Peripheral vascular disease Flashcards
What is peripheral vascular disease?
A condition characterised by narrowing, and in final stages occlusion, of the peripheral arteries due to atherosclerotic plaques; most commonly affects the legs
What are the 2 main stages of peripheral vascular disease?
Intermittent claudication
Chronic limb threatening ischaemia
What are some risk factors of peripheral vascular disease?
Smoking
Diabetes
Hypercholesterolaemia
Hypertension
What is meant by intermittent claudication?
This is intermittent muscle ischamia in the lower legs during exercise
How will intermittent claudication usually present?
Cramping in the lower legs that comes on when walking, but is relieved by rest
What is chronic limb threatening ischaemia?
This occurs when there is insufficient blood reaching the limb to maintain viability
What are some clinical signs of chronic limb threatening ischaemia?
Limb cold to touch
No peripheral pulse
Hairless
Thick nails
Shiny skin
Venous guttering
Ulcer
Gangrene
What is meant by venous guttering?
Veins will with blood when foot is down but empty when foot is raised as arterial supply cannot move blood back into veins
What causes hairlessness, thick nail and shiny skin in CLTI?
Poor tissue nutrition
How might someone with chronic limb threatening ischaemia present?
Lower limb pain that still occurs at night
Pain is relieved by reducing metabolic activity of the leg (Placing it on a cold floor)
What are some investigations required in CLTI?
Check pulses
ABPI
Duplex ultrasound
MRI / CT angiography / catheter - Digital subtraction angiogram (DSA)
What is ABPI?
Ankle Brachial Pressure Index
How do you calculate ABPI?
Ankle BP ÷ Brachial BP
What is a normal ABPI value?
0.9 - 1.2
What ABPI would suggest claudication?
0.5 - 0.85