Peripheral vascular disease Flashcards
PVD: what is it
significant narrowing of arteries distal to the arch of the aorta, most often due to atherosclerosis.
Risk factors PVD
Smoking.
Diabetes mellitus.
Hypertension.
Hyperlipidaemia: high total cholesterol and low high-density lipoprotein (HDL) cholesterol are independent risk factors.
Physical inactivity.
Obesity.
PVD: symptoms
Walking impairment
Pain in buttocks and thighs relieved at rest
PVD signs
Pale, cold leg
Hair loss
Ulcers
Poorly healing wounds
Weak or absent pulses
PVD: investigations
full cardiovascular risk assessment
- blood pressure, FBC, blood glucose, lipids and electrocardiogram
Ankle-Brachial Pressure Index (ABPI) - doppler probe for find the systolic brachial blood pressures of the arms and comparing them to the ankle blood pressures in the feet
Calculating ABPI
Ankle pressure (on side of interest)/Brachial pressure (on side of interest)
Interpretation of ABPI
More than 1.2: abnormal thickening of vascular walls (think diabetes)
0.9 - 1.2: NORMAL
0.8 - 0.9: Mild disease
0.5 - 0.8: Moderate disease
Less than 0.5: SEVERE DISEASE`
PVD imaging
Duplex arterial ultrasound - can determine the site, severity and length of stenosis (?revasc)
MR arteriogram - used for those who are candidates for revascularisation
CT arteriogram - used in those unsuitable for MR
Digital subtraction angiography - usually performed at the time of intervention or for monitoring disease
Management of the chronically ischaemic leg (non-surgical)
- risk factor modification (see previous RFs)
- inc supervised exercise programme - Managing CV risk
- Antiplatelet therapy: with clopidogrel 75mg once daily (alternative - aspirin)
- Lipid lowering therapy: with atorvastatin 80mg once nightly.
- In diabetics, glycaemic control should be optimised.
- High blood pressure should be managed appropriately - Managing pain - Naftidrofuryl oxalate - vasodilator which can alleviate pain in PVD (only if exercise ineffective and no surgery wanted)
Management of the chronically ischaemic leg (surgical)
1. Intermittent claudication
2. Critical ischaemia
- RF modification introduced and supervised exercise not working –> endovascular revascularisation or surgical revascularisation
- urgently referred to the vascular multidisciplinary team for endovascular revascularisation or surgical revascularisation.
What is critical ischaemia
Where there is rest pain, tissue loss, and ankle artery pressure of <50 mmHg
Endovascular revascularization vs surgical revascularisation
Endovascular methods are recommended for small discrete stenosis.
Surgical bypass is recommended for larger more extensive stenosis.
Indication for amputation
Amputation may be required if there is: critical limb ischaemia unsuitable for other interventions, intractable pain, an unresolving ulcer, or severe loss of function.
Acute limb ischaemia
SURGICAL EMERGENCY, to be corrected asap
severe, symptomatic hypoperfusion of a limb occurring for <2 weeks.
6Ps of acute limb ischaemia
Pulseless
Painful
Pale
Paralysis
Paraesthesia
Perishingly cold
IRL, if motor and sensory function loss –> unsalvageable
