Acute Limb Ischaemia

Question 1

3 main patterns of PAD presentation

Answer 1

• intermittent claudication
• critical limb ischaemia
• acute limb threatening ischaemia

Question 2

Signs and symptoms

Answer 2

1 or more of the 6Ps

• pale
• pulseless
• painful
• paralysed
• paraesthetic
• perishing with cold

Question 3

Causes (most common to least)

Answer 3

• thrombosis in situ (40%) = atheroma rupture and thrombus formation
• embolization (38%) = thrombus from proximal source travels distally
• trauma = e.g compartment syndrome

Question 4

Stages of disease

Answer 4

Viable
Marginally Threatened
Immediately Threatened
Irreversible

Question 5

Viable Signs

Answer 5

No sensory or motor loss

Arterial and venous doppler audible

Question 6

Marginally Threatened Signs

Answer 6

Just arterial doppler inaudible

Question 7

Immediately Threatened Signs

Answer 7

Sensory loss of toes and other areas
Pain at rest
Mild/moderate motor loss
Inaudible arterial doppler

Question 8

Irreversible Signs

Answer 8

Profound sensory loss
Paralysis
Inaudible arterial and venous doppler

Question 9

Management for all patients

Answer 9

• assessment within 4-6 hours for revascularisation involving ABPI and Duplex Doppler USS
• antiplatelets
• anticoagulation
• analgesia
• RF modification

Question 10

Management for viable limbs

Answer 10

Thrombolytics
Endovascular Revascularisation
Surgical Revascularisation

Question 11

Management for non viable limb

Answer 11

Amputation

Question 12

General management for PAD

Answer 12

• quit smoking
• treat co-morbidities
• 80mg atorvastatin for all
• clopidogrel 75mg for all > aspirin
• supervised exercise programme

Question 13

Severe PAD treatment

Answer 13

Angioplasty
Stenting
Bypass Surgery
Amputation if critical limb ischaemia + not suitable for any other interventions

Question 14

Drugs for PAD

Answer 14

Naftidrofurl oxalate = vasodilator, if poor QoL

Cilostazol = phosphodiesterase III inhibitor with antiplatelet and vasodilator effect