Peripheral arterial disease Flashcards
What is peripheral arterial disease?
Narrowing of the arteries supplying the limbs, reducing blood supply to these areas
What is intermittent claudication
A symptom of ischaemia in a limb, that occurs during exertion and is relieved by rest
What is critical limb ischaemia?
The end-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb, causing dysfunction at rest
What are the risk factors for peripheral arterial disease?
Smoking - biggest risk factor
Diabetes
Advancing age
Male
Hypercholesterolaemia
Hypertension
CKD
What are the stages of peripheral vascular disease?
1 - asymptomatic
2 - intermittent claudication
3 - critical limb ischaemia
4 - tissue loss
Where are the common sites of claudication and where would they cause pain?
Common iliac - unilateral buttock
Common femoral - unilateral thigh
Superficial femoral - unilateral calf
What is the presentation of acute limb ischaemia?
6Ps
- Pain
- Pallor
- Pulseless
- Paralysis
- Paraesthesia
- Perishing cold
What is Leriche syndrome?
Occlusion in the distal aorta or proximal common iliac artery causing:
- Thigh/buttock claudication
- Absent femoral pulses
- Erectile dysfunction
What are the first line investigations for peripheral vascular disease?
Duplex ultrasound
ABPI
What is the interpretation of ABPI results?
0.9-1.3 - normal
0.6-0.9 - mild peripheral arterial disease
0.3-0.6 - moderate to severe peripheral arterial disease
<0.3 - severe disease to critical ischaemia
What are the signs of arterial disease on inspection?
Skin pallor
Cyanosis
Muscle wasting
Hair loss
Ulcers
Poor wound healing
Gangrene
What is Buerger’s test?
The legs are held at an angle of 45 degrees for 1-2 minutes, looking for pallor
The legs are then hung over the side of the bed with the patient sat up. In arterial disease:
- The legs will go blue initially
- Legs will then turn dark red (rubor) after a short time
What is the appearance of arterial ulcers?
Smaller than venous ulcers
Deeper than venous ulcers
Well defined borders
Punched out appearance
Occur peripherally
Reduced bleeding
Painful
What is the appearance of venous ulcers?
Occur after minor injury to the leg
Larger than arterial ulcers
More superficial than arterial ulcers
Irregular, gently sloping borders
Affect the gaiter area of the leg (mid calf down to ankle)
Less painful than venous ulcers
What is the non-pharmacological management of intermittent claudication?
Lifestyle changes
Exercise training
