Acute & Chronic Limb Ischemia

Question 1

What does Pulse pressure mean?

Answer 1

The difference between systolic and diastolic pressure

Question 2

What does Mean Arterial Pressure mean?

Answer 2

The pressure that propels the blood into the tissues
MAP = diastolic + 1/3 pulse pressure

Question 3

What are differentials for a cold painful pale pulseless leg?

Answer 3

• Acute/Chronic limb ischemia
• Critical limb ischemia
• lembar stenosis & sciatica
• DVT
• Diabetic neuropathy
• Stroke
• Heart failure- peripheral oedema

Question 4

What are IX for a cold painful pale pulseless leg?

Answer 4

• ABPI
• Doppler
• ECG - Afib
• FBC, baseline U&Es & LFTs
• CT angiogrpahy
• HBa1C

Question 5

What is the Rutherford Classification?

Question 6

What is limb claudication?

Answer 6

pain or discomfort in the legs during physical activity & is relieved by rest

Question 7

What is peripheral arterial disease?

Answer 7

Occlusion or narrowing the arteries that supply blood to the legs commonly caused by atherosclerosis

Question 8

What are differentials for limb claudication?

Answer 8

• Neurogenic claudication
• Musculoskeletal - arthritis, sciatica
• Venous insuffciency
• Peripheral neuropathy

Question 9

What is the epidemiology of peripheral arterial disease?

Answer 9

Most common in men & prevalence increases with age
It is associated with coronary artery & cerebrovascular disease and their asssociated modifiable risk factors such as HTN, diabtetes & smoking

Question 10

What is the fontaine classification?

Answer 10

Used in peripheral arterial disease
I - asymptomatic
IIa- mild claudication
IIb - moderate to severe claudication
III- ischemic rest pain
IV - ulceration or gangrene

Question 11

What is leriche’s syndrome

Answer 11

1. Claudication
2. Absent femoral pulses
3. Erectile dysfunction

Question 12

What IX should be done in peripheral arterial disease?

Answer 12

• ABPI
• Duplex
• CT angiography
• magnetic resonance angiography
• contrast angiography

Question 13

What is acute limb ischemia?

Answer 13

A sudden decrease in limb perfusion that causes a potential threat to limb viability in patients who present within 2 weeks of an acute event.
Due to embolus, thrombus or trauma

Question 14

What are the 6 Ps of acute limb ischemia?

Answer 14

1. Pain
2. Pulselessness
3. Pallor
4. Paraesthesia
5. Paralysis
6. Poikilothermic - perishingly cold

Question 15

What is diagnostic in acute limb ischemia?

Answer 15

CT angiogaphy

Question 16

What is the management of acute limb ischemia?

Answer 16

Analgesia & Heparin
FBC, U&Es, LFTs, Clotting profile
Further ix include; endovascular therapies (PCI), thromboembolectomy, endarterectomy, bypass, amputation

complications include compartment syndrome & reperfusion injury

Question 17

What is Dry Gangrene?

Answer 17

Develops when blood flow to affected area is impaired, the tissue driesup & turns brown/purple/blue/black.
It can be left to auto-amputate or can be amputated after revascularisation.
It is common in people with diabetes

Question 18

What is Wet Gangrene?

Answer 18

Liquefactive necrosis due to infection.
The tissue swells & blisters - it is called wet due to pus
Infection can spread throughout the body & can become life threatening

Question 19

What is the treatment for wet gangrene?

Answer 19

IV antibiotic
Amputation or revascularisation & debridement

Question 20

What are the 3 types of arteries?

Answer 20

1. Large elastic
2. Medium muscular
3. Arterioles

Question 21

What are the 3 layers in arteries?

Answer 21

1. Tunica intima
2. Tunica media
3. Tunica adventita/externa

Question 22

What are the 3 types of capillaries?

Answer 22

1. Continuous
2. Fenestrated
3. Discontinuous

Question 23

regulation of blood flow