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6. Cardiovascular System > 15. Peripheral Vascular Disease (PVD) > Flashcards

15. Peripheral Vascular Disease (PVD) Flashcards

1
Q

Outline the arteries in the legs.

A
  • Anatomy of arteries:
  • Aorta
  • Common Iliac
  • External Iliac
  • Internal Iliac
  • Common femoral
  • Superficial femoral
  • Popliteal
  • Anterior tibial
  • Posterior tibial
  • Peroneal
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2
Q

Define ischaemia.

A

Ischaemia refers to an inadequate oxygen supply to the tissues due to reduced blood supply and impaired vascular perfusion, leading to reversible tissue damage.

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3
Q

Define infarction.

A

Irreversible tissue death due to ischaemia.

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4
Q

Define necrosis.

A

Refers to the death of the tissue.

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5
Q

What is peripheral vascular disease (PVD)?

A

Essentially, it’s the partial blockage of leg or peripheral vessels by an atherosclerotic plaque and or resulting thrombus, resulting in insufficient perfusion of the lower limb, resulting in LOWER LIMB ISCHAEMIA.

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6
Q

What causes PVD?

A

Atherosclerosis causing stenosis of arteries

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7
Q

What is PVD? Explain the pathophysiology.

A

Narrowing of the arteries in the peripheral, non-coronary arterial circulation.
- Vessels of the lower extremities are most commonly affected

So, embolus forms -> narrowed arteries -> decreases blood flow -> less gas + nutrient exchange -> acute limb ischaemia -> tissue loss -> forms ulcers -> poor healing of ulcers -> ischaemic cells release adenosine -> adenosine signals nerves -> sensation of pain -> claudication.

Claudication = pain caused by poor circulation
- Happens when O2 demand > O2 supply

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8
Q

Give 5 risk factors for peripheral vascular disease.

A
  1. Hypertension.
  2. Hyperlipidaemia / Hypercholesterolaemia
  3. Diabetes.
  4. Smoking.
  5. Obesity.
  6. Physical inactivity.
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9
Q

Give 3 signs of PVD.

A
  1. Absent femoral, popliteal or foot pulses.
  2. Cold, white leg(s)
  3. Atrophic skin
  4. Punched out ulcers
  5. Postural colour change
  6. Capillary refill prolonged
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10
Q

What is a consequence of peripheral arterial occlusion?

A

Gangrene.

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11
Q

Name the classification system for peripheral vascular disease (PVD).

A

Fontaine classification.

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12
Q

What are the 4 stages in the Fontaine classification of PVD?

A
  1. Asymptomatic
  2. Intermittent claudication
  3. Ichaemic rest pain
  4. Ulceration/gangrene (critical ischaemia)
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13
Q

Give 2 diseases that result from stress induced ischaemia.

A
  1. Exercise induced angina.
  2. Intermittent claudication.
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14
Q

What is intermittent claudication?

A

A symptom describing muscle pain that is caused by moderate ischaemia.
Intermittent claudication occurs when exercising (stress induced) and is relieved with rest.

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15
Q

Name 2 diseases that are due to moderate ischaemia.

A
  1. Angina.
  2. Intermittent claudication.
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16
Q

Describe the clinical features of intermittent claudication.

A

Muscle cramping pain in calf/thigh/buttock after walking a given distance (shorter=more severe) - relieved by rest

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17
Q

Intermittent claudication: is O2 supply normal or low at rest and when you begin exercise?

A

Normal. Intermittent claudication is stress induced so at rest and when you begin exercise O2 supply is able to meet demand.

18
Q

Intermittent claudication: is O2 supply normal or low when you do moderate/hard exercise?

A

Low. O2 supply is unable to meet demand -> anaerobic respiration -> lactic acid.

19
Q

Intermittent claudication: is O2 supply normal or low after a short rest?

A

Low. It takes longer to recover as you’re getting rid of the lactic acid. After a long rest however it is normal.

20
Q

PVD most commonly causes pain in the calf.
What artery is the claudication therefore in?

A

If the pain is in the upper 2/3: superficial femoral

If the pain is in the lower 1/3: popliteal

21
Q

What can intermittent claudication lead on to if left untreated?

A

Critical ischaemia.

22
Q

How would intermittent claudication be managed, beyond conservative risk reduction treatments?

A

Revascularisation - percutaneous transluminal angioplasty (PTA) or surgical reconstruction/arterial bypass graft.

23
Q

Name a disease that is due to severe ischaemia.

A

Critical limb ischaemia.

24
Q

Give 2 diseases that result from ischaemia due to structural/functional breakdown.

