PAD Flashcards
peripheral arterial disease
narrowing of arteries supplying limbs and periphery - reducing blood supply to these areas
intermittent claudication
symptom of ischaemia in limb
occurs on exertion, relieved by rest
crampy, achy pain
critical limb ischaemia
end-stage of PAD , inadequate blood supply to a limb meaning it cannot function properly at rest
pain at rest, non-healing ulcers, gangrene
risk losing limb
acute limb ischaemia
rapid onset of ishcaemia
typically due to thrombus blocking blood supply
atherosclerotic plaques cause…
- stiffening of artery walls –> htn and strain on heart
- stenosis –> reduced blood flow
- plaque rupture –> thrombus
atherosclerosis risk factors: non-modifiable
older age
FHx
age
atherosclerosis risk factors: modifiable
smoking alcohol poor diet sedentary poor sleep stress
medical co-morbidities increasing risk of atherosclerosis
diabetes htn CKD inflammatory conditions e.g. RA atypical antipsychotics
how does PAD present
with intermittent claudication
- crampy pain
- after walking certain distance
- releived by rest
- often calves
features of critical limb ischaemia
pain pallor pulseless paralysis paraesthesia perishing cold
critical limb ischaemia pain characteristics
burinig pain, worrse at night when leg raised (gravity no longer helps pull blood to foot)
Leriche syndrome
with occlusion in distal aorta or proximal common iliac artery
Leriche syndrome clinical triad
thigh/buttock claudication
absent femoral pulses
male impotence
examination signs
tar staining xanthomata weak peripheral pulses skin pallor cyanosis hair loss ulcers reduced temp reduced sensation prolonged CRT
Beurger’s test
- pt supine, lift up legs and look at colour (pallor)
2. sit them up w legs haging over side bed. obervse colout (blue to rubor)
arterial ulcers caused by
ischamia secondary to inadequate blood supply
arterial ulcer characteristics
smaller + deeper than venous ulcers well defined borders occur peripherally e.g. toes have reduced bleeding painful
venous ulcers are caused by
impaired drainage and pooling of blood in legs
venous ulcer characteristics
occur after minor injury larger + more superficial than arterial irregular border gaiter area of leg less painful/painless
Ix
ankle-brachial pressure index
duplex USS
angiography (CT or MRI)
ankle-brachial pressure index
ratio of systolic BP in ankle compared with arm
readings taken manually with doppler probe
ankle-brachial pressure index: 0.9-1.3
normal
ankle-brachial pressure index: 0.6-0.9
mild PAD
ankle-brachial pressure index: 0.3-0.6
mod-severe PAD
ankle-brachial pressure index: < 3
severe disease to critical ischaemic
ankle-brachial pressure index: > 1.3
can indicate calcification of arteries, making them difficult to compress
medical management of intermittent claudication
atorvastatin
clopedigrol
naftidrofuryl oxalate
surgical management options for intermittent claudication
endovascular angioplasty and stenting
endarterectomy
bypass surgery
management of critical limb ischamia
analgesia and urgent referral
urgent revascularisation - endovascular angioplasty and stenting, endarterectomy, bypass
amputation if not possible to restore blood supply
management of acute limb ischaemia
endovascular thrombolysis endovascular thrombectomy surgical thrombectomy endarterectomy bypass surgery amputatoin
