PAD Flashcards
Mx for PAD
medical - 75mg clopidogrel, 80mg atorvastatin, exercise program, stop smoking, reduce stress
Surgical - bypass using saphenous vein or angioplasty (balloon or stent)
fontaine classification of PAD
1) asymptomatic
II - claudication
III - rest / nocturnal pain
IV - necrosis or gangrene
what is claudication
pain on walking, which is not present on the first step and arises after certain distance, goes away with rest (after few seconds unlikely spinal stenosis which will take minutes to go away)
ABPI classification
> 0.9 - normal
0.8-0.9 mild
0.5-0.8 mod
<0.5 - severe (critical limb ischaemia and rest pain will be present
Ix for PAD
ABPI, duplex USS, CT angiography, HBa1C
what is chronic limb ischamia
symptomatic reduced blood supply to limbs (do burgers test), limb will be cold and may be ulcers
what is critical limb ischaemia
the advanced form of chronic limb ischaemia , may have rest pain > 2 weeks and ABPI <0.5. Need urgent doppler USS to seee where occlusion is and may need surgery
what is leriche syndrome
form of PAD affecting the aortic birfucation (presents with buttock/thigh pain and ED and absent femoral pulses)
complications of chronic limb ischamia
sepsis, acute on chronic, amputation, reduced mobility
how is ABPI worked out
measure ankle SBP and divide by highest SBP on either arm (do this for each leg)
what is the disease progression in atherosclerosis
1) fatty streak
2) simple plaque - endothelial injury, SM proliferation, accumulation of form cells and extracellular lipid
3) complicated plaque
who gets buergers disease
young men who smoke
what is buergers disease
non atherosclerotic vasculitis of medium and small arteries which causes intermittent claudicaiton and rest pain
how does buergers disease present
ischaemic limbs, ulcers, blue fingers
Management of buergers disease
smoking cessation and nifedipine
