Peripheral Vascular Disease Flashcards
Define peripheral vascular disease
Range of arterial syndromes caused by atherosclerotic obstruction of the lower limb arteries
What are the different types of peripheral vascular disease?
Claudication – inability of the vascular tree to meet the metabolic demands of the tissue
during exercise
Critical limb ischaemia – inability of the vascular tree to meet the metabolic demands of
the tissue at rest
Acute limb ischaemia – sudden blockage of artery -> decrease in limb perfusion that
threatens limb viability
What are the causes/risk factors of peripheral vascular disease?
Atherosclerosis • Smoking • Diabetes • Hyperlipidaemia • History of coronary artery or cerebrovascular disease
Acute limb ischaemia
• Thrombosis (on background of atherosclerotic disease)
• Embolism (e.g. AF, post-MI)
What are the symptoms of peripheral vascular disease?
• Asymptomatic
Claudication
• Cramping leg pain on exercise
(relieved by rest)
Critical limb ischaemia • Rest pain • Night pain relieved by hanging legs off end of bed • Ulceration • Gangrene
Acute limb ischaemia (6Ps) • Pain • Pallor • Pulseless • Perishingly cold • Paraesthesiae • Paralysis
What are the signs of peripheral vascular disease?
Claudication
• Diminished pulses
Critical limb ischaemia • Sunset foot – elevation pallor and dependent rubor • Loss of hair • Thickened toenails • Shiny/scaly skin
Acute limb ischaemia (6Ps) • Pain • Pallor • Pulseless • Perishingly cold • Paraesthesiae • Paralysis
What investigations are carried out for peripheral vascular disease?
• Bloods - FBC - Clotting - G&S • Ankle brachial pressure index (ABPI) - <0.9 – mild - 0.6-0.9 – moderate; claudication - <0.6 – severe; CLI - <0.3 – rest pain/gangrene • Duplex ultrasound • Angiography (contrast, CT, MRI)
What is the management of peripheral vascular disease?
Claudication Risk factor modification • Antiplatelet e.g. clopidogrel • Blood pressure e.g. ACE-I, Beta-blockers • Cholesterol e.g. statins • Diabetes – glycaemic control • Exercise – collateral circn. and muscle conditioning Symptomatic relief • Pentoxifylline • Cilostazol • Naftidrofuryl
Critical limb ischaemia • Risk factor modification (see above) • Endovascular revascularisation • Surgical revascularisation • Amputation
Acute limb ischaemia
• Aspirin or clopidogrel
Viable limb
• Intra-arterial thrombolysis e.g. streptokinase or recombinant tPA
• Endovascular revascularisation e.g. percutaneous transluminal angioplasty, Fogarty
balloon catheter embolectomy
• Surgical revascularisation e.g. endarterectomy, bypass grafts
Non-viable limb
• Amputation
What are the complications of peripheral vascular disease?
- Ulcers
- Gangrene
- Permanent limb weakness/numbness
- Permanent limb pain
What is the prognosis of peripheral vascular disease?
Claudication – 1% amputation; 15% dead within 5 years from stroke or MI
Critical limb ischaemia – 25% major amputation; 50% dead within 5 years from
MI/stroke
Acute limb ischaemia – variable
