Peripheral Arterial and Venous Disease Flashcards
What causes peripheral arterial stenosis/disease, reducing blood flow to the extremities?
Atherosclerosis
What is the biggest risk factor for peripheral arterial disese?
Smoking
What are other risk factors for peripheral arterial disease?
Diabetes, high BP, high cholesterol
What do 65% of people with PAD also have?
Co-morbid cerebral/coronary artery disease
What are the stages of symptoms of PAD?
1) Intermittent claudication
2) Ischaemic rest pain (critical ischaemia)
3) Ulceration/gangrene
What is intermittent claudication?
Cramping lower limb pain on walking, relieved by rest
How do you diagnose peripheral arterial disease?
Ankle-brachial pressure index
What ABPI level indicates PAD?
< 1/0.9
What other investigations can you do after ABPI?
Colour duplex US ± MR/CT angiography
How do you treat PAD conservatively if someone only has intermittent claudication?
Modify risk factors - smoking, BP, cholesterol (statin), clopidogrel, aspirin
How would you treat severe PAD e.g. causing rest pain in someone with viable tissue?
- Percutaneous transluminal angioplasty (PTA)
- Surgical bypass of femoral artery - more invasive, worse choice
What ABPI level indicates severe PAD?
< 0.5
What are signs of PAD?
Cold, weak/no peripheral pulses, purple
How would you treat severe PAD in someone with unviable tissue?
Amputation
What causes chronic venous insufficiency?
Valve dysfunction (primary or post-DVT) in veins of lower extremities, reducing blood flow back to the heart
What are risk factors for CVI?
Age, family history, smoking, previous DVT
What are varicose veins?
Long, torturous and dilated superficial veins
What are risk factors for varicose veins?
- Prolonged standing
- Obesity
- Family history
- Pregnancy/OCP
What causes primary CVI/varicose veins?
Mechanical (reflux)
What causes secondary CVI/varicose veins?
- Obstruction e.g. DVT
- AVM
- Overactive muscle pumps (cyclists)
What are signs and symptoms of CVI?
- Leg pain/cramps
- Leg fatigue
- Heavy legs (on prolonged standing)
- Dilated tortuous veins
What are complications of CVI?
Haemorrhage
Superficial thrombophlebitis
What investigations do you do to diagnose chronic venous insufficiency?
- Cough impulse of saphenous vein
- Doppler colour
- Duplex US
How do you treat CVI?
Treat underlying cause and RF modification (also surgical options - see PALS slides)