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

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

1
Q

What are examples of arterial diseases of the limbs?

A

Peripheral artery disease

Acute limb ischaemia

Diabetic foot disease

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2
Q

What is A?

A

Aorta

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3
Q

What is B?

A

Illiac arteries

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4
Q

What is C?

A

Common femoral artery

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5
Q

What is D?

A

Profunda femoris

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6
Q

What is E?

A

Superficial femoral artery

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7
Q

What is F?

A

Poplital artery

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8
Q

What is G?

A

Anterior tibial artery

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9
Q

What is H?

A

Dorsalis pedis

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10
Q

What is I?

A

Posterior tibial artery

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11
Q

What is J?

A

Peroneal artery

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12
Q

What are normal palpable pulses of the lower limbs?

A

Aorta

Common femoral artery

Popliteal artery

Posterior tibial pulse

Dorsalis pedis pulse

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13
Q

Where is the aorta palpable?

A
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14
Q

Where is the common femoral artery palpable?

A

Mid-inguinal point, half way between the anterior superior iliac spine and the pubic symphysis

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15
Q

Where is the popliteal artery palpable?

A

Use both hands to feel dleep in the popliteal fossa, leg relaxed into your hands

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16
Q

Where is the posterior tibial pulse palpable?

A

Half-way between the medial malleolus and the achilles tendon

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17
Q

Where is the dorsalis pedis pulse palpable?

A

Lateral to the extensor hallucis longus tendon

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18
Q

What does CLI stand for?

A

Critical limb ischaemia

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19
Q

What is critical limb ischaemia?

A

Advanced stage of peripheral artery diseases

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20
Q

What is the pathophysiology of critical limb ischaemia?

A

Atherosclerotic diseases of the arteries to the lower limbs

Vasculitis

Buerger’s disease

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21
Q

What is vasculitis?

A

Disorders that destroy blood vessels by inflammation

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22
Q

What are disorders that destroy blood vessels by inflammation called?

A

Vasculitis

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23
Q

What is Buerger’s disease?

A

Inflammation and thrombosis in small and medium sized blood vessels, typically in the legs

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24
Q

What is inflammation and thrombosis in small and medium sized blood vessels, typically in the legs called?

A

Buerger’s disease

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25
Q

What do critical limb diseases use the same process as?

A

Coronary and carotid atherosclerotic disease

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26
Q

What are some risk factors for critical limb ischaemia?

A

Male

Age

Smoking

Hypercholesterolaemia

Hypertension

Diabetes

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27
Q

Are males or females more at risk from critical limb disease?

A

Males

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28
Q

What classification is used to classify the stages of peripheral artery disease?

A

Fontaine classification

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29
Q

What are the different classes of peripheral artery disease?

A

Stage I

Stage II

Stage III

Stage IV

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30
Q

What is stage I peripheral artery disease?

A

Asymptomatic, incomplete blood vessel obstruction

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31
Q

What is stage II peripheral artery disease?

A

Mild claudication pain in the limb

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32
Q

What is stage III peripheral artery disease?

A

Rest pain, mostly in the feet

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33
Q

What is stage IV peripheral artery disease?

A

Necrosis and/or gangrene of the limb

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34
Q

Which stage of peripheral artery disease has a A and B?

A

As well as stage II there is,

Stage IIA

Stage IIB

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35
Q

What is stage IIA peripheral artery disease?

A

Claudication when walking a distance greater than 200m

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36
Q

What is stage IIB peripheral arterial disease?

A

Claudication when walking a distance less than 200m

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37
Q

What stages of peripheral artery disease are considered to be criticial limb ischaemia?

A

Stages III and IV

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38
Q

What is claudication?

A

A condition in which cramping pain in the leg is induced by exercise. typically caused by obstruction of the artery

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39
Q

What is a condition in which cramping of the leg is induced by exercise, typically caused by obstruction of the arteries?

A

Claudication

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40
Q

What are common findings in the history for peripheral artery disease?

A

Claudication

Tissue loss

Rest pain

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41
Q

What questions should be asked for claudication in a history?

A

Exercise tolerance

Effect of incline

Change over time

Relieved by rest?

Where in the leg

Type of pain

Bilateral?

