Peripheral vascular disease

Question 1

Define:

Answer 1

Occurs due to atherosclerosis causing stenosis of arteries

Question 2

Aetiology:

Answer 2

Due to atherosclerosis or other blockage in peripheral arteries.

Types of PVD:

• intermittent claudication - pain after exercise as exercise increases the oxygen demand, improvement on continuing exercise due to angiogenesis.
• Critical limb ischaemia - this is pain at rest and the most dangerous of the PVD
• acute limb ischaemia - this is reduced perfusion to a limb due to a thrombosis/embolus, iatrogenic, trauma or angioplastic cause. Most common cause is atherosclerosis and AF

Question 3

Risk factors:

Answer 3

diabetes 
obesity 
family history 
smoking
hyperlipidemia 
physical inactivity 
renal failure 
hypertension

Question 4

Symptoms:

Answer 4

Intermittent claudication:
- Pain in the buttock, thigh or calf following a set amount of exercise which is better on rest.

Critical limb ischaemia:

• ulcers
• gangrene
• rest pain
• night pain (made better by dangling their feet off the bed)

Leriche Syndrome (aortoiliac occlusive disease)
o Buttock claudication
o Impotence
o Absent/weak distal pulses

Fontaine Classification of Peripheral Vascular Disease
o	Asymptomatic
o	Intermittent Claudication 
o	Rest pain 
o	Ulceration/gangrene

Question 5

Signs

Answer 5

Acute limb ischaemia (6P’s)

• Pain
• pulsless
• perishingly cold
• paralysis
• parasthesia
• pale

Other symptoms:
atrophic skin (reduced dermal thickness)
hairless
punched out painful ulcers
colour change when leg rises (Beurger's sign)

Question 6

Epidemiology:

Answer 6

Increased incidence with age

more common in men

50-77 yrs = 4-12%
70+ years = 15-20%

Question 7

Investigations:

Answer 7

History and Vascular exam

Ankle Brachial pressure index - Ankle SBP/brachial SBP
-0.5-0.9 = claudication
<0.5 = critical limb ischaemia

colour duplex ultrasound - shows severity and extent of stenosis

Gold standard = CT/MRI angiogram

Full CVS risk assessment:

• BP
• Bloods - FBC as anaemia can make ischaemia worse
• U + E’s to detect renal damage
• fasting blood glucose
• ECG (to look for heart conditions)
• lipid levels
• thrombophilia if <50 yrs