FN: Chronic limb ischaemia: Investigation and Management Flashcards Preview

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Flashcards in FN: Chronic limb ischaemia: Investigation and Management Deck (16):
1

Investigations

Doppler Waveforms
ABPI
Walk test
Bloods
Imaging
Other: ECG ischaemic changes

2

Doppler wave forms

Normal: triphasic
Mild stenosis: biphasic
Severe stenosis: monophasic

3

Walk test

Walk on treadmill @ certain speed and incline to establish maximum claudication distance

ABPI measured before and after: 20% drop is significant

4

Bloods

FBC, U+E: anaemia, renovascular disease
Lipds and glucose
ESR: arteritis
G+S: possible procedure

5

Imaging:

Asses site, extent and distal run-off
1. Colour doppler US
2. CT/MRI angiogram: gadolinium contrast
3. Digital subtraction angiography
- Invasive therefore not commonly used for Dx only
- Used when performing therapeutic angioplasty or stenting

6

Conservative Management

1. Most patients with claudication can be managed consrevatively
2. incerase excercise and emply excercise programs
3. Stop smoking
4. wt. loss
5. Foot care

7

Prognosis of conservative management

1/3 improve
1/3 stay the same
1/3 deteriorate

8

Medical Management

1. Risk factors: BP, lipids, DM: note B-blockers dont worsen intermittant claudication but use with caution in chronic limb ischaemic

2. Antiplatelts: aspirin/clopidgrel
3. Analgesia: may need opiates
4. (parentral prostanoids reduce pain in patients, unfit for surgery)

9

endovascular Mx

1. Percutaneous transluminal angioplasty ± stenting
2. Good for short stenosis in big vessels e.g. iliac, SFA
3. Lower risk for pt: performed under LA as day case
4. Improved inflow and reduced pain but restoration of foot pulses is required for Rx of ulceration/gangrene

10

Surgery indications

1. v. short claudication distance

11

Pre op assesment

Need good optimisation as likely to have cardioresp co-morbidities

12

Practicalitis

Need good proximal supply and distal run-off
Saphenous vein grafts preferred below th eIL
More distal grafts have increase rates of thrombosis

13

Classifcation

Anatomical: fem-pop, fem-distal, aortobifemoral
Extra-anatomical: axillo-fem/bifem,fem-fem crossover

14

Other

Endarterectomy: core-out atheromatous plaque
Sympathectomy: chemical (EtOH injectino) or surgical: caution in DM neuropathy
Amputation

15

Prognosis 1 yr after onset of CLI

50% alive w/o amputation
25% will have had major amputation
25% dead (usually MI or stroke)

16

Following amputation prognosis

Perioperative mortality
BL=K:5-10%
AK: 15-20%

1/3 completed autonomy
1/3 partial autonomy
1.3 dead

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