Peripheral Vascular Disease Flashcards
What is PAD?
Narrowing of the arteries supplying the limbs and periphery, reducing the blood supply to these areas
List 3 presentations of PAD
- intermittent claudication
- critical limb ischaemia
- acute limb-threatening ischaemia
List 3 consequences of artheroscerotic plaque formation in arteries
- Stiffening, leading to hypertension and strain on the heart
- Stenosis, leading to reduced blood flow (ie. in angina)
- Rupture, resulting in a thrombus that can block a vessel and cause ischaemia (ie. ACS)
List 2 non-modifiable risk factors for Atherosclerosis
- Older age
- Family history
- Male
List 4 modifiable risk factors for Atherosclerosis
- Smoking
- Alcohol consumption
- Poor diet
- Low exercise / sedentary lifestyle
- Obesity
- Poor sleep
- Stress
List 2 Medical Co-Morbidities which increase risk of atherosclerosis
- Diabetes
- Hypertension
- Chronic kidney disease
- RA
- Atypical antipsychotic medications
What is Leriche Syndrome?
What is the classic triad?
Occlusion in the distal aorta or proximal common iliac artery
- Thigh/buttock claudication
- Absent femoral pulses
- Male impotence
What is Buerger’s Test?
First part
- Patient lying on back, leg lifted to 45 degrees at the hip for 1-2 minutes
- Pallor indicates PAD
- Buerger’s angle is the angle at which the leg becomes pale
Second part
- Patient sat up with legs hanging over side of the bed, blood flows back
- Normally legs will remain a pink colour
- In PAD they will go: Blue initially then Dark red after a short time
List 4 features of an arterial ulcer
- Smaller and Deeper than venous ulcers
- Well defined borders
- “punched-out” appearance
- Peripherally located (ie. on the toes)
- Reduced bleeding
- Painful
List 4 features of an venous ulcer
- Hx minor injury to leg
- Larger and more superficial than arterial ulcers
- Irregular, gently sloping borders
- Affect gaiter area (mid-calf down to the ankle)
- Less painful than arterial ulcers
- Occur with other signs of chronic venous insufficiency (eg. haemosiderin staining and venous eczema)
List 3 investigations for PAD
- Duplex ultrasound
- Ankle-brachial pressure index (ABPI)
- Angiography (CT or MRI)
Features of intermittent claudication?
- Aching or burning in leg muscles following walking
- Can typically walk for a predictable distance before symptom onset
- Relieved within minutes of stopping
- Not present at rest
Assessment of Intermittent Claudication
- Check femoral, popliteal, posterior tibialis and dorsalis pedis pulses
- Check ABPI
- Duplex ultrasound (first line investigation)
- Magnetic resonance angiography (MRA) prior to any intervention
Interpret the various values of a duplex ultrasound
Management of intermittent claudication?
- Lifestyle changes and exercise training
- Atorvastatin, Clopidogrel, Naftidrofuryl oxalate
- Surgical: angioplasty, stenting, bypass surgery
What is acute limb ischaemia?
Rapid onset of ischaemia in a limb, typically due to a thrombus
Features of acute limb ischemia
1 or more of the 6 P’s
- pale
- pulseless
- painful
- paralysed
- paraesthetic
- ‘perishing with cold’
Initial investigations for acute limb-threatening ischaemia?
- handheld arterial Doppler examination
- If Doppler signals are present, an ABPI should also be obtained
Initial management for acute limb-threatening ischaemia?
- ABCE
- analgesia: IV opioids
- IV unfractionated heparin to prevent thrombus propagation
- vascular review
Definitive management for acute limb-threatening ischaemia?
- intra-arterial thrombolysis
- surgical embolectomy
- angioplasty
- bypass surgery
- amputation: for irreversible ischaemia
What is Critical limb ischaemia?
End-stage of PAD which causes pain at rest, non-healing ulcers and gangrene
Typically causes a burning pain, worse at night when the leg is raised
Features of Critical limb ischemia?
1 or more of:
- rest pain in foot for more than 2 weeks
- ulceration
- gangrene
Patients often report hanging their legs out of bed at night to ease the pain
Management of PAD
- Atorvastatin 80 mg
- Clopidogrel 75mg
- Exercise training
- Surgery for severe cases: angioplasty, stenting, bypass surgery
- Amputation for cirital limb ischemia who are not suitable for other interventions
List another drug licensed for use in PAD
Naftidrofuryl oxalate: vasodilator
