L12 - Peripheral vascular disease

Question 1

What is peripheral vascular disease?

Answer 1

• blocking of arteries supplying lower limbs
• insufficient tissue perfusion
• aar existing atherosclerosis

Question 2

What is an atheroma

Answer 2

• core of cholesterol joined to proteins with a fibrous intravascular covering

Question 3

Does PVD manifest acute or chronically?

Answer 3

• more chronic progression of symptoms

Question 4

Symptoms indicating thrombosis of existing PVD? (3)

Answer 4

• intermittent claudication
• rest pain
• ulceration

Question 5

What are the five Ps indicating signs of peripheral vascular disease?

Answer 5

1. Pulselessness
2. Paralysis
3. Paresthesia
4. Pain
5. Pallor

Paralysis and paresthesia suggest limb threatening ischaemia.

Question 6

What is mottling?

Answer 6

• blotchy, red-purplish marbling of skin
• feet then travels up
• common in final week of death
• due to heart not being able to pump effectively
• blood pressure drops
• extremities feel cold to touch

Question 7

Advanced PVD may manifest as

Answer 7

• mottling in a fishnet pattern
• pulselessness
• numbness
• cyanosis

Question 8

Arteriogenesis

Answer 8

• enlargement of pre-existing collateral arteries to contribute to tissue perfusion
• activation of nitric oxide promotes vessel enlargement

Question 9

Angiogenesis

Answer 9

• development of new capillary networks

- due to tissue iscahemia

Question 10

Describe the response to ischaemia in peripheral artery disease?

Answer 10

1. Compensation
   - vascular remodelling
   - angiogenesis / arteriogenesis
2. Endothelial dysfunction
   - failure of compensation
   - activation WBC, platelets
   - increased leukocyte adhesion
   - increased free radicals
3. Muscle fibre damage
   - mitochondrial injury
   - free radical generation
   - inadequate perfusion
4. Decreased oxygen supply, increased metabolic demands
   - –> rest pain
   - –> gangrene

Question 11

Diagnostic tests of peripheral vascular disease (5)

Answer 11

1. physical examination
2. ankle-brachial index
3. USS
4. Angiography
5. blood tests

Question 12

What may be seen on a physical examination of a patient with peripheral vascular disease?

Answer 12

• weak / absent pulse below narrowed area of artery
• bruits (whooshing sounds)
• poor wound healing
• decreased bp in affected limb

Question 13

What is an ankle-brachial index?

Answer 13

compares blood pressure in ankle with blood pressure in arm.