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Vascular Surgery > 2: Acute and Chronic Limb Ischaemia > Flashcards

2: Acute and Chronic Limb Ischaemia Flashcards

1
Q

What causes peripheral arterial disease

A

atherosclerosis of arteries resulting in decreased limb perfusion

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2
Q

What are the 3 patterns of peripheral arterial disease

A
  1. Intermittent claudication
  2. Chronic limb ischaemia
  3. Peripheral limb ischaemia
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3
Q

What is critical limb ischaemia

A

Advanced limb-threatening form of chronic limb ischaemia

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4
Q

In which population is peripheral arterial disease more common

A

60-80y

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5
Q

What causes peripheral arterial disease

A
  1. Atherosclerosis of the arteries, reducing limb perfusion

2. Arterial clot from heart travels to occlude arteries

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6
Q

Why is there claudication in peripheral arterial disease

A

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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7
Q

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

A

Age

Family History

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8
Q

What is the most important factor for peripheral arterial disease

A

Smoking

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9
Q

What are 5 other modifiable risk factors of peripheral arterial disease

A 
HTN
Diabetes
Hyperlipidaemia
Coronary artery disease
Obesity
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10
Q

What is intermittent claudication

A

buttock, calf or leg pain on walking a certain distance

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11
Q

Which artery is affected if claudication of the buttock

A

iliac

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12
Q

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

A

femoral

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13
Q

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

A

popliteal

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14
Q

What is leriche’s syndrome

A

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

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15
Q

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

A
  1. Erectile Dysfunction
  2. Buttock Claudication
  3. Absent femoral pulses
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16
Q

What is Buerger’s disease also known as

A

Thrombophlebitis Obliterans

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17
Q

In which population does thrombophlebitis obliterates present in

A

Young Heavy Smokers

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18
Q

What is use to classify peripheral arterial disease

A

Fontaine Classification

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19
Q

What is Stage I Fontaine Classification

A

Asymptomatic

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20
Q

What is Stage IIa Fontaine Classification

A

Pain on walking >200m

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21
Q

What is Stage IIb Fontaine Classification

A

Pain on walking <200m

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22
Q

What is Stage III Fontaine Classification

A

Pain at rest

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23
Q

What is Stage IV a Fontaine Classification

A

Dry necrosis

Trophic Disorders

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24
Q

What is Stage IVb Fontain Classification

A

Infection of necrotic tissue

Humid gangrene

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25
Q

What are 3 signs of arterial disease

A
  • Pale
  • Cold
  • Atrophic skin
  • Punched out, painful ulcers
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26
Q

Describe the appearance of an arterial ulcer

A
  • small + deep lesion
  • well-defined borders
  • necrotic base
  • occur @ pressure areas
  • occur over long period
  • little healing
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27
Q

What is Buerger’s angle

A

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

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28
Q

What are the 3 ways to define critical ischaemia

A
  1. Ishaemic rest pain for more than two weeks
  2. ABPI <0.5
  3. Presences of ischaemic lesions or gangrene
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29
Q

What blood tests are indicated for peripheral arterial disease

A
  1. HbA1c
  2. U+Es
  3. FBC
  4. CRP/ESR
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30
Q

What additional blood tests are ordered for individuals <50y

A

Thrombophillia and homocysteine screen

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31
Q

What cardiovascular assessments are ordered for those with PAD

A

ECG

BP

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32
Q

What bedside test may be used for diagnose peripheral arterial disease

A

Ankle-brachial pressure index

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33
Q

What is a normal ABPI

A

1-1.2

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34
Q

What is ABPI in mild ischaemia

A

0.9-0.8

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35
Q

What is ABPI in moderate ischaemia

A

0.8-0.5

36
Q

What is ABPI in severe ischaemia

A

<0.5

37
Q

What ABPI indicates peripheral arterial disease

A

<0.9

38
Q

What ABPI indicates critical limb ischaemia

A

<0.5

39
Q

What does an ABPI of >1.2 indicate

A

calcified vessels

40
Q

What is first-line imaging test for peripheral arterial disease

A

colour duplex US

41
Q

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

A

MRI or CT angiography

42
Q

What is first step in management of peripheral arterial disease

A

Risk Factor Modification

43
Q

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

A
  1. Anti-hypertensives
  2. Clopidogrel (75mg)
  3. Atorvostatin (80mg)
  4. Smoking cessation
44
Q

