FN: Chronic limb ischaemia: Presentation and Classification Flashcards Preview

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Flashcards in FN: Chronic limb ischaemia: Presentation and Classification Deck (25):
1

Incidence

5% of males >50 yrs have intermittent claudication

2

Definition

Ankle artyer pressure

3

Cause

1. Atherosclerosis: typically asymptomatic until 50% stenosis
2. (vasculitis and fibromuscular dysplasa are very rare causes)

4

Atherosclerosis summary

1. Endothelial injury: haemodynamic, HTN, increase lipids
2. Chronic inflammation:
-lipid laden foam cells produce GFs, cytokines, RO's and MMPs
-Lymphocyte and SMC recruitment

3. SM proliferation: conversion of fatty streak to atheroscleroitc plaque

5

Arteriosclerosis

General artery hardening

6

Atherosclerosis

Arterial hardening specifically due to atheroma

7

Atheroma pathology

1. Fibrous cap: SM cells, lymphocytes, collagen
2. Necrotic centre: cell debris, choeslterol, Ca, foam cells

8

risk factors modifiable

Smoking
BP
DM control
Hyperlipidaemia
Reduced excercis

9

Non-modifiable RF

FH and PMH
Male
Increased age
Genetic

10

Associated vascular disease

IHD: 90%
Carotid stenosis: 15%
AAA
Renovascular disease
DM microvascular disease

11

Presentation

Intermittant
Critical lumb ischaem
Leriche syndrome: Aortoilliac Occlusive disease
buergers disease: throboangiitis obliterans

12

Intermittant claudication

Cramping pain after walking a fixed distance
Pain rapidly relieved by rest

13

Buttock pain

Iliac disease

14

Calf pain

Superficial femoral

15

Critical limb ischaemia

Fontaine 3 or 4
1. Rest pain
2. Ulceration
3. Gangrene

16

Describe rest pain in critical limb ischaemia

Especially @ night
Usually felt in the foot
Pt. hangs foot out of bed
- Due to reduced CO and loss of gravity helps

17

Leriches sndrome

Atherosclerotic occlusion of abdominal aort and iliacs

18

Leriches syndrome triad

Buttock claudication and wasting
Erectile dysfunction
Absent femoral pulses

19

Beurgersdisease

Young, male, heavy smoker
Acute inflammation and thrombosis of arteries and veins in the hands and feet - ulceratino and gangrene

20

Signs of limb ischaemia

1. Pulses: pulses and raised CRT (norm

21

Beurgers angle

>90 normal
20-30 ischaemia

22

+ver beurgers signs

Reactive hyperaemia due to accumulation of deoxygenated blood in dilated capillaries

23

Clinical Classification

Fontaine
Rutherford

24

Fontaine

1. Asympto (subclinical)
2. Intermittant claudication
a. >200m
b.

25

Rutherford

1. Mild claudication
2. Moderate cludication
3. Severe claudication
4. Ischaemia rest pain
5. Minor tissue loss
6. Major tissue loss

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