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Flashcards in Peripheral vascular disease Deck (17)
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1
Q

Define

A

Range of arterial syndromes caused by oatherosclerotic occlusion

2
Q

Etiology

A

Most commonly atherosclerosis

Coarctation
Fibrodysplasia
Arterial tumor
Arterial dissection
Embolism/thrombosis
Vasospasm
Trauma

Takayasus
Temporal arteritis
TOS
Buerger’s

3
Q

Stages of severity

A

Stage 1: asymptomatic
Stage 2: mild-severe claudication
Stage 3: rest pain
Stage 4: gangrene/ulceration

4
Q

Clinical presentations

A

presence of risk factors (common)
asymptomatic (common)
intermittent claudication (common)
thigh or buttock pain with walking that is relieved with rest (common)
diminished pulse (common)
sudden onset of severe leg pain accompanied by numbness, weakness, pale, and cold leg (uncommon)
no pulse in lower extremity (uncommon)

5
Q

Risk factors

A
Smoking
DIabetes
\+Homocysteine
Hyperlipidemia
Age >40
Hx of CAD/CVD
Low levels of exercise
6
Q

History

A

Presence of risk factors
Aortoilliac->pain in thigh/buttock
Femoropoliteal->pain in calf
PHx: MI, CAD/CVD, renal, RA
Pain on exercise, releived by rest. Worse at night
Erectile dysfunction
Critical-> Leg pain at rest, gangrene, non-healing ulcers, muscle atrophy, dependant rubor, pallor when elevated, loss of hair, thickened toenails, scaly/shiny skin

Pain, parasthesiae, pallor, pulselessness, perishingly cold, paralysis

7
Q

Physical examination

A

5Ps
Hairless, trophic, scaly, ulcers
Abnormal ABI

CV->Bruits, murmurs, pulses

8
Q

ABI measures

A

Normal= >0.95
IC= 0.9-0.4
Rest pain= 0.4-0.015
Gangrene=

9
Q

Investigations

A
ABI
CBC, UEC->may worsen perfusion
ECG->CV risks
Lipids, coags, glucose->CVD risks
ESR/CRP if suspect vasculitis
Other Ix to consider:
segmental pressure
duplex USS
exercise ABI
Angiography->aim to treat
CT/MRA
10
Q

Differential

A
Spinal stenosis->dermatomal, motor weakness
Arthritis
Venous claudication
Chronic compartment syndrome
Symptomatic baker's cyst
11
Q

Management of chronic limb ischemia

A
  1. Risk factor modification->smoking cessation, diet, exercise, BP, DM->Statin, metoprolol/ACEs, aspirin
  2. Supervised exercise therapy->graded walking programmes for 3 months
  3. Symptom relief->cilostazol
  4. If no relief->consideration for endovascular/surgical management
12
Q

Endovascular revascularisation

A

Recommended for aortoilliac disease w/ stenosis

13
Q

Surgical revascularisation

A

aortoiliac disease if stenosis >10 cm, chronic occlusion >5 cm, heavily calcified lesions, or lesions associated with aortic aneurysm.
common femoral artery disease if lesion >10 cm, heavily calcified lesions >5 cm, lesions involving the ostium of superficial femoral artery, and lesions involving the popliteal artery

14
Q

Patterns of claudication depending on arterial involvement

A
  1. Superficial FA->most common.
  2. Aortoiliac->Le Riche syndrome= thigh and buttock claudication with erectile dysfunction
  3. Combined
15
Q

Management of critical limb ischemia

A
  1. Vascular reconstruction treatment of choice
  2. Regular analgesia
  3. Protect limb in cage and heel pad
  4. Do not elevate limb
  5. Alprostadil IV infusion
  6. Maintain high/normal BP for perfusion
  7. Consider culture and antibiotics->signs of sepsis marked by poor circulation
  8. Admit
  9. DVT prophylaxis->LMWH
16
Q

Management of acute limb ischemia

A
  1. Brief history->acute onset and numbness, previous episodes, motor. AF, recent MI, IHD, PVD, aortic/mitral valve. Allergies, medication, past history, last meal, events
  2. Examination->mottled, dusky, poor pulses, reduced sensation, check motor
  3. IV cannulae->send for UEC, FBCs, glucose, clotting
  4. ECG->look for AF, MI
  5. Oxygen
  6. 10mg IV morphine + 10mg metoclopramide
  7. Protect limb in cage and heel pad, do not elevate
  8. Urgent surgical consult
  9. UFH 80u/kg loading dose, then 18u/kg/hour IV infusion
  10. May consider thrombolysis->alteplase
  11. Admit patient
17
Q

How long in acute limb ischemia before permanent damage

A

6H