Peripheral arterial disease Flashcards
What is peripheral arterial disease?
Refers to the narrowing of the arteries supplying the limbs and periphery, reducing the blood to these areas
Usually refers to the lower limbs= symptoms of claudication
What is intermittent claudication and its presentation?
Symptom of ischemia in a limb, occuring during exertion and relieved by rest
Typically a crampy, achy pain in the calf, thigh or buttock muscles associated with muscle fatigue when walking
What is critical limb ischaemia and its presentation?
End stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest
Presentaion:
* Pain at rest
* Non-healing ulcers
* Gangrene
* Pain is worse at night when the leg is raised
What is acute limb ischaemia and its features (6Ps)?
Rapid onset of ischeamia in a limb- typically due to a thrombus blocking the arterial supply of a distal limb
Pain
Pallor
Pulseless
Paralysis
Parasthesia (abnormal sensation or pins and needles)
Perishing cold
What is gangrene?
Death of the tissue due to inadequate blood supply
What is Leriche syndrome and its presentation?
Occurs with occlusion in the distal aorta or proximal common iliac artery
Clinical triad of:
* Thigh/buttock claudication
* Absent femoral pulses
* Male impotence
Signs to look for on examination in acute limb ischaemia?
Risk factors:
* Tar staining
* Xanthomata (cholesterol deposits)
Signs of cardiovascular disease:
* Missing limbs after amputations
* Scars from CABG
Peripheral pulses may be weaker on examination- doppler can be used to assess pulses
- Reduced skin temp
- Reduced sensation
- Prolonged cap refill time
- Changes during Buerger’s test
- Skin pallor
- Cyanosis
- Gangrene
- Dependent rubor (deep red colour when the limb is lower than the rest of the body)
What is Buerger’s test?
Used to assess for peripheral arterial disease in the leg
2 parts to the test:
1. Patient lying on their back- lift leg 45 degrees and hold for 1-2 mins looking for pallor= arterial supply is not adequate to overcome gravity
* Burgers angle refers to the angle at which the leg goes pale e..g burgers angle of 30 degrees means the leg goes pale when lifted to 30 degrees
- Involves sitting the patient up with their legs hanging over the side of the bed. Blood will flow back into the legs assisted by gravity
* Healthy patient- legs remain normal pink colour
* Patient with PAD will go blue initially as the ischaemic tissue deoxygenates the blood and then dark red after a short time due to vasodilation in response to the waste products of anaerobic repsiration
Dark red= rubor
Arterial leg ulcers?
Caused by ischaemia secondary to an inadequate blood supply
- Smaller than venous ulcers
- Deeper than venou sulcers
- Have well defined borders
- Have a punched out appearance
- Occur peripherally e.g. on toes
- Have reduced bleeding
- Are painful
Venous ulcers?
Caused by impaired drainage and pooling of blood in the legs
* Occur after a minor injury to the leg
* Are larger than arterial ulcers
* Are more superficial than arterial ulcers
* Irregular, gently sloped borders
* Affect the gaiter area of the leg (mid-calf down to the ankle)
* Less painful than arterial ulcers
* Occur with other signs of chronic venous insufficiency
Investigations for PAD?
- Ankle-brachial pressure index (ABPI)
- Duplex ultrasound- shows speed and volume of blood flow
- Angiography- using contrast to highlight the arterial circulation
What is ABPI and normal/abnormal readings?
Ratio of systolic blood pressure in the ankle compared with the sytsolic blood pressure in the arm using a doppler probe
ankle/arm=
0.9-1.3= normal
0.3-0.6= moderate to severe PAD
1.Less than 0.3= severe disease to critical ischaemic
Medication treatments of intermittent claudication?
- Atorvastatin 80mg
- Clopidogrel 75mg once daily
- Naftidrofuryl oxalate (5-HT2 receptor antagonist that acts as a peripheral vasodilator)
Surgical options for PAD?
Endovascular angioplasty and stenting
Enarterectomy- cutting the vessel open and removing the plaque
Bypass surgery- to bypass blockage