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

A

Supervised exercise program

45
Q

How is supervised exercise therapy suspected to work

A

improves collateral flow to tissues

46
Q

How long should an individual do supervised exercise therapy for

A

2h a week for 3 months

47
Q

What is second-line management for PAD

A

Naftidrofuryl Oxalate

48
Q

When is naftidrofuryl oxalate offered

A

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

49
Q

What are the conditions for surgery in PAD

A
  1. Supervised exercise programs failed
  2. Risk factor modification has been discussed
  3. Or, critical ischaemia
50
Q

What are the two main surgical options for PAD

A
  1. Bypass graft

2. Percutaneous transluminal angioplasty

51
Q

When is percutaneous transluminal angioplasty used

A

When disease is limited to a single arterial segment

52
Q

How does PTA work

A

Balloon is inflated which increases diameter of the vessel

53
Q

When are bypass grafts used

A

Extensive atheromatous disease with good distal run-off

54
Q

Which is better autologous vein grafts of prosthetic grafts

A

Autologous vein grafts are better if the knee is crossed

55
Q

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

A

Embolectomy

56
Q

When is amputation considered

A

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

57
Q

What can be given for phantom limb pain following amputation

A

Gabapentin

58
Q

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

A

WIFI

59
Q

Outline the WIFI classification

A

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

60
Q

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

A

50%

61
Q

What is the main complication of peripheral arterial disease

A

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

62
Q

What on a doppler indicates PAD

A

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

63
Q

What is done in 1-2d following amputation

A
  • Stump covered with a bandage
  • Individual is encouraged to touch their stump
  • wheelchair used
64
Q

What is done 3-5d post amputation

A
  • individual should lie flat as possible for 1h + straighten hip
65
Q

What is done 6-10d post amputation

A

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

66
Q

What is done 11-21 days post amputation

A

Transfer to amputee rehabilitation unit

67
Q

Define acute limb ischaemia

A

Sudden decrease in limb perfusion that threatens limb viability

68
Q

What are the 3 causes of acute limb ischaemia

A
  1. Thrombosis in situ
  2. Distal embolisation
  3. Trauma
69
Q

What is the most common cause of acute limb ischaemia

A

Thrombosis in situ (60%)

70
Q

Explain thrombosis in situ

A

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

71
Q

What can embolism to cause acute limb ischaemia

A

AAA
AF
Post MI mural thrombus
Prosthetic heart valves

72
Q

What trauma may result in acute limb ischaemia

A

Compartment syndrome

73
Q

What are the 6P’s of acute limb ischaemia

A
  1. Painful
  2. Pulseless
  3. Perishingly Cold
  4. Pale
  5. Paraesthesia
  6. Paralysis
74
Q

What is the classification system of acute limb ischaemia

A

Rutherford Classification System

75
Q

In the Rutherford Classification System what is I

A

Viable

76
Q

What is the prognosis of Class I

A

There is no immediate threat

77
Q

Describe features in class I

A
  1. Motor - intact
  2. Sensory - intact
  3. Arterial doppler - present
  4. Venous doppler - present
78
Q

What is Rutherford IIa

A

Marginally Threatened

79
Q

What is the prognosis of Rutherford IIa

A

Salvageable with prompt treatment

80
Q

What are the features of Rutherford IIa

A
  1. Motor - minimal weakness
  2. Sensory - Intact
  3. Arterial doppler - inaudible
  4. Venous doppler - audible
81
Q

What is the state of Class IIb

A

Immediate Threat

82
Q

What is the prognosis of class IIb

A

Salvageable with immediate treatment

83
Q

Explain the features of class IIb

A
  1. Motor - mild loss
  2. Sensory - mild loss
  3. Arterial - inaudible
  4. Venous - audible
84
Q

What is Rutherford class III

A

Irreversible

85
Q

What is the prognosis of class III

A

Major, permanent, tissue loss and nerve damage

86
Q

What are the features of Rutherford class III

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

Vascular Surgery (6 decks)

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