Peripheral Vascular Disease Flashcards
1
Q
Features of peripheral arterial disease
A
- Result of atherosclerosis and narrowing of the arteries supplying the limbs and periphery
- Presentation
- Weak peripheral pulses
- Pallor
- Cold
- Skin changes (ulceration, hair loss)
- Buerger’s test
2
Q
Investigation of peripheral arterial disease
A
- ABPI - ratio of systolic blood pressure in the ankle (around the lower calf) vs the arm (i.e. ankle SBP of 80 and arm SBP of 100 gives ratio of 0.8)
- >0.9 is normal
- 0.6 – 0.9 is mild disease
- 0.3 – 0.6 is moderate to severe disease
- <0.3 is severe disease to critical ischaemic
- Arterial doppler
- Angiography (CT or MRI)
3
Q
Features of critical limb ischaemia (remember the 6 Ps)
A
- End stage of PAD where there is inadequate blood supply to the limb to allow it to function normally at rest
- 6 P’s
- Pain
- Pallor
- Pulseless
- Paralysis
- Paraesthesia
- Perishingly cold
4
Q
Definition and management of intermittend claudication
A
- Symptom of having ischaemia in a limb during exertion at is relieved by rest - typically crampy pain in the calf
- Management
- Lifestyle changes
- Optimise medical treatment of comorbidities
- Medical treatments
- Atorvastatin
- Clopidogrel
- Naftidrofuryl oxalate (peripheral vasodilator)
- Surgical treatments
- Angioplasty and stenting
- Bypass surgery
5
Q
Management of critical limb ischaemia
A
- Urgent referral to vascular
- Analgesia
- Urgent revascularisation by antioplasty and stenting or bypass surgery
6
Q
Fontaine classification for PAD
A
- Stage I: Asymptomatic, incomplete blood vessel obstruction
- Stage II: Mild claudication, pain in limb
- Stage IIa: Claudication at a distance >200m
- Stage IIb: Claudication at a distance <200m
- Stage III: Rest pain, mostly in the feet
- Stage IV: Necrosis and/or gangrene of the limb
7
Q
Leriche’s syndrome
A
- Associated with occlusion in the distal aorta or proximal common iliac artery
- A clinical triad:
- Thigh / buttock claudication
- Absent femoral pulses
- Male impotence
