Peripheral vascular disease Flashcards
What are some ways in which peripheral vascular disease can be secondarily prevented?
Weight loss
Blood pressure control
Diabetes mellitus control
Exercise
Smoking
Anti-platelet and statin therapy
What is meant by intermittent claudication?
Intermittent cramping and pain in the lower legs upon walking (Muscle ischaemia on walking)
What are some common presentations of intermittent claudication?
Pain on walking
Mo pain at night
Pain quickly relieved at rest
What are the advantages of treating intermittent claudication?
Though it will not prevent limb loss, it can improve quality of life (IC poses no threat to limbs)
What occurs in Chronic Limb Threatening Ischaemia (CLTI)?
This occurs when there is insufficient blood reaching a limb or part of a limb to maintain limb viability
What are some signs of Chronic Limb Threatening Ischaemia (CLTI) upon clinical examination?
Foot is cold to the touch
Absence of peripheral pulses
Colour change
Hairless
Thick nails
Shiny skin
Venous guttering (Vein filled when foot is down and empty when foot is raised)
Ulcers
Gangrene
What are some forms of investigation for Chronic Limb Threatening Ischaemia?
Pulses
ABPI - Ankle Brachial Pulse Index
Duplex ultrasound
Berger’s test
Angiography
How is the ABPI (Ankle Brachial Pulse Index) calculated?
When the patient is at rest, their ankle and brachial systolic blood pressures are found
ABPI is then calculated using the formula:
ABPI = Ankle pressure ÷ Brachial pressure
What would a normal ABPI be?
0.9 to 1.2
What would a patient with claudication’s ABPI be?
0.5 - 0.85
What would a patient with CLTI’s ABPI be?
0-0.5
What could provide a falsely high ABPI?
Calcification of the blood vessels as this exerts a false outwards high pressure
How would ABPI be effected during exercise in a normal patient?
ABPI would rise
How would ABPI be effacted during exercise in a patient with IC or CLTI?
ABPI would drop
What is involved in a duplex scan?
The use of both ultrasound and doppler testing
What does the doppler test show?
It allows you to hear the velocity of blood flow through vessels
What are the 3 types of angiography used in diagnosis of Peripheral vascular disease?
MRI angiography
CT angiography
Catheter angiography
What are some treatment options of IC and CLTI?
Endovascular angioplasty with stent
Inflow bypass
Outflow bypass
Amputation
What is involved in an inflow bypass?
A bypass is performed from either the aorta, collateral lower limb or arm to the lower limb
What is involved in an outflow bypass?
The great saphenous vein is used tp bypass the occlusion
What are the 4 main types of amputation?
Transtibial - BKA - Below Knee Amputation
Transfemoral - AKA - Above Knee Amputation
Through Knee
Hip Disarticulation - Through Hip
What are the lower limb arteries
Abdominal aorta => Internal/External iliac
External iliac => common femoral
Common femoral => Deep/superifical femoral
Superficial femoral => popliteal
popliteal => Anterior/Posterior tibial & peroneal
Posterior tibial => Dorsalis pedis
