Peripheral Vascular Disease Flashcards
What is intermittent claudication?
When patients develop ischaemic pain during exercise in a limb due to insufficient blood reaching exercising muscle.
How would you calculate the ankle brachial pressure index (ABPI)?
ABPI = ankle pressure/brachial pressure.
What should the ABPI be for normal limbs, claudication and severe claudication?
Normal = 0.9-1.2. Claudication = 0.4-0.85. Severe = 0-0.4.
When does ABPI not work?
In calcified vessels e.g. diabetes or CRF.
What are some non-invasive investigations of peripheral vascular disease?
Measurement of ABPI, duplex ultrasound scanning (can help you see flow through arteries).
What are the invasive investigations of peripheral vascular disease?
Magnetic resonance angiography (MRA), CT angiography (quite a lot of radiation), catheter angiography.
Describe the guardian therapy for peripheral vascular disease?
Slowing progression (quitting smoking, lipid lowering, antiplatelets, hypertension drugs, diabetes drugs, lifestyle issues), information/realistic expectations.
What exercise recommendations would you give to someone with peripheral vascular disease?
30 minutes 3x/week for 6+ months, beyond pain.
What drug can be used to alleviate intermittent claudication?
Cilostozol.
Why would you not do an angioplasty on someone with very mild disease?
There are risks with stents.
What are the 2 types of surgeries you can do on someone with peripheral vascular disease?
Inflow bypass surgery and outflow bypass surgery.
What would you use as a graft in inflow bypass surgery?
Prosthetic/vein.
What would you use as a graft in outflow bypass?
Vein, prosthetic (dacron, ePTFE) outcomes are worse.
What is critical limb ischaemia?
Resting pain in toe/foot (nerve ending demand even at rest, including when lying and sleeping).
When can ulcers and gangrene occur?
In severe ischaemia and then damage.
