Peripheral Arterial Disease Flashcards
Causes of peripheral arterial disease.
Atherosclerosis
Emboli
Leriche’s syndrome
Buerger’s disease
Risk factors of chronic lower limb ischaemia.
Smoking
Diabetes
Hypercholesterolaemia
Hypertension
How are clinical features classified in chronic lower limb ischaemia?
Stage I-IV
I - asymptomatic
II - intermittent claudication
III - Rest pain/nocturnal pain
IV - Necrosis/gangrene
Clinical features of chronic lower limb ischaemia (CLLI)
Cramping pain in the calf, thigh or buttock after walking or exertion, then relieved by rest - stage II (intermittent claudication)
If there is rest pain/nocturnal pain there is severe unremitting pain in the foot, preventing the patient from sleeping.
This can be partially relieved by danging the foot over the edge of the bed or standing on a cold floor.
What is Leriche’s syndrome?
Buttock claudication +/- impotence.
It is an aortoiliac occlusive disease
The combination is called Leriche Syndrome
What is Buerger’s disease?
A differential for CLLI also called thromboangiitis obliterans.
It is a non-atherosclerotic smoking related disease causing ischaemia of the lower limbs.
It is usually seen in young heavy smokers.
Signs of CLLI.
Absent femoral, popliteal or foot pulses.
Cold, white legs with atrophic skin changes, loss of hair .
There might be ulcerations that are painful.
The changes might differ due to posture.
Investigations of CLLI.
Exclude DM, arteritis (CRP/ESR).
FBC, U&Es, lipids.
ECG (cardiac ischaemia)
Thrombophilia screen.
Ankle-brachial pressure index (ABPI)
Imaging
Explain Ankle-brachial pressure index (ABPI).
Measurement of the blood flow.
The cuff pressure at which blood flow is detectable by Doppler in posterior tibial or anterior tibial artery.
This is then compared to the same in the brachial artery.
Values of ABPI.
Normal = 1-1.2
CLLI/PAD = 0.5-0.9
Critical limb ischaemia = < 0.5 or ankle systolic pressure < 50 mmHg.
Explain imaging in CLLI.
1st line is Colour duplex ultrasound and colour Doppler.
If intervention is considered a MR/CT angiography is done to assess the extent and location of stenoses as well as quality of distal vessels.
Management of chronic limb ischaemia.
- *Risk modifications** - quit smoking, treat HTN + high cholesterol.
- *Clopidogrel is commonly given as first line.**
Management of claudication;
Supervised exercise programme + vasoactive drugs such as naftidrofuryl oxalate.
Percutaneous transluminal angioplasty - if symptoms are severe and disabling.
Surgical reconstruction - such as bypass.
Amputation
Explain percutaneous transluminal angioplasty.
It is done if the ischaemia is severe and disabling for the patient.
If the disease is limited to a single arterial segment this can be done.
A stent is put into the artery affected by going via the femoral artery.
Explain surgical reconstruction in CLLI.
If the disease is extensive but distal run-off is good the bypass graft can be done.
What is acute limb ischaemia?
A surgical emergency requiring revascularisation within 4-6h to save the limb.
