Peripheral Arterial Disease Flashcards
What is peripheral arterial disease?
narrowing of arteries supplying the limbs + periphery > reduced blood supply > claudication
Gold standard test for peripheral arterial disease
CT angiogram
signs of arterial disease on insepction
- skin pallor
- cyanosis
- dependent rubor
- muscle wasting
- hair loss
- ulcers
- poor wound healing
Features of arterial disease on examination
- reduced skin temp
- reduced sensation
- prolonged cap refil
- changes during buerger’s test
- weak pulses
Describe intermittent claudication due to ischaemia
Cramps achy pain in lower limbs during exertion
Relieved by rest
Most commonly in calf
Management of intermittent limb claudication
- lifestyle changes for modifiable risk factors
- smoking cessation
- optimise treatment of co-morbidities
- exercise training
- atorvastatin, clopidogrel
- surgical options: endovascular angioplasty + stenting, endarterectomy, bypass surgery
What does exercise training in intermittent claudication involve?
- structured + supervised program of regularly walking to point of near maximal claudication + pain
- then resting
- repeat
what is atherosclerosis?
accumulation of intracellular + extracellular lipids in tunica intima + media of medium + large arteries
combination of atheroma + sclerosis > develop into atheromatous plaques
what do atheromatous plaques cause?
- stiffening of artery wall > hypertension
- stenosis
- plaque rupture > thombus > ischaemia
risk factors of atherosclerosis
- male
- family history
- increasing age
- smoking
- excessive alcohol consumption
- poor diet
- low exercise
- obesity
- stress
end results of atherosclerosis
- angina
- MI
- TIA/stroke
- peripheral arterial disease
- chronic mesenteric ischaemia
what is acute limb ischaemia?
sudden decrease in limb perfusion that threatens viability of limb
causes of acute limb ischaemia
- embolisation
- thombosis in situ
- trauma
clinical features of acute limb ischaemia
pain
pallor
pulselessness
paraesthesia
perishingly cold
paralysis
investigations of acute limb ischaemia
- routine bloods: incl lactate, thrombophilia, G&S
- ECG
- doppler USS of both limbs
- CT angiogram
management of acute limb ischaemia
- surgical emergency
- urgent referral to vascular
- IV opioids
- IV unfractionated heparin infusion
- embolectomy
- endovascular thrombolysis + angiography
- bypass surgery
- amputation
long term management of acute limb ischaemia
- regular exercise
- smoking cessation
- weight loss
- anti-platelets e.g. clopidogrel
- OT+PT if amputation
Classification of acute limb ischaemia
Rutherford
clinical features of chronic limb ischaemia + classification
Fontaine classification
- stage I: asymptomatic
- stage II: intermittent claudication
- stage III: ischaemic rest pain
- stage IV: ulceration or gangrene
what is chronic limb threatening ischaemia?
end stage of peripheral arterial disease where there is inadequate blood supply to limb to allow it to function at rest
Features of chronic limb threatening ischaemia
- ischaemic rest pain >2 weeks
- worse at night
- non healing ulcers
- gangere
- ABPI <0.5
- pale cold limb + weak pulses
what is the ankle-brachial pressure index?
ratio of systolic BP in the ankle compared to systolic BP in arm
taken using a doppler probe
Interpretation of ABPI results
- >1.3: calcifications in arteries
- 1.0-1.4: normal
- 0.9-0.999: possible PAD
- <0.9: PAD
- <0.5: severe + limb-threatening ischaemia
What does an ABPI valve >1.3 indicate?
who is this common in?
calcification of arteries > difficult to compress
diabetics
