Peripheral Arterial Disease Flashcards
ESSENCE
Refers to narrowing of arteries supplying limbs and periphery
Usually refers to lower limbs, resulting in symptoms of claudication
CLINICAL FEATURES
How does peripheral arterial disease present
With intermittent claudication - crampy pain that predictably occurs after walking certain distance, then disapears with rest
CLINICAL FEATURES
Most common muscles affected
Calf muscle, but also affacts thighs and buttocks
CLINICAL FEATURES
Features of critical limb ischaemia
- Remember the 6Ps
- Pain - burning which is worse at night when leg is raised
- Pallor
- Pulselessness
- Paralysis
- Paraesthesia
- Perishing cold
What is Leriche syndrome
Occurs with occlusion in distal aorta or proximal common iliac artery
Classic triad of Leriche syndrome
- Thigh/buttock claudication
- Absent femoral pulses
- Male impotence
CLINICAL FEATURES
Signs
- Risk factors
- Tar staining of fingers
- Xanthomata
- Signs of CVD
- Missing limbs or digits after amputations
- Midline sternotomy scar from CABG
- Scar on inner calf from CABG
- Focal weakness from previous stroke
- Weak peripheral pulses
- Inspection
- Skin pallor
- Cyanosis
- Dependent rubor
- Muscle wasting
- Hair loss
- Ulcers
- Poor wound healing
- Gangrene
- Examination
- Reduced skin temperature
- Reduced sensation
- Prolonged capillary refill time
- Changes during Bueger’s test
CLINICAL FEATURES
Signs of arterial disease on inspection
- Skin pallor
- Cyanosis
- Dependent rubor (a deep red colour when the limb is lower than the rest of the body)
- Muscle wasting
- Hair loss
- Ulcers
- Poor wound healing
- Gangrene (breakdown of skin and a dark red/black change in colouration)
CLINICAL FEATURES
Signs of arterial disease on examination
- Reduced skin temperature
- Reduce sensation
- Prolonged capillary refill time (more than 2 seconds)
- Changes during Buerger’s test
What test is used to assess for peripheral arterial disease in the leg
Buerger’s test
Describe Buerger’s test
- 2 parts
- First part
- Patient supine, lift legs to angle of 45 degrees at hip, hold them for 1-2 minutes looking for pallor
- Pallor indicates arterial supply not adequate to overcome gravity
- Buergers angle refers to angle at which leg is pale due to inadequate blood supply
- Patient supine, lift legs to angle of 45 degrees at hip, hold them for 1-2 minutes looking for pallor
- Second part
- Sitting patient up with legs hanging over bed, blood flows into leg assisted by gravity
- In healthy patient legs normal pink, in disease they go blue initially and then dark red (rubor)
INVESTIGATIONS
First choice
- Ankle-brachial pressure index (ABPI)
- Duplex US
- Angiography (CT or MRI) with contrast
What is ABPI
Ratio of systolic BP in the ankle (around lower calf) compared to systolic BP in arm, taken using Doppler probe
ABPI results
- Normal
- 0.9-1.3
- Mild
- 0.6-0.9
- Moderate to severe
- 0.3-0.6
- Severe to critical ischaemia
- <0.3
What can ABPI > 1.3 indicate
Calcification of arteries, more common in diabetic patients
