Arterial disease of the limbs

Question 1

\what causes normally causes critical limb ischaemia ?

Answer 1

Atherosclerotic disease of the arteries supplying the lower limb

Question 2

What are some less common causes of critical limb ischaemia?

Answer 2

Vasculitis

Buerger`s disease

Question 3

What is the classification of CLI?

Answer 3

Fontaine Classification

Question 4

What is stage 1 CLI?

Answer 4

Asymptomatic, incomplete blood vessel obstruction

Question 5

What is stage 2 CLI?

Answer 5

Mild claudication pain in limb

a) when walking greater than 200m
b) When walking a distance of less than 200m

Question 6

What is stage 3 CLI?

Answer 6

Rest pain, mostly in feet

Question 7

Stage 4 CLI?

Answer 7

Necrosis and/or gangrene of the limbs

Question 8

What are the signs of chronic iscahemia in the limbs?

Answer 8

Ulceration
Pallor
Hair loss

Question 9

What should be done when examining for CLI?

Answer 9

(Start at toes and compare)

• Capillary refill times
• Temperature
• Pulses-start at aorta
• Peripheral sensation

Question 10

What pulses should be auscultated?

Answer 10

• Dorsalis pedis

- Posterior tibial

Question 11

What are the two special tests used when examining for CLI?

Answer 11

1. Ankle Brachial pressure Index

2. Buerger`s test

Question 12

How do you measure the ankle brachial pressure?

Answer 12

Ankle pressure
divided by
Brachial pressure

Question 13

How do you carry out Buergers test?

Answer 13

elevate legs
-pallor
in less than 20 degrees= severe ischaemia

Hang feet over bed
-Slow to regain colour
-Dark red colour
(hyperaemic sunset foot)

Question 14

What fraction of capillaries are normally open in the leg?

Answer 14

1/3

Question 15

How should patients with Peripheral vascular disease be managed?

Answer 15

The same way as those with CHD

Question 16

What is the best medical therapy for PVD?

Answer 16

• Anti-platelets
• Statin
• Bp control
• Smoking cessation
• Exercise
• Diabetic control

Question 17

How do antiplatelets help PVD?

Answer 17

Reduce risk of requiring re-vascularisation as well as reducing cardio and all cause mortality

Question 18

How do Statins help PVD?

Answer 18

inhibits platelet activation and thrombosis, endothelial and inflammation activation, plaque rupture

Question 19

What is the target for BP?

Answer 19

<140/85

Question 20

When does excess risk of cardiovascular disease diminish after smoking cessation?

Answer 20

4-6 yrs

Question 21

What percentage of Peripheral artery disease patients are undiagnosed diabetics?

Answer 21

10%

Question 22

What is added to BMT when symptoms are severe?

Answer 22

Angioplasty/stent/surgical bypass

Question 23

What is added to BMT when symptoms are critical?

Answer 23

Angioplasty/stent/endovascular reconstruction/surgical bypass/stent

Question 24

What are the advantages of Ultrasound?

Answer 24

• No radiation

- Dynamic

Question 25

What are the disadvatages of ultrasound?

Answer 25

- Not good in abdomen | - Operator dependant

Question 26

What are the advantages of CT/MRI?

Answer 26

- Detailed- allows treatment | - First line according to NICE

Question 27

What are the disadvantages of CT/MRI?

Answer 27

- Contrast radiation | - Can overestimate calcification, difficulty in low flow states

Question 28

What happens in a digital subtraction angiogram?

Answer 28

needle is placed in artery and fluorescent dye is deposited

Question 29

what does surgical bypass require?

Answer 29

-Inflow A conduit (autologous,synthetc) -Outflow

Question 30

What is the risk of complications with surgical bypass?

Answer 30

- General; bleeding, infection,pain,scar DVT,PE,MI,CVA,LRTI,Death (2%) - Technical :damage to nearby vein,artery, nerve,distal emboli,graft failure

Question 31

Define an emboli?

Answer 31

A blood clot, air bubble, peice of fatty deposit, or other object which has been carried in the bloodstream to lodge in a vessel and cause embolism?

Question 32

Define a thrombus?

Answer 32

A blod clot formed in situ within the vascular system of the body and impeding flow

Question 33

What causes an arterial embolus?

Answer 33

-MI,AF,proximal atherosclerosis

Question 34

What causes thrombosis?

Answer 34

usually thrombosis of a previously deceased artery

Question 35

What are the six Ps of CLI?

Answer 35

- Pain - Pallor - Perishingly cold - Paraesthesia - Paralysis - Pulseless

Question 36

What is paraesthesia?

Answer 36

abnormal sensation, typically tingling or pricking (‘pins and needles’), caused chiefly by pressure on or damage to peripheral nerves.

Question 37

What happens in muscle compartment syndrome?

Answer 37

- Muscle ischaemia - inflammation - oedema - Venous obstruction Tense and tender calf rise increatine kinase Risk of renal failure

Question 38

When oedema occurs what happens?

Answer 38

venous system will not be able to drain | Amputation

Question 39

How do you manage ALI?

Answer 39

ECG bloods, nil by mouth | -analgesia anticoagulants

Question 40

What percentage of acute limb ischaemia is embolic and thrombosis in situ?

Answer 40

- 30% | - 60%

Question 41

What is the mortality rate of acute limb ischaemia?

Answer 41

22%

Question 42

How many diabetics will develop a foot ulcer in their lifetime?

Answer 42

15%

Question 43

What is the pathophysiology of a foot ulcer?

Answer 43

- Microvascular peripheral artery disease - Peripheral neuropathy - Mechanical imbalance - Suceptibility to infection

Question 44

What foot care should be adhered to when foot ulcers can develop?

Answer 44

- Always wear shoes - Check fit of footwear - Check pressure points/plantar surface of foot regularly - prompt and regular woundcare of skin breaches

Question 45

What is the management of diabetic foot disease?

Answer 45

-revascularisation =Disease is very distal =distal bypass -Amputation