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Cardiovascular system SA > Arterial Disease of the Limbs - Presentation, Investigation & Therapy > Flashcards

Arterial Disease of the Limbs - Presentation, Investigation & Therapy Flashcards

1
Q

What anatomy from the aorta at the top of the leg to the bottom of the leg at the foot

A

Aorta - iliac arteries - common femoral artery - superficial femoral artery - popliteal artery;

  • 1.anterior tibial- dorsalis pedis
    1. peroneal artery
    1. posteroir tibial artery
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2
Q

What is the definition chronic limb ischaemia

A

Atherosclerotic disease of the arteries supplying the lower limbs

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3
Q

What is the possible aetiologies of Chronic limb lischaemia

A

Atheosclerotic
vasculitis
buergers disease

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4
Q

What is the risk factors for Chronic limb ischaemia

A 
Male
Age
Smoking
Hypercholesterolaemia
Hypertension
Diabetes
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5
Q

What is stages of symptoms of CLI

A
  1. Asymptomatic, incomplete blood vessel obstruction
  2. Mild claudication pain in limb
    A. walking more than 200m
    B. walking less than 200m
  3. Rest pain, mostly in feet
  4. Necrosis and/or gangrene of the limb
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6
Q

Claudication definition

A

a condition in which cramping pain in the leg is induced by exercise

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7
Q

In diagnosing, what factors need to be considered with a presenting history of claudication

A 
Exercise tolerance, effect of incline,
does it change over time, is it relieved by rest
Where in the leg is the pain,
type of pain
is it Bilateral
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8
Q

In diagnosing what factors needs to be considered with a
history of

  1. rest pain
  2. tissue loss
A
  1. character of the pain
    is there any relieving factors

2.Duration
History of trauma
peripheral sensation

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9
Q

What is the signs of chronic ischaemia in the legs

A

Ulceration
Pallor
Hair loss

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10
Q

In examination of chronic ischaemia of the leg what should you examine for

A 
PALPABLE 
Capillary refill times
Temperature 
Pulses – start at the aorta
Peripheral sensation

AUSCULTATE
auscultate for Dorsalis pedis and posterior tibial pulses if they are not palpable

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11
Q

What is the two special tests tried on examination

A

Ankle brachial pressure index

Buergers test

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12
Q

What does the ankle brachial pressure index show if it is

  • less than 1
  • 0.95 -0.5
  • less than 0.2
A
  • ischaemia in the legs
  • claudication present
  • gangrene and ulceration is occuring
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13
Q

What is the investigations and sign in the buergers test

A

Elevation of legs - show pallor

Hanging feet of the bed - slow to regain colour as shows a dark red colour

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14
Q

Why does a dark red colour appear as you hang your feet of the bed

A

As all the the capillaries are open - so fills with blood rapidly = red

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15
Q

How could you test for severe ischaemia in burgers test

A

If pallor appears at elevation of legs at 20 degrees

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16
Q

What is the best medical therapy treatments for CLI

A 
Antiplatelet therapy 
statin therapy 
BP control 
Smoking cessation 
Diabetic control 
Exercise
  • same management as CAD
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17
Q

Patients with CLI can potentially have an under diagnosis of what

A

Diabetes

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18
Q

What is the management of CLI when the symptoms become severe

A

angioplasty/stent

surgical bypass

Amputation

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19
Q

What imagery investigations are used in the diagnosis in CLI

A

Duplex

CTA/MRA

Digital subtraction angiogram

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20
Q

What is the advantages and disadvantages to Duplex imaging

A

Advantage
Dynamic
No radiation/contrast

Disadvantage
Not good in the abdomen
Operator dependent, time consuming

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21
Q

What is first line imaging in diagnosis in peripheral arterial disease and why

A

CT/MRI – allows treatment planning

22
Q

What is the disadvantage of CT/MRI imaging in diagnosing peripheral arterial disease

A

Contrast and radiation

Can overestimate calcification, difficulty in low flow states

23
Q

What is Digital subtraction angiogram and what does it increase the risk of

A

type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment.

haematoma or infection

24
Q

What is duplex imaging

A

form of medical ultrasonography that incorporates that involves imaging of structure and flow of movement of structure

