Peripheral Arterial Disease Flashcards
Risk factors for chronic lower limb ischaemia
- Smoking
- Diabetes
- Hypercholesterolaemia
- Hypertension
Fontaine classification of PAD
- Stage I- asymptomatic
- Stage II- intermittent claudication
- Stage III- rest pain/ nocturnal pain
- Stage IV- necrosis/gangrene
What is rest pain?
Severe, unremitting pain n the foot which stop a patient from sleeping.
What is intermittent claudication
Exertional discomfort, most commonly in the calf which is relieved by rest
Patient with aorto-iliac disease may experience pain in the buttock, hip or thigh
What are the primary features of critical lower limb ischemia?
Necrosis and gangrene
Differential diagnosis of chronic lower limb
- Spinal canal claudication
- osteoarthritis hip/knee
- Peripheral neuropathy
- popliteal artery entrapment
- venous claudication
- Fibromuscular dysplasia
- Buerger’s disease
ABPI
Measurement of the cuff pressure at which blood flow is detectable by Doppler in the posterior tibial or anterior tibial arterial
ABPI with intermittent claudication
0.5-0.9
Critical limb ischaemia ABPI
<0.5
Falsely elevated ABPI causes
Heavy calcification and renal disease
Pharmacological management of PAD
Cilostazol - is a phosphodiesterase III inhibitor that increases levels of cAMP, produces vasodilation and reversibly inhibits platelet aggregation.
Naftidrofuryl is a vasodilator agent that inhibits vascular and 5-HT2 receptors and can reduce lactic acid levels.
Oxpentifylline, inositol nicotinate and cinnaraizine
Surgical and radiological management for PAD
Percutaneous transluminal angioplasty
Bypass procedures- using Dacron, PTFE or autologous veins
Amputation
Acute lower limb ischemia- symptoms
Five P’s
- Pain
- Pallor
- Parasthesia
- Paralysis
- Perishingly cold
ALI features
Embolic disease
Thrombus may also form in normal vessels in hypercoagulable patients because of malignancy or thrombophilia defects
Side effects of revascularization
Reperfusion injury, with release of toxic metabolites into the circulation
Acute aortic syndrome- diseases involved
- Aortic dissection
- Intramural haematoma
- Penetrating aortic ulcers
Management of acute aortic syndromes
Antihypertensive emdication - labetalol, metoprolol and vasdilators
Signs of Acute aortic syndromes
Sudden onset of severe and central chest pain that often radiates to the back and down the arms, mimicking MI.
Tearing in nature and may be migratory to the back
Shocked patient
Aortic regurg, coronary ischaemia and cardiac tamponade
Type A and B aortic dissection
Type A - aortic arch and aortic valve proximal to Left subclavian artery- worse prognosis
Type B- involves descending throracic aorta- distal to the left subclavian artery - worse prognosis
Raynaud’s phenomenon- features
consists of spasm of digital arteries- usually precipitated by cold and relieved by heart- affects more women than men
Pallor, cyanosis due to sliugish blood flow, redness secondary to hyperaemia
Management of Raynaud’s
Vasodilators but they cause severe headaches
Sympathectomy or prostacyclin infusion- ILOPROST
Beurger’s disease features
Small vessels of the lower limbs- young men who smoke
Pathological inflammation of the arteries and veins
Presents with severe claudication and rest pain- gangrene
Thrombophlebitis is sometimes present
