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Vascular Surgery > Peripheral Arterial Disease > Flashcards

Peripheral Arterial Disease Flashcards

(43 cards)

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1
Q

What is peripheral arterial disease?

A

narrowing of arteries supplying the limbs + periphery > reduced blood supply > claudication

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2
Q

Gold standard test for peripheral arterial disease

A

CT angiogram

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3
Q

signs of arterial disease on insepction

A
  • skin pallor
  • cyanosis
  • dependent rubor
  • muscle wasting
  • hair loss
  • ulcers
  • poor wound healing
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4
Q

Features of arterial disease on examination

A
  • reduced skin temp
  • reduced sensation
  • prolonged cap refil
  • changes during buerger’s test
  • weak pulses
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5
Q

Describe intermittent claudication due to ischaemia

A

Cramps achy pain in lower limbs during exertion
Relieved by rest
Most commonly in calf

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6
Q

Management of intermittent limb claudication

A
  • lifestyle changes for modifiable risk factors
  • smoking cessation
  • optimise treatment of co-morbidities
  • exercise training
  • atorvastatin, clopidogrel
  • surgical options: endovascular angioplasty + stenting, endarterectomy, bypass surgery
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7
Q

What does exercise training in intermittent claudication involve?

A
  • structured + supervised program of regularly walking to point of near maximal claudication + pain
  • then resting
  • repeat
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8
Q

what is atherosclerosis?

A

accumulation of intracellular + extracellular lipids in tunica intima + media of medium + large arteries
combination of atheroma + sclerosis > develop into atheromatous plaques

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9
Q

what do atheromatous plaques cause?

A
  • stiffening of artery wall > hypertension
  • stenosis
  • plaque rupture > thombus > ischaemia
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10
Q

risk factors of atherosclerosis

A
  • male
  • family history
  • increasing age
  • smoking
  • excessive alcohol consumption
  • poor diet
  • low exercise
  • obesity
  • stress
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11
Q

end results of atherosclerosis

A
  • angina
  • MI
  • TIA/stroke
  • peripheral arterial disease
  • chronic mesenteric ischaemia
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12
Q

what is acute limb ischaemia?

A

sudden decrease in limb perfusion that threatens viability of limb

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13
Q

causes of acute limb ischaemia

A
  • embolisation
  • thombosis in situ
  • trauma
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14
Q

clinical features of acute limb ischaemia

A

pain
pallor
pulselessness
paraesthesia
perishingly cold
paralysis

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15
Q

investigations of acute limb ischaemia

A
  • routine bloods: incl lactate, thrombophilia, G&S
  • ECG
  • ABPI
  • handheld doppler USS of both limbs
  • CT angiogram
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16
Q

management of acute limb ischaemia

A
  • surgical emergency
  • urgent referral to vascular
  • IV opioids
  • IV unfractionated heparin infusion
  • embolectomy
  • endovascular thrombolysis + angiography
  • bypass surgery
  • amputation
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17
Q

long term management of acute limb ischaemia

A
  • regular exercise
  • smoking cessation
  • weight loss
  • anti-platelets e.g. clopidogrel
  • atorvastatin
  • OT+PT if amputation
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18
Q

Classification of acute limb ischaemia

19
Q

clinical features of chronic limb ischaemia + classification

Study These Flashcards
A

Fontaine classification
- stage I: asymptomatic
- stage II: intermittent claudication
- stage III: ischaemic rest pain
- stage IV: ulceration or gangrene

20
Q

what is chronic limb threatening ischaemia?

Study These Flashcards
A

end stage of peripheral arterial disease where there is inadequate blood supply to limb to allow it to function at rest

21
Q

Features of chronic limb threatening ischaemia

Study These Flashcards
A
  • ischaemic rest pain >2 weeks
  • worse at night
  • non healing ulcers
  • gangere
  • ABPI <0.5
  • pale cold limb + weak pulses
22
Q

what is the ankle-brachial pressure index?

Study These Flashcards
A

ratio of systolic BP in the ankle compared to systolic BP in arm
taken using a doppler probe

23
Q

Interpretation of ABPI results

Study These Flashcards
A
  • >1.3: calcifications in arteries
  • 1.0-1.2: normal
  • 0.9-0.999: possible PAD
  • <0.9: PAD
  • <0.5: severe + limb-threatening ischaemia
24
Q

What does an ABPI valve >1.3 indicate?
who is this common in?

Study These Flashcards
A

calcification of arteries > difficult to compress
diabetics

25
management of chronic limb ischaemia
- smoking cessation, weight reduction, exercise - *atorvastatin* 80mg - *clopidogrel* 75mg - *naftidrofuryl oxalate* - vasodilator - optimise diabetes control - exercise training - angioplasty +/- stenting - bypass grafting - amputation
26
Surgical management of chronic limb threatening ischaemia
- endovascular angioplasty +/- stenting - bypass surgery - amputation
27
what is the buerger's test used for?
to assess for peripheral arterial disease in the leg
28
outline buerger's test
- **to assess for peripheral arterial disease in legs** - patient lies supine + lifts legs to 45 - hold there for 1-2 mins looking for pallor - lower until colour returns - **Buerger's angle**: angle at limb goes pale (*<20 - severe ischaemia*) . - patient sits up with legs over bed - blood flows back to legs - pink: healthy person - blue > dark red: PAD
29
What colour will a person with PAD in their legs go when doing Buerger's test and why?
- **blue** first as ischaemic tissue deoxygenates blood - **dark red** due to vasodilation
30
what is leriche syndrome?
occurs with occlusion of distal aorta or proximal common iliac artery
31
triad of leriche syndrome
- thigh/buttock claudication - absent femoral pulses - male impotence
32
What is Buerger disease?
Thromboangitis obliterans Inflammatory condition that causes thrombus formation in distal small + medium arteries Affects hands + feet
33
Demographic is buerger disease
Men 25-35 Smokers
34
Notable features of buerger disease
<50 NOT having risk factors for atherosclerosis other than smoking
35
Presentation of buerger disease
- pain worse at night - blue discolouration of finger tips or toes
36
Findings of angiogram of buerger disease
Corkscrew collaterals
37
Management of buerger disease
- complete smoking cessation - IV *iloprost*
38
What antiplatelet is first line in PAD?
Clopidogrel
39
What is first line investigation in acute limb ischaemia?
Handheld Doppler USS
40
What process within the arterial tree may allow improvement in symptoms with exercise + time?
Development of collateral vessels
41
Where in the lower limb does rest pain most typically occur?
Toes Foot Forefoot
42
In a person with peripheral arterial disease, why does their leg go pale on elevation?
Perfusion of leg is reduced on elevation
43
In buerger’s test, why does their leg appear redder than normal after?
- severe ischamia (during elevation) > release of local vasodilators *e.g. ADP, CO2, lactate* - increases perfusion of the ischaemic limb

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