Peripheral Artery Disease Flashcards
What are the risk factors for peripheral artery disease?
Smoking Diabetes Hypertension Age Hyperlipidaemia History of coronary artery disease / cerebrovascular disease Low levels of exercise
What is the most common aetiology of peripheral vascular disease?
Atherosclerosis
Atherosclerosis is the most common cause of peripheral vascular disease. Give examples of some rarer causes of PAD?
Aortic coarctation Arterial fibrodysplasia Arterial tumour Arterial dissection Arterial embolism Thrombosis Vasospasm Trauma
Describe the American cardiology society classification of peripheral artery. disease?
Asymptomatic
Claudication - inadequate blood flow during exercise causing fatigue, discomfort or pain
Critical limb ischaemia - compromise of blood flow to extremity causing limb pain at rest
Acute limb ischaemia - a sudden decrease in limb perfusion that threatens limb viability
What is the main diagnostic test for peripheral artery disease?
Ankle brachial index
Other than ankle brachial index, what diagnostic tests can be used in peripheral artery disease?
Segmental pressure examination Duplex ultrasound Pulse volume recording Continuous wave doppler ultrasound Exercise ABI Angiography
What are the signs and symptoms of peripheral artery disease?
Calf or foot cramping with walking that is relieved with rest
Thigh or buttock pain with walking that is relieved with rest
Erectile dysfunction
Pain worse in one leg
Diminished pulse
What are the signs and symptoms of critical limb ischaemia?
Leg pain at rest Gangrene Non-healing wound / foot ulcer Muscle atrophy Dependent rubor Pallor when the leg is elevated Loss of hair over the dorsum of the foot Thickened toenails Shiny / scaly skin
What are 6 Ps which are the signs of acute limb ischaemia?
Pain Paralysis Paraesthesia Pulselessness Perishingly cold Pallor
How is the ankle brachial reflex measured?
Measure the systolic pressure of the left and right brachial arteries and the left and right posterior tibial and dorsals pedis arteries pressure
ABI is the highest of the dorsals pedis and posterior tibial arteries pressure divided by the higher of the left and right arm brachial artery pulse pressure
All patients with peripheral artery disease require aggressive risk factor modification. What does this entail?
Control of blood pressure <130/80 Lipid control LDL <2.59 mol/l Smoking cessation Diabetes control Antiplatelet therapy.
Once the diagnosis is established, patients should be started on what drug for systemic anticoagulation?
Heparin
What drug(s) should be used for analgesia in the management of acute limb ischaemia?
Paracetamol and an opioid
What is the definitive management for patients with a non-viable limb with acute limb. ischaemia?
Amputation
Patients with. acute limb ischaemia with a viable limb should undergo revascularisation. What techniques can be used for revascularisation?
Percutaneous catheter directed thrombolysis therapy
Percutaneous mechanical thrombus extraction
Thrombo-aspiration
Surgical thrombectomy
Bypass
Arterial repair
