Peripheral Vascular Disease

Question 1

What is PVD?

Answer 1

Partial blockage of leg/peripheral vessels by an atherosclerotic plaque and/or resulting in thrombus –> insufficient perfusion of lower limb –> lower limb ischaemia

Question 2

What is intermittent claudication?

Answer 2

• Cramping pain induced by exercise and relieved by rest
• pain is distal to site of atheroma
• pain is a result of lactic acid buildup
• caused by inadequate blood supply to affected muscles, resulting in moderate ischaemia, caused by atheroma of leg arteries
• tissue is NOT dying

Question 3

What is acute limb ischaemia (6Ps)

Answer 3

Pale, pulseless, painful, paralysed, paraesthesia, perishing cold

• sudden decrease in limb perfusion that threatens viability of limb
• complete or even partial occlusion of arterial supply –> rapid ischaemia –> poor functional outcomes within hours

Question 4

What is critical limb ischaemia?

Answer 4

• blood supply is barely adequate to allow basal metabolism
• rest pain, typically nocturnal
• risk of gangrene/infection
• chronic condition, most severe manifestation of PVD
• tissue is DYING at rest

Question 5

Sx and signs of PVD

Answer 5

cold, white legs
absent femoral, popiteal pulses

6Ps: pale, pulseless, paralysed, paraesthesia, painful, perishingly cold

Question 6

Ix for PVD

Answer 6

Colour duplex US: first line, diagnostic

FBC: exclude anaemia, polycythaemia

ECG: exclude cardiac ischaemia

Severity of disease: ABPI**

Question 7

Tx for PVD

Answer 7

Treat RFs: stop smoking, tx HTN, hyperlipidaemia, DM, weight loss

1. antiplatelet to prevenet progression: clopidogrel

Revascularisation: percutaneous transluminal angioplasty, bypass, amputate if severe

Revascularise within 4-6h to save limb