Condition- PVD (acute & chronic) Flashcards
Define Peripheral Vascular Disease
Occurs due to atherosclerosis causing stenosis of arteries via a multifactorial process involving modifiable and non-modifiable risk factors
What is the main cause of PVD?
ATHEROSCLEROSIS
What are the classifications of PVD?
- CHRONIC LIMB ISCHAEMIA:
- Intermittent Claudication
- Critical Limb Ischaemia
- ACUTE LIMB ISCHAEMIA
Which of the three different types of PVD and limb ischaemia is the most severe?
CRITICAL LIMB ISCHAEMIA => tissue loss (ulcers+ gangrene)
What is acute limb ischaemia?
A sudden decrease in arterial perfusion in a limb
List some causes of acute limb ischaemia
- thromboembolic event
- AF
- trauma
- iatrogenic- pos angioplasty/sugery
- Choleserol from long bone #
List some modifiable risk factors for PVD
- Diet- high cholesterol
- Smoking
- Lack of exercise
- High BP
- Obesity
List some non-modifiable risk factors for PVD
- Genetics
- FHx: of hyperlipidaemia/ Hypertension/ T2DM
- Age
- Gender: Male
- PMHx: of T2DM
What level of vascular stenosis is required for a patient with PVD to be symptomatic?
50%
List some common presenting symtpoms of someone with Intermittent Claudication
- Cramping pain on exercise aftere a set distance/ time (=claudication distance)
- Rapidly relieved on rest
- Pain absent on rest/ at
- Calf pain/ Buttock pain
- risk factors present
List two arteries which are commonly claudicated and state which part of the body may feel pain
- Calf claudication = superficial femoral disease
- Buttock claudication = iliac disease (internal or common)
List some common presenting symptoms of a patient with Critical limb ischaemia
- Pain at rest
- Pain at night (relieve by dangling leg over the edge of the bed)
- Ulceration
- Gangrene
SIGNS:
- Shiny scaly skin (due to SC tissue loss)
- thickened toe nails
- Loss of hair over dorsum of foot
- Dependent rubor
- Muscle atrophy
Which classification system is used to classify PVD?
FONTAINE CLASSIFICATION
Describe the different stages of the Fontaine Classification system which is used to classify symptoms of PVD
- Asymptomatic
- Intermittent claudication
- Ischaemic pain
- Ulceration/ Gangrene
List some signs and symptoms of acute limb ischaemia
6Ps
- Pain
- Pulseless
- Pale
- Paralysis
- Paraesthesia
- Perishingly Cold
Other symptoms:
- Atrophic skin
- Hairless
- Punched-out ulcer (often painful)
- Colour change when raising leg
What is the first line examination for a patient presenting with PVD
ANKLE BRACHIAL PRESSURE INDEX (ABPI)
How is ABPI calculated?
Ankle SBP/ Brachial SBP
What are the typical ABPI values for:
i. Normal people
ii. Intermittent claudication
iii. Critical limb ischaemia
iv. the range where tissue loss occurs
i. Normal people: 1-1.2
ii. Intermittent claudication: 0.5-0.9
iii. Critical limb ischaemia: <0.5
iv. the range where tissue loss occurs: <0.2
Which investigation would you conduct on a patient with suspected chronic limb ischaemia
- History + exam
- BEDSIDE: ABPI + ECG (check for AF=clots)
- BLOODS: lipid profile + HbA1c, FBC (anaemia), U+Es (renal disease)
- IMAGING:
- Gold standard: MRI/CT angiogram
- US Duplex scan
Why is it important not to place a pressure cuff on a patient with an ABPI of less than 0.8?
this will worsen the ischaemia
How are patients with Chronic Limb Ischaemia managed?*
- CONSERVATIVE: diet mods, smoking cessation, exercise
- MEDICAL: preventative (BP + BM control), statins, anti-platelets (clopidogrel)
- SURGICAL:
- Percutaneous Transluminal Angioplasty +/- stent
- Surgical reconstruction (Bypass)
- Amputation
How is acute limb iscahemia managed?*
- EMBOLECTOMY- wire fed through vessel and withdrawn with balloon
- THROMBOLYSIS
- POST-EMBOLECTOMY: anticoagulated with heparinà warfarin
State two major complication treating acute limb ischaemia*
- Reperfusion Injury: tissue damage caused when blood supply returns to the tissue after a period of time
- Swelling causing COMPARTMENT SYNDROME
