Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Basic Sciences Relevant to Surgical Practice
- Section 2 Basic Surgical Skills
- Section 3 The Assessment and Management of the Surgical Patient
- Section 4 Perioperative Care of the Surgical Patient
- Section 5 Common Surgical Conditions
- 16 Assessment and early treatment of patients with trauma
- 17 Fundamentals of the central nervous system
- 18 Fundamentals of head and neck surgery
- 19 Fundamentals of thoracic surgery
- 20 Oesophago-gastric surgery
- 21 Fundamentals of hepatobiliary and pancreatic surgery
- 22 Fundamentals of endocrine surgery
- 23 Fundamentals of the breast
- 24 Lower gastrointestinal surgery
- 25 Fundamentals of the genitourinary system
- 26 Hernias
- 27 Fundamentals of vascular surgery
- 28 Fundamentals of orthopaedics
- 29 Fundamentals of plastic surgery
- 30 Surgical care of the paediatric patient
- 31 Fundamentals of organ transplantation
- Index
- References
27 - Fundamentals of vascular surgery
Published online by Cambridge University Press: 03 May 2011
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Basic Sciences Relevant to Surgical Practice
- Section 2 Basic Surgical Skills
- Section 3 The Assessment and Management of the Surgical Patient
- Section 4 Perioperative Care of the Surgical Patient
- Section 5 Common Surgical Conditions
- 16 Assessment and early treatment of patients with trauma
- 17 Fundamentals of the central nervous system
- 18 Fundamentals of head and neck surgery
- 19 Fundamentals of thoracic surgery
- 20 Oesophago-gastric surgery
- 21 Fundamentals of hepatobiliary and pancreatic surgery
- 22 Fundamentals of endocrine surgery
- 23 Fundamentals of the breast
- 24 Lower gastrointestinal surgery
- 25 Fundamentals of the genitourinary system
- 26 Hernias
- 27 Fundamentals of vascular surgery
- 28 Fundamentals of orthopaedics
- 29 Fundamentals of plastic surgery
- 30 Surgical care of the paediatric patient
- 31 Fundamentals of organ transplantation
- Index
- References
Summary
Chronic lower limb ischaemia
Lower limb arterial disease is present in about 20% of the UK population aged over 60 years and is asymptomatic in 75%, causes symptoms of intermittent claudication in 4–5% and critical limb ischaemia in about 1%. All patients should be assessed for their cardiovascular risk factors, have a full vascular examination to assess co-existing carotid disease and aneurysmal disease, ankle:brachial pressure index (ABPI) measurement and imaging using Duplex ultrasound in the first instance and angiography if indicated (intra-arterial digital subtraction angiography, CT angiography, MR angiography).
Intermittent claudication (IC)
This is characterized by the gradual onset of pain in the calf muscles (infra-inguinal artery disease) and/or the thigh and buttocks (supra-inguinal artery disease) after walking a certain distance and disappears quickly with rest. The pain recurs if walking is resumed. Only about 1–2% of claudicants will progress to develop critical limb ischaemia per annum, but about 5% will die from other cardiovascular events such as myocardial infarction or stroke.
All patients with cardiovascular disease (where coronary, cerebrovascular or peripheral) should be commenced on best medical therapy to reduce cardiovascular risk (smoking cessation, exercise and dietary advice, diagnosis and treatment of diabetes, antiplatelets, statins, antihypertensives). In patients with IC, best medical therapy will also increase walking distance and improve their quality of life.
- Type
- Chapter
- Information
- Fundamentals of Surgical PracticeA Preparation Guide for the Intercollegiate MRCS Examination, pp. 505 - 520Publisher: Cambridge University PressPrint publication year: 2011