Peripheral Arterial Disease Flashcards
What is it?
Significant narrowing of the arteries distal to the arch of the aorta
What causes it?
Usually caused by atherosclerosis caused by modifiable and non-modifiable risk factors
Where does it occur?
It can occur anywhere but generally happens at the areas of turbulent flow such as at bifurcations
Which limbs?
It can affect both arms and legs but legs are more common
Any associated co-morbidities?
65% of patients have clinically relevant cerebral or coronary artery disease
Is it common?
Yes, it affects 4-12% of people aged 55-57, and 15-20% of over 70s, there are 500-1000 new cases each year
What are the risk factors? (6)
Smoking, diabetes, hypertension, hyperlipidaemia, physical inactivity, obesity
Symptoms (3)
Cramping pain in calf/thigh/buttock after exertion, pain relieved by rest, foot pain at night relieved by hanging legs over the bed
Signs (9)
Ulcers, gangrene, absent pulses, cold, pale, atrophic skin, punched out ulcers, beurgers angle <20, cap refill >15 seconds
Differentials (4)
Sciatica, Spinal Stenosis, DVT, Musculoskeletal
What bloods would you do? (6)
FBC, ESR, Lipids, D-Dimer, Clotting, blood glucose
Other investigations (7)
Blood pressure, Thrombophilia screen, ECG, doppler ultrasonography, ABPI, MR angiography, CT angiography
Treatment (8)
Thrombolysis, Heparin, Stenting, Angioplasty, Antiplatelet therapy e.g Aspirin and Clopidogrel, Natidrofuryl Oxalate (peripheral vasodilator), surgical reconstruction (bypass), Amputation
Complications (6)
Quality of life often impaired due to restricted ability to mobilise, infection and poor wound healing, ulceration, gangrene, amputation, multiorgan failure
Is there a good prognosis?
Mortality rate is 50% at 5 years, 70% at 10 years, Coronary heart disease is present in 90% of patients with peripheral arterial disease, amputation is required in 1-2% of cases
