peripheral arterial disease Flashcards
what are the 3 types of PAD?
- intermittent claudication:
- inadequate increase in muscle perfusion during exercise - critical limb ischaemia
- advanced form of chronic ischaemia, symptoms include night pain - acute limb ischaemia
- caused by emboli
- tend to lodge at artery bifurcations
what are the risk factors for PAD?
- Smoking is the greatest risk factor
- advancing age
- hypertension
- hypercholesterolaemia
- heart disease (AF) for acute limb ischaemia
- CKD
- high serum homocystine- increases when eat meat
what is the name of the classification system for PAD?
Fontaine classificiation
why may PAD appear to be asymptomatic, and what might you see on examination of these patients?
Symptoms may be masked by an inability to walk (e.g. severe heart failure) or due to pain insensitivity (e.g. diabetic neuropathy)
on examination: Low ABPI (<0.90) or lack of palpable pulse
what are the different stages of PAD according to fontaine classification?
stage 1: asymptomatic
stage 2: intermittent claudication which is not present at rest.
2a-> happens after walking more than 200m
2b-> happens after walking less than 200m
stage 3: critical limb ischaemia
- pain present at rest
- dangling leg over bed at night can help pain
- imminent risk of limb loss
stage 4: tissue loss, ulceration and gangrene
where is the underlying pathology if person presents with unilateral buttock pain?
common illiac
where is the underlying pathology if person presents with unilateral thigh pain?
common femoral
where is the underlying pathology if person presents with unilateral calf pain?
superficial femoral
what is it called when you have the triad of ….
Bilateral buttock and thigh claudication
Absent or decreased femoral pulses
Erectile dysfunction
Aortoiliac (Leriche syndrome)
what is the appearance of an arterial ulcer?
Site: lower legs and tops of feet or toes
Symmetrical shape, well-defined borders, ‘punched-out appearance’
Painful, particularly at night
Minimal bleeding when touched or knocked
what is the primary investigation for peripheral arterial disease?
Ankle-brachial pressure index (ABPI)
what does ABPI >1.3 suggest?
Abnormally calcified vessels; false-negative often due to diabetes. Any value >1.5 should not be used to guide decision making
which ABPI values are considered normal?
0.8-1.3
what value ABPI will someone with intermittent claudication likely have?
0.5-0.79
what does an ABPI value <0.5 suggest?
Severe arterial disease; rest pain, ulceration, gangrene (critical limb ischaemia)
