Peripheral Artery Disease Flashcards
What is PAD?
Narrowing of arteries –> reduced blood supply to limbs
What are the risk factors of PAD? (9 things)
- Age
- FHx
- Male
- Smoking / Alcohol
- Poor diet
- Low exercise / sedentary
- Obesity
- Poor sleep
- Stress
What is the pathophysiology of PAD? (5 steps)
- Atherosclerosis
- Plaques
- Stiffening of walls + Stenosis
- Plaque rupture
- Reduced blood supply
- Ischaemia
- Necrosis
How do PAD patients present? (5 things)
- Asymptomatic (25%)
- Intermittent Claudication
- Limb numbness / weakness
- Impotence
- Critical Limb Ischaemia Symptoms (end stage PAD)
What are the findings @ examination of PAD? (7 things)
- Poorly healing wounds
- Ulcers / gangrene
- Discolouration (pale + cyanosis)
- Weak / absent pulse
- Reduced BP in affected limb
- Loss of hair follicles / sweat glands (severe disease)
- Smooth + shiny skin (sever disease)
What is Intermittent Claudication a symptom of?
Commonest symptom of PAD
How would you describe Intermittent Claudication pain?
Crampy achy pain in calf / thigh / buttock
What is Intermittent Claudication associated with?
Assoc w muscle fatigue after walking certain distance
When does Intermittent Claudication occur and when is it relieved?
Occurs @ exertion
Relieved by rest
What does Critical limb ischaemia suggest about PAD?
End stage PAD
What is Criticial limb ischaemia?
Inadequate blood supply to limb to function @ rest
What are the features of Critical limb ischaemia? (6 P’s)
- Pain
- Pallor
- Pulseless
- Paralysis
- Paraesthesia (pins and needles)
- Perishingly cold
What is the pain like in Critical Limb ischaemia?
- Burning
2. Worse @ night (bc leg raised so gravity not pulling blood to foot)
What is Leriche Syndrome?
A subtype of PAD
What artery occlusion causes Leriche Syndrome?
Distal aorta / Prox. Common Iliac Artery
What is the clinical triad of symptoms for Leriche Syndrome? (3 things)
- Thigh / buttock claudication
- Absent femoral pulses
- Male impotence
What investigations should you do for sus PAD? (3 things)
- Ankle-brachial pressure index (ABPI)
- Duplex US
- Angiography (CT / MRI)
What is ABPI a ratio of?
Systolic BP of ankle compared with Systolic BP of arm
What do the different results of an ABPI indicate? (5 classifications)
1.3+ = Calcification of arteries
0.9 – 1.3 = normal
0.6 – 0.9 = Mild PAD
0.3 – 0.6 = Moderate – Severe PAD
Less than 0.3 = Severe PAD – Critical Limb Ischaemia
What does a Duplex US show?
Speed + volume of blood flow
What does Angiography show?
Uses contrast to highlight arterial circulation
What are the CONSERVATIVE management options for Intermittent Claudication? (3 things)
- X Smoking
- Exercise training
- Better treatment of co-morbs (e.g DM / HTN)
What are the MEDICAL management options for Intermittent Claudication? (3 things)
- Atorvastatin (80mg)
- Clopidogrel (75mg once daily)
- Naftidrofuryl oxalate (peripheral vasodilator)
What are the SURGICAL management options for Intermittent Claudication? (3 things)
- Endovascular angioplasty + Stenting
- Endarterectomy
- Bypass surgery
What is Endovascular angioplasty + Stenting? (3 steps)
- Insert catheter thru arterial system w XR guidance
- Inflate balloon @ stenosis site –> dilates lumen
- Insert stent
What is Endarterectomy?
Cutting vessel open + removing atheromatous plaque
What is Bypass surgery?
Using a graft to bypass the blockage
What are the management options for Critical Limb Ischaemia? (4 things)
- Endovascular angioplasty + Stenting
- Endarterectomy
- Bypass surgery
- Amputation (if not possible to revasc)
What are the management options for Acute Limb Ischaemia? (6 things)
- Endovascular thrombolysis
- Endovascular thrombectomy
- Surgical thrombectomy
- Endarterectomy
- Bypass surgery
- Amputation
What is Endovascular thrombolysis?
Inserting a catheter thru arterial system to directly thrombolyse clot
What is Endovascular thrombectomy?
Inserting a catheter thru arterial system to remove thrombus by aspiration / mechanical devices
What is Surgical thrombectomy?
Cutting open a vessel + removing thrombus
What are the complications of PAD? (3 things)
- MI
- Stroke
- Death
