Chronic limb ischaemia Flashcards Preview

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Flashcards in Chronic limb ischaemia Deck (18)
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Describe chronic limb ischaemia?

  • Peripheral arterial disease
    • Resulting in symptomatic reduced blood to the limbs 
  • Typically due to atherosclerosis and in the lower limbs 
    • ULs and gluteals sometimes 


What are the risk factors for chronic limb ischaemia?

  • Smoking
  • DM
  • HTN
  • Hyperlipidaemia


What are the clinical features of Chronic limb ischaemia?

  • Fontaine classification
    • Stage 1: Asymptomatic 
    • Stage 2: Intermittent claudication
    • Stage 3: Ischaemic rest pain
    • Stage 4: Ulceration, gangrene or both


Name a diagnostic test for chronic limb ischaemia?

  • Buerger's test
    • Lie patient supine and raise their legs until they go pale
    • Lower them until colour returns (there may be hyperaemia)
    • Buerger's angle: the angle where the limb goes pale
      • Less than 20o indicates severe ischaemia 


What is Leriche syndrome?

  • Peripheral arterial disease affecting aortic bifurcation
  • Presents with buttock/thigh pain + erectile dysfunction 


Describe Critical limb ischaemia?

  • Advanced form of chronic limb ischaemia
  • Clinically defined in 3 ways:
    • Ischaemic rest pain >2weeks, requiring opiates
    • Ischaemic lesions or gangrene 
    • ABPI <0.5
  • Limbs pale and cold, + weak/absent pulses


What are the differentials for some presenting with limb ischmia symptoms?

  • Spinal stenosis (neurogenic claudication)
  • Acute limb ischaemia 
    • Features less than 14 days, symptom onset within hours


Describe spinal stenosis?

  • Pain in back radiating down lateral leg (tensor fascia lata)
  • Symptoms on initial movement, relieved by sitting  


Describe Acute-on-chronic limb ischaemia?

  • Acute, often embolic, event occurs
  • Patient has previous peripheral vascular disease


Describe the diagnosis of chronic limb ischaemia?

  • Clinical diagnosis
  • Confirmed with ABPI
  • Doppler US
    • severity and location
  • CT angiography 


Describe the relevance of ABPI in Chronic limb ischaemia?


Describe the management of Chronic limb ischaemia?

  • Medical
    • Lifestyle advice
    • Atorvastatin (80mg OD)
    • Clopidogrel (75mg OD)
  • Supervised exercise programme may help claudication
  • Surgery


When would surgery be used in chronic limb ischaemia?

  • Risk factor modification has been discussed
  • Supervised exercise showed no improvement 
  • Patients with critical limb ischaemia


Describe the use of surgery in Chronic limb ischaemia?

  • Angioplasty (w/ or wo/ stenting)
  • Bypass grafting (younger patients)
  • Amputation


Describe the complications of Chronic limb ischaemia?

  • Sepsis (sec to infected gangrene)
  • Acute-on-chronic ischaemia
  • Amputation
  • Reduced mobility and QoL


Key points of Chronic limb ischaemia?

  • Clinical diagnosis, quantified by ABPI testing then angiogram imaging
  • Surgery if conservative mangement fails or critical limb ischaemia
  • 5 year mortality is 50% in those diagnosed with chronic limb ischaemia 


Describe the relationship between homocysteine and chronic limb ischaemia?

  • Homocysteine is an amino acid gained from eating meat 
  • Lower homocysteine => reduced risk of CV events