PAD- Ulcers, ABPI and Management Flashcards
What do leg ulcers suggest?
Indication skin and tissues are struggling to heal due to imparied blood flow
What are arterial ulcers caused by?
Ischaemia secondary to inadequate blood supply
What are venous ulcers caused by?
Impaired drainage and pooling of blood in the legs
Compare arterial and venous ulcer features
What investigations can be used for peripheral arterial disease?
Ankle-brachial pressure index (ABPI)
Duplex ultrasound
Angiography
What is ankle-brachial pressure index?
Ration of SBP in the ankle to the SBP in the arm
Taken manually using a doppler probe
What do different ABPI values suggest?
1.3 < Calcification of arteries making them more difficult to compress
0.9-1.3 Normal
0.6-0.9 Mild PAD
0.3-0.6 Moderate to severe PAD
< 0.3 Severe disease to critical ischaemia
How can intermittent claudication be managed?
Lifestyle changes for modifiable risk factors
Medical treatment of co-morbidities
What medical treatments are used for intermittent claudication?
Atorvastatin 80mg
Clopidogrel 75mg once daily (use aspirin if not suitable)
Naftidrofuryl oxalate (5-HT2 receptor antagonist, acts as peripheral vasodilator)
What surgical options are available for intermittent claudication?
Endovascular angioplasty and stenting
Endarterectomy
Bypass surgery
When are endovascular angioplasty and stenting used?
Less extensive disease as lower risks but not suitable for extensive disease
How are patients with critical limb ischaemia managed?
Urgent referral to vascular team
Analgesia for pain
How can urgent revascularisation be achieved?
Endovascular angioplasty and stenting
Endarterectomy
Bypass surgery
Amputation- if not possible to restore blood supply
How can acute limb ischaemia be managed?
Urgent referral to vascular team for assessment
What management options are available for acute limb ischaemia?
Endovascular thrombolysis
Endovascular thrombectomy
Surgical thrombectomy
Endarterectomy
Bypass surgery
Amputation
