Peripheral Vascular Disease

Question 1

What is the defintion of peripheral vascular disease?

Answer 1

Occurs due to atherosclerosis causing stenosis of arteries via a multifactorial process involving modifiable and non-modifiable risk factors.

Question 2

What is the aetiology of peripheral vascular disease?

Answer 2

Occurs due to ATHEROSCLEROSIS in peripheral arteries

Types of PVD include:

• Intermittent claudication - calf pain on exercise
• Critical limb ischaemia - pain at rest -> NOTE: this is the MOST SEVERE manifestation of peripheral vascular disease
• Acute limb ischaemia - a sudden decrease in arterial perfusion in a limb, due to thrombotic or embolic causes
• Arterial ulcers
• Gangrene

Question 3

What are the risk factors associated with peripheral vascular disease?

Answer 3

(same as the risk factors for any other atherosclerotic disease)

Smoking

Diabetes

Hypertension

Hyperlipidaemia

Physical inactivity

Obesity

Question 4

What is the epidemiology of peripheral vascular disease?

Answer 4

55-70 yrs = 4-12% affected

70+ yrs = 15-20% affected

More common in MALES

Incidence increases with AGE

Question 5

What are the presenting symptoms of peripheral vascular disease?

Answer 5

Intermittent claudication - cramping pain in the calf, thigh or buttock after walking for a given distance (claudication distance) and relieved by rest

• Calf claudication = femoral disease
• Buttock claudication = iliac disease

Features of Critical Limb Ischaemia

• Ulcers
• Gangrene
• Rest pain
• Night pain (relieved by dangling leg over the edge of the bed)

Leriche Syndrome (aortoiliac occlusive disease)

• Buttock claudication
• Impotence
• Absent/weak distal pulses

Fontaine Classification of Peripheral Vascular Disease

• Asymptomatic
• Intermittent Claudication
• Rest pain
• Ulceration/gangrene

Question 6

What are the signs of peripheral vascular disease upon examination?

Answer 6

Acute Limb Ischaemia - 6 Ps

• Pain
• Pale
• Pulseless
• Paralysis
• Paraesthesia
• Perishingly Cold

Other symptoms:

• Atrophic skin
• Hairless
• Punched-out ulcers (often painful)
• Colour change when raising leg (to Buerger’s angle)

Question 7

What are the appropriate investigations for peripheral vascular disease?

Answer 7

Full cardiovascular risk assessment

• Blood pressure
• FBC - anaemia will worsen ischaemia
• Fasting blood glucose
• Lipid levels
• ECG - check for pre-existing coronary artery disease
• Thrombophilia screen - for patients < 50 yrs

Colour Duplex Ultrasound

• FIRST-line
• Shows site and degree of stenosis

MRI/CT - Assesses extent and location of stenoses -

ABPI (Ankle-Brachial Pressure Index)

• Marker of cardiovascular disease
• ABPI < 0.8 = do NOT apply a pressure bandage because this will worsen ischaemia