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42
Q

What questions should be asked for rest pain in the history of peripheral vascular disease?

A

Type of pain

Relieving factors

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43
Q

What questions should be asked fpr tissue loss in the history?

A

Duration

History of trauma

Peripheral sensation

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44
Q

What are clinical examination findings for peripheral arterial disease?

A

Ulceration

Pallor

Hair loss

Temperature

Capillary refill time

Peripheral sensatio

Pulses

Dorsalis pedis and posterior tibial pulses listened to

45
Q

What are some special examination findings for peripheral arterial disease?

A

Ankle brachial pressure index

Elevate legs and look for pallor and Buerger’s angle

Hang feet over edge of bed and look for time to regain colour

46
Q

What is the ankle brachial pressure index?

A

Ratio of the blood pressure at the ankles to the blood pressure in the upper arm

47
Q

What is pallor?

A

An unhealthy pale appearance

48
Q

What is an unhealthy pale appearance?

A

Pallor

49
Q

What is Buerger’s angle?

A

Angle which the leg has to be raised before it becomes pale whilst lying down

50
Q

What is the angle at which the leg has to be raised before it becomes pale whilst lying down?

A

Buerger’s angle

51
Q

What Buerger’s angle is severe ischaemia?

A

Less than 20 degrees

52
Q

What does ABPI stand for?

A

Ankle brachial pressure index

53
Q

What imaging investigations are done for peripheral arterial disease?

A

Duplex

CTA/MRA

Digital subtraction angiography

54
Q

What is duplex imaging?

A

Ultrasound captures images of arteries

55
Q

What are advantages of duplex imaging?

A

Dynamic

No radiation/contrast

56
Q

What are disadvantages of duplex imaging?

A

Not good in the abdomen

Operator dependant

Time consuming

57
Q

What are the advantages of CTA/MRA?

A

Detailed

First line according to NICE

58
Q

What are the disadvantages of CTA/MRA?

A

Contrast and radiation

Can overestimate calcification

59
Q

What is digital subtraction angiography?

A

Fluoroscopy technique used in interventional radiology to clearly visualise blood vessels in a body or dense soft tissue environment

60
Q

What is imagine using fluoroscopy technique used in interventional radiology to clearly visualise blood vessels in a body or dense soft tissue environment?

A

Digital subtraction angiography

61
Q

What is the management of peripheral artery disease?

A

Medical therapy

Risk factor control

Exercise

Revascularisation

62
Q

What is peripheral arterial disease managed in the same way as?

A

Established coronary artery disease

63
Q

Why is peripheral arterial disease managed in the same way as established coronary artery disease?

A

People with peripheral arterial disease are at high risk of developing coronary artery disease

64
Q

What is the best medical therapy for peripheral vascular disease?

A

Combination of antiplatelets and statins

65
Q

How to antiplatelets help with peripheral arterial disease?

A

Reduces risk of requiring revascularisation as well as cardiovascular and all-cause mortality

66
Q

How do statins help with treating peripheral arterial disease?

A

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

67
Q

What management is used for risk factor control for peripheral arterial disease?

A

Blood pressure target of <140/85

Smoking cessation

Diabetic control

68
Q

What are 2 different categories of revascularisation?

A

Open surgery

Endovascular intervention

69
Q

What are examples of open surgery procedures for revascularisation?

A

Bypass

Endarterectomy

70
Q

What are examples of endovascular intervention procedures for revascularisation?

A

Balloon angioplasty

Stent placement

Atherectomy

71
Q

What does a surgical bypass require?

A

Inflow

A conduit

Outflow

72
Q

What are risks of complications for surgical bypass?

A

Bleeding

Wound infection

Pain

Scar

Deep vein thrombosis

Myocardial infarction

Pulmonary embolism

Cerebrovascular accident

Lower respiratory tract infection

Death

73
Q

What is the re-intervention rate of surgical bypass?

A

10-39%

74
Q

What is the 5 year patency rate of surgical bypass?

A

45-75%

75
Q

What is the cost of using surgery for revascularisation?

A

Greater short term morbidity as a price for greater long term durability

76
Q

What is angioplasty?

A

A non-invasive procedure to widen narrowed arteries

77
Q

What is acute limb ischaemia?

