Peripheral vascular disease Flashcards
What is intermittent claudication
Pain or discomfort in legs during activity that subsides with rest
What can confirm PAD
ABPI and US duplex
Presenting features of PAD with intermittent claudication
Pain - cramp or burn
Location - calf muscles. can occur anywhere in leg
Duration - lasts a few minutes and go with rest - worsens over time
Distance - claudication distance
Numb, tingle or wekaness also
How can measure PAD severity
Claudication distance
Commorbidities with PAD
Strong link with smoking
hypertension
diabetes mellitus
obesity
Management of PAD
Clopidogrel first line
Statin
Exercise training
Management of severe PAD or critical limb ischaemia
endovascular revascularization
surgical revascularization
endovascular revascularization options
percutaenous transluminal angioplasty +/- stent placement
surgical revascularization options
surgical bypass with an autologous vein or prosthetic material
endarterectomy
when use endovascular vs surgical vascularisation
endovascular - short segment stenosis (e.g. < 10 cm), aortic iliac disease and high-risk patients
open surgical - long segment lesions (> 10 cm), multifocal lesions, lesions of the common femoral artery and purely infrapopliteal disease
Amputation when done in PAD
patients with critical limb ischaemia who are not suitable for other interventions such as angioplasty of bypass surgery.
Drugs licensed in PAD
Naftidrofuryl oxalate (QOL)
Colostazol - PDE3 inhibitor (not recommended by NICE)
What is critical limb ischaemia characterised by
chronic ischemic rest pain, non-healing wounds, and gangrene.
What is acute limb threatening ischaemia characterised by
Sudden onset of pain, pallor, pulselessness and paralysis in the affectee limb
Management of acute limb threatening ischaemia
thrombolysis, angioplasty, or surgical bypass.
Pain management
6 Ps of acute limb ischaemia
pale
pulseless
painful
paralysed
paraesthetic
‘perishing with cold’
What causes PAD
Atheromatous plaquws
Stiffening of the artery walls, leading to hypertension (raised blood pressure) and strain on the heart (whilst trying to pump blood against increased resistance)
Stenosis, leading to reduced blood flow (e.g., in angina)
Plaque rupture, resulting in a thrombus that can block a distal vessel and cause ischaemia (e.g., in acute coronary syndrome)
Risk facotrs
Non-modifiable risk factors:
Older age
Family history
Male
Modifiable risk factors:
Smoking
Alcohol consumption
Poor diet (high in sugar and trans-fat and low in fruit, vegetables and omega 3s)
Low exercise / sedentary lifestyle
Obesity
Poor sleep
Stress
Atherscleroiss other manifestations
Angina
Myocardial infarction
Transient ischaemic attack
Stroke
Peripheral arterial disease
Chronic mesenteric ischaemia
What is leriche syndrome and triad
Occlusion in distal aorta or proximal common iliac artery
Thigh/buttock claudication
Absent femoral pulses
Male impotence
Signs of PAD
Skin pallor
Cyanosis
Dependent rubor (a deep red colour when the limb is lower than the rest of the body)
Muscle wasting
Hair loss
Ulcers
Poor wound healing
Gangrene (breakdown of skin and a dark red/black change in colouration)
On examination, there may be:
Reduced skin temperature
Reduce sensation
Prolonged capillary refill time (more than 2 seconds)
Changes during Buerger’s test
What is buergers test
Patient lying lift legs to 45 degree angle for 1-2 mins
Look for pallor
Buergers angle = angle where legs go pale
Part 2 - hang legs off bed
INitially blue as ischaemic tissue deoxygenates blood then dark red - vasodilation due to anaerobic respiration products
What is rubour
Dark red colour in PAD legs
What treatment is contraindicated in PAD
Compression stockings
