Peripheral Arterial Disease Flashcards
How does peripheal arterial disease present?
Can be asymptomatic
Claudication
- Due to mismatch between O2 demand and supply
Rest pain
- Continuous pain in feet when elevated
- Relieved when lowered
6 P’s
- Pallor
- Pulseless
- Perishing cold
- Paralysis
- Pain
- Paraesthesia
Ulcers
Elevation pallor/dependent rubor
Iliac artery bruit (whoosh)
Gangrene/necrosis
Hair loss
Decreased capillary refill
Give the three main patterns of presentation of arterial limb disease
(From mild to emergency)
Intermittent claudication
Critical limb ischaemia
Acute limb-threatening ischaemia
Give specific features of critical limb ischaemia
Triad of rest pain, arterial ulcers and gangrene
Rest pain in foot for more than 2 week
- Patients often report hanging their legs out of bed at night to ease the pain
Ulceration
Gangrene
Give specific features of intermittent claudication
Intermittent claudication
- Aching or burning in the leg muscles following walking
- Patients can typically walk for a predictable distance before the symptoms start
- Usually relieved within minutes of stopping
- Does not present at rest
Give specific features of acute limb threatening ischaemia present
1 or more of the 6 P’s
Pale
Pulseless
Painful
Paralysed
Paraesthetic
Perishing cold
What risk factor has the strongest association with peripheral arterial disease?
Smoking
What classification is used in peripheral arterial disease?
Fontaine classification
Describe Fontaine classification 1
Asymptomatic
Describe Fontaine classification 2A
Mild claudication, >200m before pain
Describe Fontaine classification 3
Rest pain
Describe Fontaine classification 2B
Walk <200m
Describe Fontaine classification 4
Ulcers, gangrene, necrosis
What investigations are used in peripheral arterial disease diagnosis?
Duplex US
- First line
Ankle-Brachial Pressure Index (ABPI)
Magnetic Resonance Angiography
- Performed prior to any intervention
Buerger’s Angle
What is the first line investigation in peripheral arterial disease?
Duplex US
What is the ankle-brachial pressure index (ABPI)?
Ratio of the systolic blood pressure in the lower leg to that in the arms
Lower blood pressure in the legs (result in a ABPI < 1) is an indicator of peripheral arterial disease
An ankle-brachial pressure index (ABPI) of what is normal?
1-1.2
An ankle-brachial pressure index (ABPI) of what is suggestive of claudication?
0.6-0.9
An ankle-brachial pressure index (ABPI) of what is suggestive of critical limb ischaemia
<0.5
An ankle-brachial pressure index (ABPI) of what is suggestive of vessel calcification common in diabetes?
>1.2
What is Buerger’s angle?
Pallor <20 degrees
What is the management for peripheral arterial disease?
Smoking cessation
Manage comorbidities
- DTM
- Obesity
- HTN
Exercise training
Statin/Atorvastatin 80mg
Antiplatelets/Clopidogrel 75mg
Heparin and urgent vascular review for acute limb ischaemia
Severe/Acute
- Angioplasty, in single segment disease
- Stenting
- Bypass surgery
Limb amputation
- Reserved for patients with critical limb ischaemia not suitable for other interventions
What is first line management of peripheral arterial disease?
Exercise training
What is cervical rib?
Supernumery fibrous band arising from seventh cervical vertebra, which may cause thoracic outlet syndrome
How is cervical rib managed?
Surgical division of rib
What is subclavian steal syndrome?
Proximal stenotic lesion of the subclavian artery, resulting in retrograte flow through vertebral or internal thoracic arteries, causing a decrease in cerebral blood flow and syncopal symptoms
What is Buergers disease/thromboangiitis obliterans?
Small and medium vessel vasculitis that is strongly associated with smoking and raynauds phenomenon
