Peripheral Vascular Disease Flashcards
How does PVD usually present?
Cramping pain
In calf/thigh/buttock
Worse on exertion and relieved by rest (intermittent claudication)
What causes peripheral vascular disease?
Atherosclerosis
What may you find on examination in PVD?
Pallor Cold limb Absent foot pulses Atrophic skin Venous guttering Punched out ulcers Increased cap refill time Positive buergers test
What are the cardinal features of critical limb ischaemia?
Ulceration
Gangrene
Pain at rest, relieved by hanging foot over side of bed
Why is there often pain worse at night?
Systolic BP drops while sleeping
Warm blankets etc cause peripheral vasodilation, further decreasing BP
Gravity
What initial investigations would you do in a patient with PVD?
Glucose - diabetes FBC - anaemia/infection/platelets U&E - renal disease Lipids - dyslipidaemia ESR - rule out vasculitis ECG - rule out cardiac ischaemia Clotting
What is a reliable non invasive investigation for diagnosis PVD?
Ankle brachial pressure index (ABPI)
What is the normal value for ABPI?
> 0.95
What factors could give a falsely high ABPI result?
Very bad calcification
Diabetes
Renal failure
What lifestyle advice would you give to a patient with PVD?
Exercise
Lose weight
Quit smoking
Dietary changes
How would you medically treat a patient with PVD?
Treat risk factors e.g. Treat DM, hypertension and dyslipidaemia
Aspirin
What is the definitive treatment for PVD?
Surgery
Angioplasty and stentint
Bypass
Amputation
What are the features of acute limb ischaemia?
Pallor Pain Pulseless Perishingly cold Paraesthesia Paralysis
What are the causes of acute limb ischaemia?
Thrombosis in situ
Embolus
Graft or stent occlusion
Trauma
How soon should you aim to treat acute limb ischaemia?
Within 6 hours
