Chronic lower limb ischaemia Flashcards
(21 cards)
What is PAD?
Peripheral arterial disease
What is PAD due to?
Atherosclerosis of the lower limb vessels due to stenosis of arteries
What is a key feature of PAD?
Intermittent claudication - pain when walking, fine at rest
Describe critical limb ischaemia?
One of the latter stages of PAD, key features are gangrene and ulceration. Pain in foot at rest - common, burning pain in leg at night, relieved by hanging over the bed.
Describe the 4 classifications of PAD?
- asymptomatic
- Intermittent claudication
- Ischamic pain at rest
- Gangrene and ulceration (critical limb ischamia)
What are some of the signs of PAD?
Absent pulses
Cold/white feet/legs
Punched out ulceration (painful)
Colour changes
Give the ranges of ABPI, normal, PAD and Critical limb ischamia?
Normal = 1-1.2
PAD = 0.5-0.9
Critical limb ischamia = <0.5
What is usually 1st and 2nd line in imaging investigations for PAD?
1st = duplex uses 2nd = if considering intervention - MR/CT angiography
What would be the treatment for PAD?
-1. lifestyle
Lifestyle - stop smoking, treat hypertension/cholesterol, anti platelets
What would be the treatment for PAD?
- 2. managing claudicaiton
Exercise programmes
2hrs per week for 3 months
aim to push patient to maximal pain to help improve collateral blood flow
What would be the treatment for PAD?
- 3. vasoactive drugs
Naftodrofuryloxalate
recommended in those who do not want revasuclarisation and did not improve via exercise
What would be the treatment for PAD?
- 4. PTA
Percutanous transluminal angioplasty
Only is only one vessel is affected
Balloon through narrowed artery
+/- stent
What would be the treatment for PAD?
- 5. Surgical reconstruction
If atheromatous disease is extensive but distal run off is good (distal arteries filled with collaterals) then you can reconsturct with a bypass graft
What is the outcome for some patients with PAD worst scenario?
Amputation
What is acute limb ischaemia?
A medical emergency requiring revascularisation within 4-6hrs to save the limb
What might acute limb ischaemia be due to?
Thrombosis in situ, emboli, graft./angioplasty occlusion…; etc
What are the 6 P’s of acute limb ischamia?
Pale Perishingly cold Paralysed Paraesthetic (tingling) Pulseless Painful
What is a post op complication of acute limb ischaemia?
Compartment syndrome, very painful, due to bleeding/swelling causing high pressure, decreasing blood flow and O2 getting to that compartment of muscle.
What might make a patient more susceptible to amputation?
- smoking
- diabetes
Are males or females more prone to PAD?
Males
What is chronic lower limb ischaemia a marker for, and what is it associated with?
It is a marker for atherosclerosis elsewhere and is associated with a large cardiovascular morbidity and mortality.
