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
What ABPI would suggest CLTI?
0 - 0.5
What condition could give a false normal ABPI value?
Calcification of the blood vessels
How will ABPI be effected by exercise in a normal person?
It will increase
How will ABPI be effected by exercise in a person in IC or CLTI?
It will drop
What peripheral pulses should be checked in suspected peripheral vascular disease?
Femoral pulse
Popliteal pulse
Posterior tibialis pulse
Dorsalis pedis pulse
What are some lifestyle modification that should be recommended in peripheral vascular disease?
Weight loss
Blood pressure control
Diabetes control
Exercise
Smoking cessation
What are some pharmacological management options in peripheral vascular disease?
Statins
Naftidrofuryl oxalate (Vasodilator) used in patients who do not want surgery
Analgesics
What are some surgical options used in peripheral vascular disease?
Endovascular angioplasty + Stent
Bypass grafting
Amputation
What are the 2 main forms of bypass grafting in peripheral vascular disease?
Inflow bypass
Outflow bypass
What are the 3 forms of inflow bypass grafting in peripheral vascular disease?
Graft from aorta to lower limb
Graft from contralateral lower limb
Graft from ipsilateral arm to lower limb
What occurs in outflow bypass grafting?
The great saphenous vein is used to bypass the blockage
What are the 4 main classes of lower limb amputation?
Below Knee Amputation (BKA) - Trans-tibial
Above Knee Amputation (AKA) - Trans-femoral
Through knee amputation
Hip disarticulation - Through hip
