Peripheral Vascular Disease Flashcards
When does PVD occur
When there is a narrowing of distal arteries normally caused by atherosclerosis
What are the risk factors for PVD
>55 Smoking Diabetes Mellitus HTN Hyperlipideamia Sedentary life Obesity
What are the symptoms of PVD
Butt pain relieved with rest (intermittent claudication)
High limb pain esp. foot @night (severe claudication)
What are the signs of PVD
ABPI <0.9 /Weak leg pulse
Skin change = cool/ ulcer and colour change
Bruits
Positive Buerger test (Pallor then reactive hyperaemia )
6 Ps in Critical limb ischemia
CT Angiogram (Invase so use ABPI)
What causes PVD
Atherosclerosis
Embolus
Vasospasm
What would you check for in a cardiovascular risk assessment
Blood Pressure FBC Blood Glucose Lipids ECG
What first line investigation would you do for PVD
ABPI (compare systolic brachial pressure against ankle with doppler probe)
<0.5 = severe
>1.2 = diabetes
What are the follow up investigations after ABPI
Duplex Ultrasound (find site, severity and length) Auscultation = Whoosh at iliac arteries CT Angiogram
What is the non medical management of PVD
Smoking cessation and weight control
What is the medical management of PVD
Clopidogrel (Anti-platelet)
Atorvastatin (lipid lower)
Gylcaemic control
BP control
What is the surgical intervention for PVD
EVAR
Surgical Bypass
Amputation
What is the gold standard investigation for PAD/PVD
Coronary Angiogram
-Use ABPI as less invasive
What is the pathology for Intermittent claudication
Partial lumen occlusion by atherosclerosis causing pain on exertion
What is the pathology of critical limb ischemia
Major lumen occlusion causing insufficient blood supply causing pain at rest
-Risk of gangrene and infection
What is the difference of pain exertion between Intermittent claudication and critical limb ischemia
IC = Pain on exertion CLI = Pain at rest
What is the main complication of Peripheral vascular disease
Acute limb schema
-Total vessel occlusion by thrombosis at the site of critical limb ischemia lesion
What are the 6 Presentation Ps of Acute limb ischema
Pulseless Pain Pallor Perishing Cold Paralysis Parasthesia
What is the physiology of BV occlusion to a region
<6hs = Irreversible nerve damage 6-10hrs = Irreversible muscle damage Last = Gangrenous/Infective skin change
What is the beurger test
Raise leg 45 degrees for 1 minute
Skin change = Pallor to hyperaemia
What is the Fontaine Classification of PVD
1=Asymptomatic
2=Intermittent claudication
3=Chronic limb ischemia
4=Ulcers and gangre
In the Fontaine Classification what can intermittent claudication be split into
2a = 200m pain free walking 2b = <200m
What is the ABPI and its results
Compare Blood between tibial and brachial aretery w/ Doppler ultrasound
0.5-0.9 = Intermitten claudication
<0.5 = Critical limb ischemia
Absent = Acute limb Ischemia
How is Intermittent claudication managed
RF Managaement
How is critical and Acute limb Ischemia managed
PCI or Amputation
