Peripheral vascular disease

Question 1

Define

Answer 1

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

Question 2

Causes

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

Risk Factors

Answer 3

Smoking

Diabetes

Hypertension

Hyperlipidaemia

Physical inactivity

Obesity

Question 4

Epidemiology

Answer 4

55-70 yrs = 4-12% affected

70+ yrs = 15-20% affected

More common in MALES

Incidence increases with AGE

Question 5

Symptoms

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

Signs

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

Investigations

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