chronic arterial ischaemia

Question 1

what are the three disorders of arteries ?

Answer 1

arterial occlusive disease
aneurysmal disorders
injuries

Question 2

what are the causes of acute arterial ischaemia ?

Answer 2

embolic
thrombotic
traumatic

Question 3

what are the causes of chronic arterial ischaemia ?

Answer 3

atherosclerotic or otherwise

Question 4

what are the common causes of peripheral arterial occlusive disease?

Answer 4

atherosclerosis
burgers disease
SLE

Question 5

what are the rare causes of peripheral arterial occlusive disease ?

Answer 5

external compression
popliteal entrapment
thoracic outlet syndrome
coartication of the aorta

Question 6

what are the risk factors for atherosclerosis ?

Answer 6

hypercholesteremia
smoking
diabetes mellitus
hypertension

Question 7

what are the determinants of the clinical presentation of chronic ischaemia ?

Answer 7

downstream organ
degree of stenosis
chronicity of obstruction
availability of collateral circulation

Question 8

what does the proposed arterial adaptation suggest ?

Answer 8

initially the artery enlarges to maintain its luminal diameter despite the enlarging plaque , after the plaque creates a stenosis of more than 40%the artery can no longer adapt

Question 9

what are the subdivisions of the anatomic sections affected by chronic occlusive disease in the LL ?

Answer 9

• Aortoilliac (inflow disease)
• femoral-popliteal (outflow disease)
• tibial-peroneal (runoff disease)

Question 10

which arteries are involved in the aorto-iliac area ?

Answer 10

infrarenal aorta , common iliac and external iliac arteries

Question 11

which arteries are involved the femoral popliteal area ?

Answer 11

common femoral
superficial femoral
popliteal arteries

Question 12

which arteries are involved with the tibial-peroneal area ?

Answer 12

distal to popliteal artery

Question 13

what are the distal aorta and iliac arteries mostly affected byu ?

Answer 13

atherosclerosis

Question 14

which collateral circulation is present in the aorto-illiac area ?

Answer 14

pelvic and groin collaterals

Question 15

what are the classifications of aorto-iliac disease ?

Answer 15

type 1- focal disease affecting the distal aorta and proximal common iliac artery
type 2- represents diffuse aortoiliac disease above the inguinal ligament
type 3- represents multisegment occlusive diseases involving aortoilliac and infra inguinal

Question 16

which artery passes deep to the adductor canal ?

Answer 16

superficial femoral artery

Question 17

why may the occlusion of the distal SFA be asymptomatic ?

Answer 17

because of the development of collaterals from the proximal SFA

Question 18

which area is more likley to be affected by smokers and Buergers disease ?

Answer 18

infrapopliteal or the tibioperoneal area

Question 19

why is ischaemia in the infrapopliteal area limb threatning ?

Answer 19

because the collaterals are less developed than the other two regions

Question 20

what are the most common causes of occlusive arterial disease in Egypt ?

Answer 20

atherosclerosis and Buerger’s disease

Question 21

what is buerger’s disease ?

Answer 21

a form of vasculitis, inflammatory occlusive disease affecting small and medium sized vessels affecting male smokers below
40

Question 22

what is the clinical triad of buerger’s disease ?

Answer 22

• claudication of affected extremities
• raynauds phenomenon
• migratory superficial thrombophlebitis

Question 23

how would you make a diagnosis of Buergers disease ?

Answer 23

angiography of all four limbs but pathological examination is necessary for confirmation

Question 24

what would be the treatment for buergers disease ?

Answer 24

no specific treatment except abstinence from smoking q

Question 25

what are the clinical presentation of chronic limb ischaemia

Answer 25

intermittent claudications rest pain ulcerations and gangrene

Question 26

how is claudication pain relieved?

Answer 26

on cessation of walking

Question 27

what is the clinical presentation if the aorto-illiac is blocked ?

Answer 27

buttock, thigh and calf claudication known as Leriche syndrome

Question 28

what is the clinical presentation if the common femoral disease is blocked ?

Answer 28

thigh and calf claudication

Question 29

what is the clinical presentation if the SFA is blocked ?

Answer 29

calf claudication

Question 30

what is the clinical presentation if the if the popliteal artery is blocked ?

Answer 30

calf claudication

Question 31

what is the clinical presentation if the infra popliteal artery is blocked ?

Answer 31

calf and maybe sole claudication

Question 32

what could be the differential diagnosis of vascular claudication?

Answer 32

neurogenic pseudoclaudication

Question 33

what is ischemic rest pain caused by?

Answer 33

ischaemic neuritis

Question 34

what is rest pain aggravated by ?

Answer 34

horizontal position or elevation of the extremity

Question 35

what is rest pain relieved by ?

Answer 35

hanging leg over the side of the bed

Question 36

where are arterial insufficiency ulcers mostly located ?

Answer 36

lateral surface of the ankle or the distal digits

Question 37

how do you diagnose an arterial ulcer ?

Answer 37

arterial doppler

Question 38

why may radiograph be necessary when suspecting arterial ulcers ?

Answer 38

to rule out osteomyelitis

Question 39

what pressures suggest critical limb ischaemia ?

Answer 39

ankle pressure less than 70 mmhg | or a toe systolic pressure of less than 50 mmhg

Question 40

what are the investigations of chronic ischaemia ?

Answer 40

doppler/duplex | ankle brachial index

Question 41

what is the normal shape of the duplex wave ?

Answer 41

triphasic

Question 42

why might CTA be an inappropriate method of investigation for diabetics ?

Answer 42

due to calcifications

Question 43

what is the fontaine classification?

Answer 43

``` stage I - asymptomatic stage IIa -mild claudication stage IIb - moderate to severe claudication stage III-ischemic rest pain stage IV- ulceration or gangrene ```

Question 44

what is the Rutherford classification ?

Answer 44

``` category 0 - asymptomatic 1- mild claudication 2-moderate claudication 3- severe claudication 4-ischemic rest pain 5- minor tissue loss 6- major tissue loss ```

Question 45

what can symptomatic peripheral chronic arterial disease be broadly managed as ?

Answer 45

intermittent claudication | critical limb ischaemia

Question 46

what would the treatment be for chronic limb ischaemia ?

Answer 46

conservative treatment including risk factor modification along with exercise rehabilitation

Question 47

what are the types of vascular grafts

Answer 47

bio-prosthetic | synthetic

Question 48

what is the normal ABI ?

Answer 48

1.0-1.2

Question 49

what does an ABI of more thann 1.2 indicate ?

Answer 49

non-compressible, severely classified vessel in DM

Question 50

what does an ABI of 0.5-0.9 indicate ?

Answer 50

intermittent claudication ( mild to moderate ischaemia )

Question 51

what does an ABI of 0.1-0.4 indicate ?

Answer 51

critical limb ischaemia ( ischaemic ulceration and gangrene)