Peripheral vascular disease Flashcards

1
Q

What is peripheral vascular disease?

A

A condition characterised by narrowing, and in final stages occlusion, of the peripheral arteries due to atherosclerotic plaques; most commonly affects the legs

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2
Q

What are the 2 main stages of peripheral vascular disease?

A

Intermittent claudication
Chronic limb threatening ischaemia

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3
Q

What are some risk factors of peripheral vascular disease?

A

Smoking
Diabetes
Hypercholesterolaemia
Hypertension

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4
Q

What is meant by intermittent claudication?

A

This is intermittent muscle ischamia in the lower legs during exercise

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5
Q

How will intermittent claudication usually present?

A

Cramping in the lower legs that comes on when walking, but is relieved by rest

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6
Q

What is chronic limb threatening ischaemia?

A

This occurs when there is insufficient blood reaching the limb to maintain viability

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7
Q

What are some clinical signs of chronic limb threatening ischaemia?

A

Limb cold to touch
No peripheral pulse
Hairless
Thick nails
Shiny skin
Venous guttering
Ulcer
Gangrene

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8
Q

What is meant by venous guttering?

A

Veins will with blood when foot is down but empty when foot is raised as arterial supply cannot move blood back into veins

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9
Q

What causes hairlessness, thick nail and shiny skin in CLTI?

A

Poor tissue nutrition

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10
Q

How might someone with chronic limb threatening ischaemia present?

A

Lower limb pain that still occurs at night
Pain is relieved by reducing metabolic activity of the leg (Placing it on a cold floor)

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11
Q

What are some investigations required in CLTI?

A

Check pulses
ABPI
Duplex ultrasound
MRI / CT angiography / catheter - Digital subtraction angiogram (DSA)

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12
Q

What is ABPI?

A

Ankle Brachial Pressure Index

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13
Q

How do you calculate ABPI?

A

Ankle BP ÷ Brachial BP

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14
Q

What is a normal ABPI value?

A

0.9 - 1.2

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15
Q

What ABPI would suggest claudication?

A

0.5 - 0.85

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16
Q

What ABPI would suggest CLTI?

A

0 - 0.5

17
Q

What condition could give a false normal ABPI value?

A

Calcification of the blood vessels

18
Q

How will ABPI be effected by exercise in a normal person?

A

It will increase

19
Q

How will ABPI be effected by exercise in a person in IC or CLTI?

A

It will drop

20
Q

What peripheral pulses should be checked in suspected peripheral vascular disease?

A

Femoral pulse
Popliteal pulse
Posterior tibialis pulse
Dorsalis pedis pulse

21
Q

What are some lifestyle modification that should be recommended in peripheral vascular disease?

A

Weight loss
Blood pressure control
Diabetes control
Exercise
Smoking cessation

22
Q

What are some pharmacological management options in peripheral vascular disease?

A

Statins
Naftidrofuryl oxalate (Vasodilator) used in patients who do not want surgery
Analgesics

23
Q

What are some surgical options used in peripheral vascular disease?

A

Endovascular angioplasty + Stent
Bypass grafting
Amputation

24
Q

What are the 2 main forms of bypass grafting in peripheral vascular disease?

A

Inflow bypass
Outflow bypass

25
Q

What are the 3 forms of inflow bypass grafting in peripheral vascular disease?

A

Graft from aorta to lower limb
Graft from contralateral lower limb
Graft from ipsilateral arm to lower limb

26
Q

What occurs in outflow bypass grafting?

A

The great saphenous vein is used to bypass the blockage

27
Q

What are the 4 main classes of lower limb amputation?

A

Below Knee Amputation (BKA) - Trans-tibial
Above Knee Amputation (AKA) - Trans-femoral
Through knee amputation
Hip disarticulation - Through hip