HTHSCI 1DT3 Lecture Notes - Lecture 12: Digital Subtraction Angiography, Intermittent Claudication, Atheroma
26 Dec 2020
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Falsely high results may be obtained in dm / crf due to calcification of vessels: mediasclerosis. Use toe pressure with small cuff: <30mmhg. Walk on treadmill @ certain speed and incline to establish maximum claudication distance. Abpi measured before and after: 20% is sig. Invasive not commonly used for dx only. Used when performing therapeutic angioplasty or stenting. Most pts. c claudication can be managed conservatively. Prog: 1/3 improve, 1/3 stay the same, 1/3 deteriorate. B don"t worsen intermittent claudication but use c caution in cli. Analgesia: may need opiates (parenteral prostanoids pain in pts. unfit for surgery) Good for short stenosis in big vessels: e. g. iliacs, sfa. Improved inflow pain but restoration of foot pulses is required for rx of ulceration / gangrene. Need good optimisation as likely to have cardiorespiratory co-morbidities. Need good proximal supply and distal run-off. Saphenous vein grafts preferred below the il. More distal grafts have rates of thrombosis.
