Peripheral vascular disease

Question 1

how do we interpret findings in ABPI measurement?

Answer 1

> 0.9 = normal
0.9 - 0.6 = Mild PVD
0.6 - 0.3 = mod-severe PVD
<0.3 = Critical PVD - risk of losing limbs/digits

Question 2

how does peripheral venous disease present?

Answer 2

Pulses present
Legs warm
Irregularly outline ulcers
Shallow ulcers - lots of exudate

Ulcers located commonly in the inner ankle or ‘gaiter’ region
Minimal pain in leg - if any, dull
Skin discolouration - haemosiderin deposits
thickened toe nails

Question 3

risk factors for venous ulcers?

Answer 3

Previous deep venous thrombosis (DVT) (a blood clot in the deep veins)
Obesity
Lower limb fracture, surgery or injury
Immobility
High blood pressure

Uncontrolled diabetes
Smoking
Multiple previous pregnancies
Varicose veins.

Question 4

most common PVDs?

Answer 4

Venous ulcers account for at least 40–50% of chronic lower limb ulcers and contribute to a further 20% of mixed arterial and venous ulcers.

Question 5

IVX for venous ulcers?

Answer 5

Duplex USS

Concomitant arterial disease is identified using the ankle-brachial index (ABI)

Question 6

treatment of venous ulcers?

Answer 6

Elevate the leg - to improve venous return

Compression;

1. Compression (eg, four-layer elastic bandaging) helps heal stasis ulcers, limits leg swelling and provides symptomatic relief.
2. Compression stockings are less effective in the treatment of established ulcers but are useful for wound prevention.
3. Debridement is used to remove dead tissue along the borders of the wound and excessive slough from the wound bed.
4. Superficial vein ablation

General;
Keep exercising and moving. Lose weight

Resistant ulcer:

1. Hyperbaric o2 therapy
2. Meds that cause venous coconstriction

Question 7

complications of venous ulcers?

Answer 7

Venous eczema - rx with steroids

Wound infection/cellulitis

Question 8

presentation of arterial ulcers / PAD?

Answer 8

Diminished/Absent pulses
cold feet
well demarcated round punched out ulcers
sharp calf pain - intermittent claudication

Buttock or thigh pain relieved by rest - as progresses, rest doesn’t help

Question 9

Complications of PAD?

Answer 9

Necrosis/gangrene of toes or part of foot - indicative of critical ischaemia

Acute limb ischaemia: 6Ps

Permanent pain and numbness

Question 10

sx of acute limb ischaemia?

Answer 10

pain, paralysis, paraesthesias, pulselessness, perishingly cold, and pallor.

Question 11

IVx for PAD?

Answer 11

ABPI

Question 12

Rx for acute limb ischaemia and critical limb iscahemia?

Answer 12

Surgical:
1. Revascularisation; eg stent
Or Amputation

Pharma:
1. Aspirin/Clopi + iv U Heparin + Morphine

Note; Though mx is similar for the 2, ALI is done more urgently because is acute rather than chronic!

Question 13

rx for intermittent claudication?

Answer 13

Lifestyle limitiing:

1. Aspirin/Clopi
2. Supervised Exercise programme
3. Symptom relief; Naftidrofuryl oxalate - if exercise not helping & doesnt want step

Not Lifestyle limitiing:

1. Supervised Exercise programme
2. Refer for angioplasty/bypass

Question 14

what are the classes of PVD?

Answer 14

Peripheral vascular disease can be either;

1. Occlusive (e.g. intermittent claudication) in which occlusion of the peripheral arteries is caused by atherosclerosis, or
2. Vasospastic (e.g. Raynaud’s phenomenon)

Question 15

Mx of Reynauds?

Answer 15

1. Avoidance of exposure to cold AND smoking cessation
2. Nifedipine:
   • If lifestyle modifications fail and symptoms are having a significant negative impact, a trial of nifedipine