Peripheral vascular disease Flashcards

1
Q

Peripheral artery disease
- Description

A

Obstruction of lower extremity arteries
- Causing a syndrome of symptoms
- Most common cause is atherosclerosis

Other causes
- Aortic coarctation
- Arterial dissection
- Thrombosis/ embolisnm

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2
Q

Peripheral artery disease
- Risk factor

A

Smoking

Hyperlipidaemia

Diabetes

HTN

Age >40

Low physical activity

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3
Q

Peripheral artery disease presentation (9)

A

Claudication
- Intermittent pain, pain in legs with onset during exercise/ walking.
- Lower aorta/ iliac = pain in glutes and hips.
- Common femoral/ Iliac= pain in thigh
- Superficial femoral= pain upper 2/3 of calf
- Popliteal= pain in lower 1/3 calf
- Tibial/ peroneal= pain in foot.

Pain at rest= critical limb ischaemia

Diminished pulse/ pulseless lower extremity

Bruit in artery
- Indicates narrowed artery

Signs of acute limb ischaemia

Erectile dysfunction
- Indicates internal iliac or high artery narrowing

Ulcer/ non-healing wound

Gangrene

Muscle atrophy

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4
Q

Elevation pallor vs dependent rubor

A

Elevation pallor
- When limb turns pale after it is lifted
- Due to blood unable to overcome narrowed arteries and gravity

Dependent rubor
- When the limb turns red after being lowered
- Due to sudden increased perfusion due to gravity

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5
Q

Critical limb ischaemia

A

When >1 level of the arterial tree is affected
- Leading poor or no flow to tissue

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6
Q

Ischaemic arterial ulcers
- Cause
- Presentation

A

Cause
- Poor blood supply, demand> supply.

Starts off as small wounds and does not heal due to poor blood supply.
- Can progress to gangrene

Presentation
- Location= pressure points: toe joint, malleoli, base of heel

  • Dry and punched out
  • Painful
  • Little bleeding.
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7
Q

Ankle brachial pressure index (ABPI)

A

The ratio of systolic BP in the arm (brachial) compared to the ankle

1-1.4= normal

<0.9= vascular disease
0.6-0.9= mild
0.3-0.6= moderate
<0.3= severe
- Can show false negative in diabetics (>1.4, due to calcification)

If ABI decreases 15-20% fater exercise testing= diagnostic of arterial disease

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8
Q

Toe brachial index

A

Systolic BP ratio between Toe and brachial BP.

<0.6= Vascular disease

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9
Q

Investigations for PVD

A

Colour duplex ultrasound
- Assesses location and degree of stensosis

CT angiogram
- Gold standard test

MR angiogram
- No radiation, gold standard

ABI/ exercise ABI

TBI

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10
Q

Lifestyle modification for management of arterial vascular disease

A

Smoking cessation

Balanced diet
- Low sugar, low saturated fat

Increase in exercise
- Collateral vascularisation

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11
Q

Pharmacological treatment of peripheral arterial disease

A

Antiplatelet
- Aspirin/ clopidogrel 75mg

Statins/ lipid-lowering drugs
- atorvastatin 80mg

DM control

Weight loss

Analgesia
- Paracetamol + opioid for acute ischaemia

Antihypertensives
- ACEi, ARBs, beta-blockers

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12
Q

Surgical revascularization for critical limb ischaemia

A

Percutaneous transluminal angioplasty
- For single short segment of blood vessel with uniform occlusion

Open surgery
- Endarterectomy if clot
- Indicated for long segment occlusion
- Multifocal/ calcified lesion

Surgical bypass
- For very long clots or when area of ischaemia is extension

Amputation
- When tissue is non-viable

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13
Q

Acute limb ischaemia
- Viable limb treatment

A
  1. Thrombolysis + endovascular revascularisation (angioplasty)
    - Urokinase
    - Alteplase
  2. Surgical revascularisation
    - Thrombectomy/ bypass
    - Indicated in large aortoiliac stensosi/ chronic occlusion
    - Aortic anuerysm
    - Heavy calcified lesions
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14
Q

Venous insufficiency

A

Persistent elevation of venous pressure causing functional changes in lower extremity.

Main causes
- venous reflux due to poor valves= blood stasis
- chronic obstruction
- Common after episode of DVT

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15
Q

Venous insufficiency presentation

A

Peripheral oedema, esp ankle swelling
- Proteins enter interstitium and draw in water

Venous ulcers

Corona phlebectatica
- Ankle flar

Lipodermatosclerosis
- Stasis dermatitis
- Inflammation of fat under skin

Varicose veins

Atrophie blanche
- Loss of skin pigmentation due to RBC death

Brown discolouration of leg (haemosiderin)
- Due to extravascularisation from venous hypertension

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16
Q

Venous ulcer
- Features of ulcers

A

Shallow

Irregular borders

Yellow, fibrinous exudate/ Red and oozing

Usually in lower, inner leg- gaiter area
- Between malleous and mid calf

17
Q

Risk factors for venous ulcers

A

Older

Orthostatic occupation

Men smokers

Female

Obese

Pregnant

Previous DVT

18
Q

chronic venous insufficiency investigations

A

Duplex USS
- Shows venous reflex
- Slow valve closure

Ascending venography
- supplanted with duplex

CT/ MR
venography

19
Q

Non-surgical Treatment of chronic venous insufficiency

A
  1. Compression stockings
    - Exlcude arterial disease
    - Class 2 generally suitabel

Pentoxifylline
- Helps ulcers heal

20
Q

Surgical treatment for chronic venous insufficiency

A

Removal of veins
- Saphenectomy/ endovenous ablation

Percutaneous iliac angioplasty
/ stenting
- If iliac vein ostructed

Valvular reconstruction
- If deep venous reflux

21
Q

Leriche Syndrome definition

A

Triad of symptoms due to occlusion in the distal aorta or proximal common iliac arteries:
- Thigh/buttock claudication
- Absent femoral pulses
- Male impotence

22
Q

Lifestyle for venous insufficiency

A
  • Smoking cessation
  • Good diet
  • Exercise
  • Weight loss
  • Leg elevation on rest
  • Regular emollients