A

Occurs when there is a lack of blood flow to a limb

78
Q

What is the pathophysiology of acute limb ischaemia?

A

Arterial embolus

Thrombosis

Trauma

Dissection

Acute aneurysm thrombosis

79
Q

What is an embolus?

A

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 obstruction

80
Q

What is 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 obstruction called?

A

Embolus

81
Q

What is a thrombus?

A

A blood clot formed in sutu within the vascular system of the body and impeding blood flow

82
Q

What is a blood clot formed in sutu within the vascular system of the body and impeding blood flow called?

A

Thrombus

83
Q

What is the clinical presentation of acute limb ischaemia?

A

Pain

Pallor

Pulse deficit

Paraesthesia

Paresis/paralysis

Poikilothermia

84
Q

What is poikilothermia?

A

The inability of someone to regulate their body temperature

85
Q

What is the inability of someone to regulate their body temperature called?

A

Poikilothermia

86
Q

What is the usual history for acute limb ischaemia?

A

Cardiac history

Onset/duration of symptoms

Histroy of chronic limb ischaemia

Risk factors for critical limb ischaemia

Functional status

87
Q

What syndrome can cause acute limb ischaemia?

A

Compartment syndrome

88
Q

What is compartment limb syndrome?

A

Painful condition that occurs when pressure within the muscles builds up to dangerous levels, which can decrease blood flow

89
Q

What is a painful condition that occurs when pressure within the muscles builds up to dangerous levels which can decrease blood flow?

A

Compartment syndrome

90
Q

How does compartment syndrome present?

A

Muscle ischaemia (irreversible after 6-8 hours)

Inflammation, oedema and venous obstruction

Tense, tender calf

Rise in creatine kinase

Risk of renal failure (myoglobulinaemia)

91
Q

What is myoglobulinaemia?

A

Presence of myoglobin in the urine

92
Q

What is presence of myoglobin in the urine called?

A

Myoglobulinaemia

93
Q

When is muscle ischaemia due to compartment syndrome irreversible?

A

After 6-8 hours

94
Q

What are the different categories of acute limb ischaemia?

A

I (viable)

II (threatened)
A (marginally)
B (immediately)

III (irreversible)

95
Q

What is stage I acute limb ischaemia?

A

Not imminently threatened

96
Q

What is stage IIA acute limb ischaemia?

A

Salvageable if promtly treated

97
Q

What is stage IIB acute limb ischaemia?

A

Salvageable with immediate revascularisation

98
Q

What is stage III acute limb ischaemia?

A

Major tissue loss or permanent nerve damage inevitable

99
Q

What is required if the limb due to acute limb ischaemia is not salvageable?

A

Amputation or palliation

100
Q

What is diabetic foot disease?

A

Foot affected by ulceration associated with neuropathy and/or peripheral artery disease of the lower limb in a patient with diabetes

101
Q

What is foot affected by ulceration associated with neuropathy and/or peripheral artery disease of the lower limb in a patient with diabetes called?

A

Diabetic foot disease

102
Q

What percentage of diabetic patients will develop a foot ulcer in their lifetime?

A

25%

103
Q

What percentage of diabetic foot ulcers become infected and what percentage requires amputation?

A

50% become infected

20% require amputation

104
Q

What is the pathophysiology of diabetic foot disease?

A

Microvascular peripheral artery disease

Peripheral meuropathy

Mechanical imbalance

Foot deformity

Minor trauma

Susceptibility to infection

105
Q

What is some foot care for diabetic foot ulcer prevention?

A

Always wear shows

Check fit of footwear

Check pressure points/planter surface of foot regularly

Prompt and regular wound care of skin breaches

Effective glycaemic control

106
Q
A
107
Q

What does the management of diabetic foot ulcers involve?

A

Prevention

Diligent wound care

Infection

Investigate for osteomyelitis, gas gangrene, necrotising fascitis

Revascularisation (very distal disease)

Amputation

Adjunctive measures

108
Q

Where are different amputations for diabetic foot disease?

A

Hip dislocation

Above knee

Through knee

Below knee

Symes

Trans-metatarsal

Digital

cardiovascular system (41 decks)

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