25
Q

What is the requirements for surgical bypass

A

Inflow
A conduit: autologous (vein from legs, arm), synthetic (PTFE/Dacron)
Outflow

26
Q

What is the general risk of complications in surgical bypass

A 
Bleeding, 
wound infection, 
pain, 
scar, 
DVT, 
Pulmonary Embolism, 
MI, 
CVA, 
LRTI, 
death (2%)
27
Q

What is the technical risks of complication in surgical bypass

A

Damage to nearby vein, artery, nerve,
distal emboli,
graft failure (stenosis, occlusion)

28
Q

What is the procedure formed in a surgical bypass

A

restoring normal blood supply to the heart by creating new routes for the blood to travel into the heart when one or both of the coronary arteries have become clogged

29
Q

What is the two forms of surgical procedures for server peripheral ischeamia

A

Bypass first or angioplasty

amputation

30
Q

What is in the survival procedure of an angioplasty

A

procedure that can open up a blocked blood vessel using a small, flexible plastic tube, or catheter, with a “balloon” at the end of it. When the tube is in place, it inflates to open the blood vessel, or artery, so that normal blood flow is restored

31
Q

What determines what surgical treatment patients should have between angioplasty and bypass

A

If patients expected to live <2 years should have angioplasty first.

If life expectancy >2yrs, and they have vein, should have bypass first.

32
Q

What follows surgical amputation

A

rehabilitation

33
Q

What is the definition of acute limb ischaemia

A

Emboli: a blood clot, air bubble, piece of fatty deposit, or other object which has been carried in the bloodstream to lodge in a vessel and cause an embolism.

Thrombus: a blood clot formed in situ within the vascular system of the body and impeding blood flow

34
Q

What is the aeitology of acute limb ischameia

A

Arterial embolus:

Thrombosis:
Usually thrombosis of a previously diseased artery due to MI, AF, proximal atherosclerosis

Trauma
Dissection
Acute aneurysm thrombosis i.e. popliteal

35
Q

What is the history that needs to be gathered form presentation of acute limb ischameia

A 
History of chronic limb ischaemia
Risk factors for CLI
Cardiac history
Onset/duration of symptoms 
Functional status - can they walk on it 
Social history
36
Q

What are the 6P’s in the presentation of ALI

A 
Pain
Pallor
Perishingly cold
Paraesthesia
Paralysis
Pulseless
(compared in both legs)
37
Q

What is the pathology and presentation of compartment syndrome

A

Muscle ischaemia causes inflammation which leads to oedema and results in venous obstruction

Presentation: Tense and tender calf

38
Q

What enzyme does compartment syndrome increase in the legs

A

Creatinine kinase -a protein necessary for muscle cells of the body to achieve their different chemical reactions

39
Q

What does compartment syndrome increase the risk of

A

renal failure (myoglobulinaemia)

40
Q

What is the investigations for ALI

A

ECG

Bloods

41
Q

What is the medical treatment for management of ALI

A

Anti coagulate

anlagesia

42
Q

What is the management of the limb is not salvageable in ALI

A

Either amputation

43
Q

If there is a suspicion of embolus in ALI what is the management

A

Embolectomy

44
Q

If there is a suspicion of a thrombosis in situ what is the management

A

Mechanical thrombectomy

Thrombolysis

Open embolectomy bypass

45
Q

Why is acute limb ischaemia considered a medical emergency

A

Because it becomes irreversible after 6-8hours

46
Q

What is the pathophysiology of diabetic disease

A

Microvascular peripheral artery disease
Peripheral neuropathy
Mechanical imbalance
Susceptibility to infection

47
Q

What is the foot care recommendations for diabetics

A

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

48
Q

what is the management for foot disease in diabetics

A

Prevention
Good wound care
Tracking infection – consider systemic antibiotics
Investigate for osteomyelitis, gas gangrene, necrotising fasciitis

49
Q

What is the surgical management for diabetic foot disease

A

Revascularation - Angioplasy / Bypass

Amputation

50
Q

What is the disadvantages to revascularation

A

Limited success of endovascular/surgical revascularisation (distal disease)

stent doesn’t stay well in small vessels

Cardiovascular system SA (43 decks)

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