Peripheral Vascular disease Flashcards
What are the symptoms of peripheral vascular disease?
1) Intermittent claudication
2) Worsening calf pain
3) Rest pain
4) Pain all the time / night
What are the symptoms of intermittent claudication?
- cramp like pain
- after walking some distance
- walking uphill
- pain goes with rest
- pain restarts on exercise
What is sharp pain, acute onset, pale whole leg and then no pain associated with?
Thrombosis
What is “Leriche Syndrome”?
aortoiliac occlusive disease that leads to pain in the buttocks and thighs, with associated impotence.
What are the examination signs of peripheral artery disease?
1) cold / numb extremeties
2) smooth, dry skin with no hair on legs
3) Thickened / brittle toenails.
4) Pale / blue foot
5) Pallor when extremity raised
6) Delayed cap refil
7) diminished / absent pedal pulse
8) small, circular, painful ulcers over bony prominences
9) +ve Buerger’s test
10 ankle BP <50mmhg
What is Buerger’s test?
Buerger’s test is used to assess the adequacy of the arterial supply to the leg.
With the patient supine, elevate both legs to an angle of 45 degrees and hold for one to two minutes. Observe the color of the feet. Pallor indicates ischaemia. It occurs when the peripheral arterial pressure is inadequate to overcome the effects of gravity. The poorer the arterial supply, the less the angle to which the legs have to be raised for them to become pale.
Then sit the patient up and ask them to hang their legs down over the side of the bed at an angle of 90 degrees. 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.
Both legs are examined simultaneously as the changes are most obvious when one leg has a normal circulation.
What are the risk factors of peripheral vascular disease?
- smoking,
- diabetes,
- hypercholesterolaemia
- hypertension
What invx should be done for peripheral vascular disease?
1) ABPI
2) Angiogram
How is peripheral vascular disease managed?
Medical:
- stop smoking
- foot care for DM patients
- Statin
- Low dose aspirin (to reduce MI / stroke risk)
- exercise
Surgery:
- Percutaneous transluminal angioplasty (stents)
- Bypass
- amputation
What are the differential diagnoses of peripheral vascular disease?
- spinal cord claudication (pulses are present)
- knee / hip osteoarthritis
- Peripheral neuropathy (numbness/tingling)
- Popliteal artery entrapment (young pt with normal pulses)
- Venous claudication (bursting pain on walking with a hx of DVT_
- Buerger’s disease (young males, heavy smokers)
Who is at risk of buerger’s disease?
young males who are heavy smokers.
Bursting pain on walking with a hx of DVT are signs of what?
Venous claudication
