Peripheral Vascular Disease Flashcards
What are the 3 presentations of PVD
Intermittent claudication
Critical limb ischaemia
Acute limb ischaemia
What is the main cause underlying PVD
Atherosclerosis
What are the risk factors for PVD
- Male
- Increasing age
- Smoking
- HTN
- Diabetes
What is the presentation of intermittent claudication
Aching and cramping in the legs when walking - typically relieved by rest, not present at rest
How do we investigate intermittent claudication
Duplex USS = first line investigation
Check for weak pulses in leg
ABPI = diagnostic
What ABPI reading can be used for PVD diagnosis
< 0.9 = PVD 1 is normal
How does critical limb ischaemia present
- Foot pain at rest
- Gangrene/ ulceration (arterial ulcers)
- Muscle atrophy
- Dependent rubor - pallor if lifted
- Loss of hair, especially dorsum of foot
- Thick toenails
- Scaly skin
- Patient may have to sleep in a chair or hang legs off end of bed at night due to pain at night
What is the ABPI of critical limb ischaemia
< 0.5
What is Leriche syndrome
Occlusion in distal aorta or proximal iliac artery causing ED, intermittent claudication, and diminished femoral pulses
How does acute limb ischaemia present
- Pain
- Pallor
- Pulselessness
- Parasthaesia
- Paralysis
- Perishingly cold
Acute onset - do a doppler US first line
How do we manage acute limb ischaemia
- ABCDE
- IV opioids
- IV unfractioned heparin
- Embolectomy/bypass surgery if viable tissue
- Amputation if extensive tissue death
How are all patients of PVD managed
- All patients should stop smoking
- All patients should receive a statin + clopidogrel
- All patients should have an exercise regimen
How do we manage critical limb ischaemia
Revascularisation - can be done with endovascular (angioplasty + stent) or surgical (bypass) - depending on length of lesion and morbidity of patient
When do we amputate in PVD
- Acute limb ischaemia if there is necrosis - assess with tissue viability nurse
- Critical limb ischaemia when patient is not eligible for revascularisation
