triad of symptoms seen in Leriche’s syndrome

Erectile Dysfunction
Buttock Claudication
Absent femoral pulses

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What is Buerger’s disease also known as

Thrombophlebitis Obliterans

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In which population does thrombophlebitis obliterates present in

Young Heavy Smokers

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What is use to classify peripheral arterial disease

Fontaine Classification

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What is Stage I Fontaine Classification

Asymptomatic

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What is Stage IIa Fontaine Classification

Pain on walking >200m

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What is Stage IIb Fontaine Classification

Pain on walking <200m

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What is Stage III Fontaine Classification

Pain at rest

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What is Stage IV a Fontaine Classification

Dry necrosis

Trophic Disorders

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What is Stage IVb Fontain Classification

Infection of necrotic tissue

Humid gangrene

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What are 3 signs of arterial disease

- Pale - Cold - Atrophic skin - Punched out, painful ulcers

Describe the appearance of an arterial ulcer

- small + deep lesion - well-defined borders - necrotic base - occur @ pressure areas - occur over long period - little healing

What is Buerger's angle

The angle at which the legs go pale on lifting them in PAD. Less than 20 degrees indicates critical ischaemia

What are the 3 ways to define critical ischaemia

1. Ishaemic rest pain for more than two weeks 2. ABPI <0.5 3. Presences of ischaemic lesions or gangrene

What blood tests are indicated for peripheral arterial disease

1. HbA1c 2. U+Es 3. FBC 4. CRP/ESR

What additional blood tests are ordered for individuals <50y

Thrombophillia and homocysteine screen

What cardiovascular assessments are ordered for those with PAD

ECG | BP

What bedside test may be used for diagnose peripheral arterial disease

Ankle-brachial pressure index

What is a normal ABPI

1-1.2

What is ABPI in mild ischaemia

0.9-0.8

What is ABPI in moderate ischaemia

0.8-0.5

What is ABPI in severe ischaemia

<0.5

What ABPI indicates peripheral arterial disease

<0.9

What ABPI indicates critical limb ischaemia

<0.5

What does an ABPI of >1.2 indicate

calcified vessels

What is first-line imaging test for peripheral arterial disease

colour duplex US

What imaging test is used if intervention for peripheral arterial disease is being performed

MRI or CT angiography

What is first step in management of peripheral arterial disease

Risk Factor Modification

What are 4 elements of risk factor modification for peripheral arterial disease

1. Anti-hypertensives 2. Clopidogrel (75mg) 3. Atorvostatin (80mg) 4. Smoking cessation

What is the first step in medical management of peripheral arterial disease

Supervised exercise program

How is supervised exercise therapy suspected to work

improves collateral flow to tissues

How long should an individual do supervised exercise therapy for

2h a week for 3 months

What is second-line management for PAD

Naftidrofuryl Oxalate

When is naftidrofuryl oxalate offered

If supervised exercise program has failed and individual is un-fit or does not want surgery

What are the conditions for surgery in PAD

1. Supervised exercise programs failed 2. Risk factor modification has been discussed 3. Or, critical ischaemia

What are the two main surgical options for PAD

1. Bypass graft | 2. Percutaneous transluminal angioplasty

When is percutaneous transluminal angioplasty used

When disease is limited to a single arterial segment

How does PTA work

Balloon is inflated which increases diameter of the vessel

When are bypass grafts used

Extensive atheromatous disease with good distal run-off

Which is better autologous vein grafts of prosthetic grafts

Autologous vein grafts are better if the knee is crossed

If peripheral arterial disease is caused by AF, how is it managed

Embolectomy

When is amputation considered

Any patient unsuitable for revascularisation when symptoms have resulted in gangrene or incurable sepsis

What can be given for phantom limb pain following amputation

Gabapentin

What classification system is used to predict the risk of amputation in PAD

WIFI

Outline the WIFI classification

Wound (ulcers) Ischaemia (on ABPI) FI: foot infection

What is the 5-year mortality rate of critical limb ischaemia

50%

What is the main complication of peripheral arterial disease

65% of individuals will have co-existing cerebral or coronary artery disease

What on a doppler indicates PAD

Peak systolic flow volume of more than 2 - indicates stenosis of >50%

What is done in 1-2d following amputation

- Stump covered with a bandage - Individual is encouraged to touch their stump - wheelchair used

What is done 3-5d post amputation

- individual should lie flat as possible for 1h + straighten hip

What is done 6-10d post amputation

pneumatic post amputation mobility aid (PPAM aid) used to mobilise

What is done 11-21 days post amputation

Transfer to amputee rehabilitation unit

Define acute limb ischaemia

Sudden decrease in limb perfusion that threatens limb viability

What are the 3 causes of acute limb ischaemia

1. Thrombosis in situ 2. Distal embolisation 3. Trauma

What is the most common cause of acute limb ischaemia

Thrombosis in situ (60%)

Explain thrombosis in situ

Atheromatous plaque in the artery forms and ruptures. Thrombus forms on the plaque

What can embolism to cause acute limb ischaemia

AAA AF Post MI mural thrombus Prosthetic heart valves

What trauma may result in acute limb ischaemia

Compartment syndrome

What are the 6P's of acute limb ischaemia

1. Painful 2. Pulseless 3. Perishingly Cold 4. Pale 5. Paraesthesia 6. Paralysis

What is the classification system of acute limb ischaemia

Rutherford Classification System

In the Rutherford Classification System what is I

Viable

What is the prognosis of Class I

There is no immediate threat

Describe features in class I

1. Motor - intact 2. Sensory - intact 3. Arterial doppler - present 4. Venous doppler - present

What is Rutherford IIa

Marginally Threatened

What is the prognosis of Rutherford IIa

Salvageable with prompt treatment

What are the features of Rutherford IIa

1. Motor - minimal weakness 2. Sensory - Intact 3. Arterial doppler - inaudible 4. Venous doppler - audible

What is the state of Class IIb

Immediate Threat

What is the prognosis of class IIb

Salvageable with immediate treatment

Explain the features of class IIb

1. Motor - mild loss 2. Sensory - mild loss 3. Arterial - inaudible 4. Venous - audible

What is Rutherford class III

Irreversible

What is the prognosis of class III

Major, permanent, tissue loss and nerve damage

What are the features of Rutherford class III

1. Motor - profound loss 2. Sensory - profound loss 3. Arterial - inaudible 4. Venous - inaudible

2: Acute and Chronic Limb Ischaemia Flashcards

(86 cards)