Chronic Limb Ischaemia/Peripheral Artery Disease (PAD/PVD) Flashcards
What are patients with PVD/PAD at high risk of developing or dying from?
- CHD
Who should patients with PVD/PAD be treated in the same way?
- Patients who have established CHD because they are so at risk of it
What is the cardinal sign of PVD/PAD?
- Intermittent claudication
What is intermittent claudication?
- Cramp like pain in muscles of the leg occuring on exercise (usually walking)
What relieves intermittent claudication?
- Rest
What three muscles are mostly affected by intermittent claudication?
- Buttocks
- Thigh
- Mostly the calfs
What are the requirements for severe limb ischaemia?
- Rest pain for more than 2 weeks a year
- Tissue loss
- ABPI (ankle brachial pressure index) under 0.5
What is the ankle brachial pressure index?
Ratio of blood pressure in ankle vs blood pressure in the upper limb
What is critical limb ischaemia?
- Absolute ankle pressure <50mmHg
What is the treatment for critical limb ischaemia?
- Same prevention methods as severe ischaemia
- May require amputation
What can result from critical limb ischaemia?
- Gangrene
- Ulceration
- Rest pain
- Sleep disturbances
What are the 6 P’s?
- Pain
- Pallor
- Pulseless
- Parasthesia
- Paralysis
- Poikilothermia
What are the risk factors?
- Lipids
- Smoking
- Hypertension
- Diabetes
- Exercise
What conditions may increase the likelihood of developing chronic limb ischaemia?
- Atherosclerosis
- Diabetes mellitus
- Beurgers disease
- Hyperhomocysteinaemia
What is beurgers disease?
- Inflammation and thrombosis in small and medium blood vessels of the legs leading to gangrene
What are the initial investigations of chronic limb ischaemia?
- History
- Examination
- Ankle brachial pressure index (ABPI)
- Screen for diabetes
What is the ABPI?
- Ankle pressure/brachial pressure
- If below 0.5 then severe limb ischaemia
What is the first line of treatment for claudication/critical limb ischaemia?
- Try and prevent CHD
What 3 drug treatments should be used to prevent CHD?
- Anti platelets
- Statins
- ACEi
- SMOKING CESSATION
What anti platelets should be started?
- Aspirin
- Clopidogrel
What patients should be started on a statin?
- Those with LDL level of >3.5mmol/L
What should the ACEi be used for?
- Treating hypertension
What is the BP target when using ACEi?
- 140/85
What other levels in the blood should be controlled?
- Glucose levels
What does reducing glucose levels prevent?
- Microangiopathy
What surgical options are available?
- Angioplasty
- Amputation
When are surgical options explored?
- When pharmacotherapy fails
What patients can have surgery?
- Those with good control of risk factors
- Poor quality of life
- Acceptable co morbidity
- Informed consent
What angioplasty technique is used?
- Percutaneous transluminal angioplasty
What is PTA?
- Revascularisation
Why is PTA rarely used in CLI?
- Only suitable for minority of individuals
What are the initial investigations in severe limb ischaemia?
- ECG
- CxR
- Routine bloods
- Crossmatch