A
  1. Critical limb ischaemia.
  2. Vascular dementia.
25
What is critical limb ischaemia?
The end-stage of PVD, where there is an inadequate supply of blood to a limb to allow it to function normally at rest. AKA - Blood supply is barely adequate for life. - There is no reserve for an increase in demand. - Very severe, cells are dying. - O2 supply is ALWAYS low, even at rest!
26
Give 4 signs of critical limb ischaemia.
1. Rest pain. 2. Classically nocturnal. - Burning foot pain at night relieved by hanging legs over the side of the bed. 3. Ulceration. 4. Gangrene.
27
Diagnosis of peripheral vascular disease - critical limb ischaemia
1. Ankle/brachial pressure index (ABPI) - The ratio of systolic blood pressure (SBP) in the ankle (around the lower calf) compared with the systolic blood pressure in the arm - Indicates the severity of disease 2. Colour duplex ultrasound with cross sectional CT - First-line 3. MR/CT angiography - To assess extent and location of stenoses and quality of distal vessels - if considering intervention 4. Bloods * ESR/CRP: Exclude arteritis by looking at ESR/CRP - they would be raised in arteritis * FBC: - Looking particularly at haemoglobin to exclude anaemia or polycthaemia (increased red blood cells)
28
Management of critical limb ischaemia.
Patients with critical limb ischaemia require urgent referral to the vascular team. They require analgesia to manage the pain. Urgent revascularisation can be achieved by: 1. Endovascular angioplasty and stenting 2. Endarterectomy 3. Bypass surgery 4. Amputation of the limb if it is not possible to restore the blood supply
29
What is acute lower limb ischaemia?
Acute limb ischaemia refers to a rapid onset of ischaemia in a limb.
30
What can cause acute ischaemia?
1. Embolism 2. Thrombosis
31
Give 6 symptoms of acute ischaemia.
The 6 P's: 1. Pain. 2. Pale. 3. Paralysis. 4. Paraesthesia. 5. Perishing cold. 6. Pulseless. The more P’s present, the more sudden and the more complete your ischaemia
32
Acute ischaemia is not a surgical emergency. True or False?
False! - SURGICAL EMERGENCY requiring REVASCULARISATION WITHIN 4-6 HOURS TO SAVE THE LIMB!! * This is an EMERGENCY and requires urgent surgery and angioplasty (widening of arteries with balloon)
33
Management of acute limb ischaemia.
Patients with acute limb ischaemia need an urgent referral to the on-call vascular team for assessment. Management options include: 1. Endovascular thrombolysis – Inserting a catheter through the arterial system to apply thrombolysis directly into the clot 2. Endovascular thrombectomy – Inserting a catheter through the arterial system and removing the thrombus by aspiration or mechanical devices 3. Surgical thrombectomy – Cutting open the vessel and removing the thrombus 4. Endarterectomy 5. Bypass surgery 6. Amputation of the limb - If it is not possible to restore the blood supply
34
Describe conservative treatment of limb ischaemia.
1. Risk factor modificaition - Exercise + lose weight - Quit smoking - Treat hypertension, hyperlipidaemia and diabetes - Clopidogrel (anti-platelet) to prevent progression and reduce risk.
35
Give 4 treatments for peripheral vascular disease.
1. Risk factor modification. 2. Vein bypass for critical leg ischaemia. 3. Balloon angioplasty. 4. Stenting of occlusion. 5. Amuptation.
36
Vasodilator drug commonly used in PVD if supervised exercise has not led to satisfactory improvement + patient doesn't want to do surgery?
Naftidofuryl oxalate
37
Describe the differences in the pain felt for intermittent claudication + critical leg ischaemia.
Intermittent claudication: 1. Tissue is NOT DYING just SUFFERING 2. When doing mild/moderate exercise, you have an oxygen debt, resulting in a build up of lactic acid resulting in pain. 3. NO resting pain Critical leg ischaemia; 1. Tissue is DYING and SUFFERING AT REST 2. Blood supply is inadequate to allow basal metabolism; there is no reserve available for the increased demand. 3. Resting pain - typically nocturnal
38
What is a non-healing painful ulcer on big toe with no trauma a symptom of?
Critical leg ischaemia
39
What is 'severe nocturnal pain in all toes of the left foot only relieved by hanging foot over the edge of bed (using gravity to perfuse)' a symptom of?
Critical leg ischaemia
40
What type of ischaemia is an acute MI an indicator of?
Acute ischaemia
41
What is 'a loss of the use of right side of body and fast irregular pulse' a symptom of?
Acute ischaemia

6. Cardiovascular System (24 decks)

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