Arterial Diseases of the Limb Flashcards

Question

How do you investigate PAD What is 1st line imaging Other imaging options

Answer 1

``` H+E Bloods - FBC, U+E, lipid, blood glucose for DM, Thrombophilia screen if <50 ECG for cardiac ischaemia Assess pulses Bueger's ABPI Doppler USS ``` If stage 3 Arterial Duplex (USS + doppler) = 1st line MR angiogram if considering intervention CT angiogram if CI i.e. due to pacemaker (radiation / contrast nephropathy) / or to plan Rx - looks like normal CT CT / MRI Digital subtraction angiography (invasive as puncture artery) - X-Ray

Answer 2

Ratio of BP in legs (posterior tibial or dorsals pedis) to arms (brachial artery) Use hand held doppler + BP cuff to get Should be >8 If <1 = PAD Won't work if calcified will be inappropriately high - DM / low sun / 2 PTH / CKD / via D deficiency

Answer 3

``` >1 = asymptomatic (0.9-1.2) or calcification - DM / CKD 0.5-0.95 = intermittent claudication / absent distal 0.3-0.5 = severe refer as critical limb ischaemia / Bueger +ve / absent distal / ulceration / rest pain <0.2 = gangrene ```

Answer 4

Elevate legs and look at pallor Go pale at lower degrees <20 = indicate severe ischaemia >90 = normal Hang over bed and skin goes bright red due to loss of auto regulation / slow to return = +ve sign

Answer 5

``` Modify CVS RF If >200 = BMT If <200m = stent / angioplasty If rest pain = urgent referral for stent or surgical bypass Amputation if not possible / gangrene ```

Answer 6

Good influx of blood Conduit vein Aorta - femoral Femoral femoral bypass if don't want to use aorta due to chest

Answer 7

``` Anti-platelet - single clopidogrel > aspirin Statin BP control Stop smoking Exercise - supervised Weight loss Diabetic control Vascular clinic follow up ```

Answer 8

Vascular RF Exercise tolerance Claduciation pain - effect of incline/. changes SOCRATES Any rest pain Tissue loss - duration / trauma / sensation

Answer 9

Emboli - Post MI - Atrial fibrillation Arterial thrombus from stenosed artery Rare cause Trauma Dissection

Answer 10

``` 6P's - Pale - Pulseless - Pain - Paraesthesia - Paralysis - Perishingly cold Always compare to contralateral Irreversible after 6 hours ```

Answer 11

``` Dx = clinical as Ix delays RX History - critical ischaemia / cardiac / onset and duration Bloods ECG Doppler USS - absent CT angio to image ```

Answer 12

Discuss with senior NBM Analgesia Anti-coagulate - IV heparin infusion to prevent extension URGENT surgery - bypass or stent / embolectomy Can do on table angio +- tPA thrombosis if fails Amutation if not salvageable Life-long anti-coagulation required after

Answer 13

Compartment syndrome

Answer 14

``` Hind quarter Hip disarticulation - more trauma / malignancy Transfemoral (above knee) Through knee Transtibial (below knee) - less energy Symes Transmetatarsal Digit ```

Answer 15

Bypass / angioplasty not an option Peripheral vascular disease Trauma Malignancy

Answer 16

DM Atherosclerosis Adrenaline large dose = vasoconstriction -> gangrene

Answer 17

``` Age Co-morbid CVS disease DM Blood loss / GA Coronary and cerebral artery disease ```

Answer 18

``` Stump breakdown Wound infection DVT /PE HAP Phantom limb MI / stroke - optimise CVS / BMT Falls Mortality ```

Answer 19

Ischaemia / poor blood - higher amputation may be needed Infection Trauma - control falls Control BG

Answer 20

LMWH admission to discharge

Answer 21

Transmetatarsal as risk other toes will become affected

Answer 22

Neuropathic pain relief | Wound catheter giving LA

Answer 23

Aorta Common iliac Internal iliac External iliac -> superficial femoral at inguinal ligament Posterior tibial -> dorsalis pedis -> pedal arch Collateral - profunda femoris, anterior tibial, peroneal

Answer 24

Neuropathy | Microvascular complications

Answer 25

Cramp like pain in back of calfs when blood supply to muscle is reduced Worse up hills Relieved by rest Progressive but reduced by formation of collateral

Answer 26

