Peripheral Vascular Disease Flashcards
What is peripheral vascular disease?
a chronic condition due to atherosclerosis of arteries in the limbs. The level of arterial occlusion present is proportional to the symptoms.
How does PVD classically present?
peripheral vascular disease presents as pain in the lower limbs which is brought on by exertion (typically the patient will be able to walk a specific distance before the pain comes on) and the pain is relieved by rest.
What two major arteries does peripheral vascular disease most commonly affect?
- Aorto-iliac artery
- Infra-inguinal artery
What is the epidemiology of PVD?
affects about 10-15%
Give 4 risk factors for chronic limb ischaemia:
1) smoking
2) diabetes
3) hypercholesterolaemia
4) hypertension
What system is used to classify the stages of chronic limb ischaemia?
Fontaine Classification
List and describe the four Fontaine stages of chronic limb ischaemia:
1) stage 1: asymptomatic
2) stage 2: intermittent claudication
3) stage 3: pain at rest
4) stage 4: necrosis/ gangrene
What is claudication?
Pain that occurs in the extremities due to limited blood flow and resultant tissue hypoxia in the leg - exacerbated by exercise
Where is claudication associated with chronic limb ischaemia most commonly experienced?
Calf
List 4 consequences of claudication associated with aorto-iliac disease:
1) pain in buttock
2) pain in hip
3) pain in thigh
4) erectile dysfunction
What is spinal claudication?
y impingement of the caudal equina by a spinal stenosis. This also classically causes pain in the back of the legs on exertion.
What is Beuger’s angle?
the leg will go pale and cold upon raising it 20’ off the couch.
Give 7 signs of chronic limb ischaemia:
1) cold limbs
2) ulceration
3) dry skin
4) increased capillary refill time
5) lack of hair on limbs
6) discolouration
7) diminished/ absent pulses
Give 2 potential differentials for chronic limb ischaemia symptoms:
- popliteal artery entrapment
- peripheral neuropathy
What does ABPI stand for?
ankle brachial pressure index
What is ABPI?
a measurement of the cuff pressure at which blood flow is detectable by Doppler in the posterior tibial or arterial tibial artery compared to pressure in the brachial artery
What does an ABPI less than 0.9 indicate?
some degree of peripheral vascular disease
What disease is associated with an ABPI of less than 0.5?
critical limb ischaemia
Give 3 imaging techniques used to diagnose chronic limb ischaemia:
1) Duplex ultrasound (FIRST LINE)
2) contrast-enhanced MR angiography
3) CT angiography
Give 3 management techniques for chronic limb ischaemia:
- Risk factor management e.g. statins, antiplatelets, diet
- exercise plan
- consider giving naftidrofuryl oxalate
Describe how naftidrofuryl oxalate can treat chronic limb ischaemia:
it is a vasodilator that inhibits the 5-HT2 receptors and can reduce lactic acid levels
Name 3 potential surgical interventions for critical limb ischaemia:
- angioplasty and stenting
- Bypass surgery
- Amputation
When is amputation considered?
if the ischaemia is severe with unreconstructible arterial disease
What is critical limb ischaemia?
the end stage of peripheral artery disease where there is an inadequate supply of blood to the limb to allow it to function at rest
How does critical limb ischaemia present? (3)
- Gangrene
- non-healing ulcers
- pain at rest
Give the 6ps of acute limb ischaemia:
1) pain
2) pallor
3) pulseless
4) paralysis
5) paraesthesia (pins and needles)
6) perishingly cold
Give the two main causes of acute limb ischaemia:
1) thrombosis
2) emboli
What is the most common form of investigation for acute limb ischaemia?
Duplex ultrasound
Give 5 potential surgical interventions for acute limb ischaemia:
1) endovascular thrombolysis
2) surgical thrombectomy
3) endarterectomy
4) bypass surgery
5) amputation
What is surgical thrombectomy?
cutting open the affected vessels and removing the thrombus
What is endarterectomy?
surgical removal of fatty deposits
Give the two steps of Buerger’s Test:
1) have patient lie on their back and lift their legs to an angle of 45 degrees at the hip and hold them there for 1-2 mins, looking for pallor
2) sit the patient up with their legs hanging over the side of the bed so blood will flow back into the legs - in PAD, the limb will initially turn BLUE followed by DARK RED due to vasodilation
What is Buerger’s disease?
Occlusion of the small vessels of the hands and feet seen in young men who smoke and can lead to gangrene and amputation
What is Leriche syndrome?
a clinical triad caused by occlusion in the distal aorta or proximal common iliac artery
1) thigh/ buttock claudication
2) absent femoral pulse
3) erectile dysfunction
What is the most common form of investigation for acute limb ischaemia?
Duplex ultrasound
What is endovascular thrombolysis?
inserting a catheter through the arterial system to apply thrombolysis directly into the clot
