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Arterial Occlusion, :pen:
Key words
Arterial occlusion: blocking of an…
Arterial Occlusion
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Pathophysiology
= artery blockage = d in blood flow = under perfused = anaerobic metabolism = ^ lactate production + acidosis
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:pen:
Key words
Arterial occlusion: blocking of an artery usually caused by atherosclerosis
Atherosclerosis: build up of plaque = thrombus = narrows lumen
Embolus: when a thrombus breaks off and occludes a blood vessel = thromboembolism
Paraesthesia: tingling
Poikilothermia: inability to regulate core body temperature
Intermittent claudication: pain affecting he calf, induced by exercise
ABPI: ankle brachial pressure index
-ban: anticoagulant
Clopidogrel: antiplatelet
Percutaneous transluminal angioplasty: procedure to open up blocked vessel
Acute limb ischaemia: a sudden decrease in limb perfusion that threatens limb viability
Chronic limb ischaemia: diminished circulation = pain in lower limb on walking or exercise relieved by rest
Critical limb ischaemia: circulation is so impaired that there is imminent risk of limb loss
Naftidrofuryl oxalate: vasodilator
Iliac = near ileum (large bone of pelvis)
Femoral = near femur (thighbone)
Popliteal = knee
DAPT = dual antiplatelet therapy
Dipyridamole = antiplatelet
OD = once daily
BD = twice daily
TDS = three times daily
CAD = coronary artery disease
PAD = peripheral arterial disease
ACS = acute coronary syndrome
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- PAD = narrowing/occlusion of peripheral arteries = affecting blood supply to lower limbs
- in acute limb ischaemia decreased perfusion and symptoms develop over less than 2 weeks
- chronic limb ischaemia can present as intermittent claudication or critical limb ischaemia
- PAD of lower limbs is most commonly caused by atherosclerosis = narrows affected arteries = limits blood flow to affected limb
- acute limb ischaemia caused by sudden reduction in arterial perfusion of the limb, most commonly due to thrombosis within a diseased artery when an atherosclerotic plaque ruptures
- main risk factors: smoking + DM
- acute limb ischaemia should be suspected when there is sudden onset of leg pain or a sudden deterioration in claudication + loss of pulses + pallor. Can also have cyanosis or loss of muscular power and sensation - these may be subtle or absent
- if acute limb ischaemia suspected = vascular specialist should be arranged
- chronic limb ischaemia should be suspected when there is progressive development of a cramp like pain in the calf, thigh or buttock on walking which is relieved by resting, unexplained foot or leg pain, or non healing wounds on lower limb
- diagnosis of chronic limb ischaemia = features + ABPI
- management of chronic limb ischaemia: management of cardiovascular risk including smoking cessation advise, urgent referral to vascular MDT, pain management, advice on PAD, foot care and driving
- intermittent claudication management: cardiovascular risk management including smoking cessation advice, offer supervised exercise programme, consider referral for angioplasty or bypass surgery if no improvement with above, consider Naftidrofuryl oxalate if no improvement with above
- advice on PAD and driving
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A 70 year old male presents with a history of cramping in his right calf. He states that the pain comes on whilst exercising but resolves when at rest. This patient has a past medical history of hypertension and DM. Which of the following options is true
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