``` H+E ECG FBC, U+E, LFT, coag, glucose, G+S CXR PFT / ECHO / myocardial perfusion scan ```

Answer 27

``` MI Infection Pneumonia Stroke Limb loss PE / DVT Graft failure ```

Answer 28

Coronary Carotid Peripheral

Answer 29

Dynamic images and flow 1st line if not severe / IC Non-invasive, no radiation, done at bedside User dependent

Answer 30

Contrast safer than CT Better soft tissue contrast Not if pacemaker Less available

Answer 31

``` Inject contrast IV Take photos in arterial phas Good resolution Less invasive Radiation, nephrotoxic Can't visualise if calcified Useful if deciding anatomy ```

Answer 32

``` X-Ray used Have to puncture artery to inject Can do angioplasty / stent after if vessel found to be stenosed High radiation Nephrotoxic contrast ```

Answer 33

Catheter and balloon to open up artery | Only 15% suitable

Answer 34

If multiple Long stenosis Failed angio

Answer 35

``` Fibroid AV Tumour GI bleed Endoleak post EVAR Trauma Varciocele ```

Answer 36

``` Peripheral neuropathy Peripheral vascular disease OM Neuropathic pain Charcot Ulceration ```

Answer 37

Ischaemia Neuropathy Mixed

Answer 38

Microvascular complication = nerve hypoxia | Hyperglycaemia = affects metabolism

Answer 39

Asymptomatic Burning pain Altered temp sensation Altered touch - allydonia where touch perceived as pain Autonomic = reduced sweat / loss of auto regulation Motor = muscle wasting and deformity Charcot

Answer 40

Regular foot exam

Answer 41

Surgical debridement | Amputation may be needed

Answer 42

Neuropathic Ischaemic Intermittent claudication

Answer 43

``` Foot / shin Tingling / burning Night time worse Exercise better Warm foot Bounding pulse ```

Answer 44

``` Foot / calf Aching pain Elevation worsen Hanging foot = better Feet cold Pulsless ```

Answer 45

``` Calf / thigh Cramping Exercise worse Rest better Weak or absent pulse ```

Answer 46

DM neuropathy

Answer 47

``` Fragmentation Swelling Red Warmth X-Ray shows soft tissue swelling / bony fragmentation / dislocation ```

Answer 48

Coalescenece X-Ray shows healing Reduced swelling

Answer 49

Reconstruction | X-Ray shows residual deformity

Answer 50

SCM Mandible Midline Clavicle

Answer 51

SCM | Trapezius

Answer 52

``` Common carotid Internal carotid External carotid Vagus nerve (runs beside CCA) Hypoglossal and accessory nerve ```

Answer 53

Subclavian artery and vein Brachial plexus Occipital artery Nerves

Answer 54

``` Superior thyroid Acending pharyngeal Lingual Occpital Facial Posterior auricular Maxillary Superficial temporal ```

Answer 55

Biceps femoral (lateral) Semimembranous Plantaris Gastrocnemius

Answer 56

Sciatic branches into tibial and common fibular Popliteal vein and artery Sural nerve

Answer 57

>70% stensosis | Symptomatic - Arthrus fujax / TIA / stroke

Answer 58

High risk of stroke / emboli

Answer 59

1 in 5 will have another event | 1 in 100 will have stroke due to op

Answer 60

Ask red flag - caudal equina Weight loss / B symptoms Surgical Hx

Answer 61

Occlusion in distal aorta / iliac

Answer 62

Thigh / buttock claudication Absent femoral pulses Male impotence

Arterial Diseases of the Limb Flashcards

(89 cards)