Peripheral vascular/arterial disease Flashcards
What is PVD
stenosis of arteries –> reduced blood supply to limbs
Who gets its and how common is it
10% prevalence
+50yrs
What are the causes
ATHEROSCLEROSIS
- Rarely = vasculitis, popliteal entrapment, trauma
ACUTE LIMB ISCHAEMIA
- Thrombosis
- Cardiac embolism
- Aortic dissection
- Aneurysm
- Hypercoagulable state
What are some risk factors for PVD
- Smoking, HTN, obesity, DM, hyperlipidaemia
- Ass conditions –> CAD, CCVD, renal artery stenosis, DM
What are the symptoms of intermittent claudication
- Cramping leg pain
- Calf = femoral, buttock = iliac
- Worsened by walking, relived by rest
What are the symptoms of critical ischaemia + some complications
- Ischaemic rest pain (relieved by swinging foot over bed)
- Ulceration
- Gangrene
What are the 6Ps of acute limb ischaemia
Pallor Pulseless Paraesthesia Paralysis Painful Perishingly Cold
What are the signs of PVD
- Absent pulses (femoral, popliteal, foot)
- Hair loss
- Pale white leg
- Punched out ulcer
- Atrophic skin
- Postural colour change
What are the signs of critical limb ischaemia
- Cap refill time >15secs
- Vascular/Beurgers angle <20deg
What are some DDx
- diabetic neuropathy
- Vasculitis
- DVT
- Arteritis
- Entrapment syndrome
- muscle/tendon injury
- spinal stenosis
- sciatica
What investigations do you perform
BLOODS
- FBC (anaemia polycythaemia)
- ESR/CRP (DM, arteritis)
- U+E (renal disease)
- Lipid
ABPI
- <0.5 = critical limb, 0.5-0.9 = PAD, 1-1.2 = normal
If <50yrs do thrombophilia + serum homocysteine
What is the treatment for PVD
NON-PHARM
- cessation of smoking, exercise, diet
PHARM
- ACEi, statins, antiplatelets (aspirin, CLOPIDOGREL - 1ts line)
- peripheral vasodilation
SURGERY
- Percutaneous transluminal angioplasty (PTA)
- Surgical reconstruction
- Amputation
- Fem-pop bypass, fem-fem crossover
