Peripheral arterial disease Flashcards
What is meant by peripheral arterial disease?
What causes peripheral arterial disease?
Narrowing of the arteries supplying the limbs/periphery
Caused by atherosclerosis
What is intermittent claudication?
- Symptom of peripheral arterial disease
- Crampy pain in calf, thigh and/or buttocks
- Occurs during exertion, relieved by rest
What is meant by critical limb ischaemia?
Inadequate blood supply to allow the limb to function normally at rest (end-stage of peripheral arterial disease)
What is acute limb ischaemia? What typically causes this?
Rapid onset of limb ischaemia, typically caused by a thrombus (clot)
What is meant by necrosis? What is gangrene?
Necrosis = death of tissue Gangrene = death of tissue (specifically due to inadequate blood supply)
What are the features of critical limb ischaemia?
6 P’s:
- Pain (typically burning)
- Pallor
- Pulseless
- Paralysis
- Paraesthesia
- Perishingly cold
What are the features of Leriche syndrome? Describe its pathophysiology
Triad of:
- Thigh/buttock claudication
- Absent femoral pulses
- Male impotence
Caused by occlusion of the distal aorta or proximal common iliac artery
What is Buerger’s test?
Used to assess for peripheral arterial disease in the leg
Which investigations can be performed in suspected peripheral arterial disease?
- Ankle brachial pressure index (ABPI)
- Duplex USS
- Angiography
How are the results of ABPI interpreted?
- 0.9 and above = normal
- 0.6-0.9 = mild PAD
- 0.3-0.6 = moderate PAD
- less than 0.3 = severe PAD
Describe the conservative, medical and surgical management of intermittent claudication (PAD)
Conservative:
- Lifestyle changes
- Exercise training
Medical:
- Secondary prevention of CVD, e.g. atorvastatin etc.
Surgical:
- Stenting
- Endarterectomy
- Bypass surgery
Describe the management of critical limb ischaemia
Surgical:
- Stenting
- Endarterectomy
- Bypass surgery
If above fails, amputation
Describe the management of acute limb ischaemia
- Analgesia
- IV heparin
- Vascular r/v (surgery)
