peripheral vascular disease Flashcards
what is most commonly affected with peripheral vascular disease
legs
what are the 4 stages of chronic limb ischaemia
Stage I - asymptomatic
Stage II – intermittent claudication
Stage III – rest pain/nocturnal pain
Stage IV – necrosis/gangrene
risk factors for pvd
same as atherosclerosis
Smoking
Diabetes
Dyslipidaemia
HTN
what causes pvd
Blockage – atherosclerosis
`
which artery is affected if pain is in hip or buttocks
aorta or iliac arteries
which artery is affected if pain is in thigh
common femoral artery
which artery is affected if pain is in upper 2/3rd of calf
superior femoral artery
which artery is affected if pain is in lower 1/3rd of calf
popliteal artery
which artery is affected if pain is in foot
tibial or peroneal artery
what is Intermittent Claudication
nerve pain caused by release of adenosine in response to muscle ischaemia
symptoms of pvd
Cramping pain in calves, thighs and buttocks when walking
Pain relieved by rest
signs of pvd
- Absent pulses
- Punched out ulcers
- Postural colour change (Buerger’s Test) – foot turns white when elevated, red when lowered
- 6 P’s of limb ischaemia
what are the 6 P’s of limb ischaemia
Pain
Pallor
Pulseless
Perishing cold
Paraesthesia
Paralysis
how to carry out Buergers test
- keep patient supine
- elevate both legs to an angle of 45 degrees and hold for one to two minutes.
- Observe colour of the feet.
- Pallor indicates ischaemia. - sit the patient up and ask them to hang their legs down over the side of the bed at an angle of 90 degrees.
when does pallor occur
it occurs when the peripheral arterial pressure is inadequate to overcome the effects of gravity.
.
impact of poor arterial supply on pale legs
The poorer the arterial supply, the less the angle to which the legs have to be raised for them to become pale
impact of gravity on blood flow
Gravity aids blood flow and colour returns in the ischaemic leg.
The skin at first becomes blue, as blood is deoxygenated in its passage through the ischaemic tissue, and then red, due to reactive hyperaemia from post-hypoxic vasodilatation.
what are investgations used to exclude
to exclude
- DM
- arteritis
- anaemia
- renal disease
- lipids
what investgations for pvd
- Ankle Brachial Pressure Index (ABPI)
- Colour Duplex USS
- MRI/CT angiography
- Bloods
- Auscultation
how does ankle brachial pressure change with pvd
Normal is 1-1.2
Peripheral Arterial Disease is 0.5-0.9
describe colour duplex USS
Quick and non-invasive
Can show vessels and blood flow within them
What are MRI and CT angiography used for
to identify stenosis and quality of vessels
how are bloods used for pvd
raised CK-MM shows muscle damage
management of pvd
risk factor modiciaton
medications
excercise programmes
Percutaneous transluminal angioplasty or surgery
