Arterial Disease of the Limbs - Presentation, Investigation & Therapy Flashcards
(50 cards)
What anatomy from the aorta at the top of the leg to the bottom of the leg at the foot
Aorta - iliac arteries - common femoral artery - superficial femoral artery - popliteal artery;
- 1.anterior tibial- dorsalis pedis
- peroneal artery
- posteroir tibial artery
What is the definition chronic limb ischaemia
Atherosclerotic disease of the arteries supplying the lower limbs
What is the possible aetiologies of Chronic limb lischaemia
Atheosclerotic
vasculitis
buergers disease
What is the risk factors for Chronic limb ischaemia
Male Age Smoking Hypercholesterolaemia Hypertension Diabetes
What is stages of symptoms of CLI
- Asymptomatic, incomplete blood vessel obstruction
- Mild claudication pain in limb
A. walking more than 200m
B. walking less than 200m - Rest pain, mostly in feet
- Necrosis and/or gangrene of the limb
Claudication definition
a condition in which cramping pain in the leg is induced by exercise
In diagnosing, what factors need to be considered with a presenting history of claudication
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
In diagnosing what factors needs to be considered with a
history of
- rest pain
- tissue loss
- character of the pain
is there any relieving factors
2.Duration
History of trauma
peripheral sensation
What is the signs of chronic ischaemia in the legs
Ulceration
Pallor
Hair loss
In examination of chronic ischaemia of the leg what should you examine for
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
What is the two special tests tried on examination
Ankle brachial pressure index
Buergers test
What does the ankle brachial pressure index show if it is
- less than 1
- 0.95 -0.5
- less than 0.2
- ischaemia in the legs
- claudication present
- gangrene and ulceration is occuring
What is the investigations and sign in the buergers test
Elevation of legs - show pallor
Hanging feet of the bed - slow to regain colour as shows a dark red colour
Why does a dark red colour appear as you hang your feet of the bed
As all the the capillaries are open - so fills with blood rapidly = red
How could you test for severe ischaemia in burgers test
If pallor appears at elevation of legs at 20 degrees
What is the best medical therapy treatments for CLI
Antiplatelet therapy statin therapy BP control Smoking cessation Diabetic control Exercise
- same management as CAD
Patients with CLI can potentially have an under diagnosis of what
Diabetes
What is the management of CLI when the symptoms become severe
angioplasty/stent
surgical bypass
Amputation
What imagery investigations are used in the diagnosis in CLI
Duplex
CTA/MRA
Digital subtraction angiogram
What is the advantages and disadvantages to Duplex imaging
Advantage
Dynamic
No radiation/contrast
Disadvantage
Not good in the abdomen
Operator dependent, time consuming
What is first line imaging in diagnosis in peripheral arterial disease and why
CT/MRI – allows treatment planning
What is the disadvantage of CT/MRI imaging in diagnosing peripheral arterial disease
Contrast and radiation
Can overestimate calcification, difficulty in low flow states
What is Digital subtraction angiogram and what does it increase the risk of
type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment.
haematoma or infection
What is duplex imaging
form of medical ultrasonography that incorporates that involves imaging of structure and flow of movement of structure
