Peripheral Vascular Disease Flashcards by Kirsten Davis

what are the two types of PVD?

organic and functional

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what is organic PVD?

where a blockage has occurred

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what is functional PVD?

blood vessels change diameter

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what are the causes of organic PVD?

atherosclerosis
embolus
stenosis/occlusion
disruption/ulceration

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what is the cause of functional PVD?

vasospasms

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what is PVD?

narrowing or arteries, usually affecting the limbs

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what are the risk factors for PVD?

SMOKING
Also: diabetes, dyslipidaemia, hypertension, obesity, age, male, hypocholestrolemia, hyperhomocysteinaemia, geography, family history

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what is claudication?

pain during exercise, occurs in calf, may also involve thigh or buttock, frequently 2 or 3 muscle groups become symptomatic, cramp like,

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what are the exacerbating causes of claudication?

walking quickly, climbing hills, cold weather, medications (e.g. beta blockers)

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what is a symptom of mild PVD?

claudication

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what are the symptoms of severe PVD?

o	Claudication at rest
o	Pain at night when legs are raised on bed, relieved by lowering legs/sitting up
o	Ulcers - punched out
o	Gangrene 
o	Reduced/absent peripheral pulses
o	Skin atrophy
o	Hair loss
o	Colour changes or cyanosis
o	Excessive sweating 
o	Erectile dysfunction

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what is beugers angle test?

highlights if Lower limb arterial pressure is insufficient to perform the additional work against gravity

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what are the investigations for PVD?

Palpation of femoral and distal pulses 
Auscultation of iliac artery – bruit
Doppler ultrasound 
ABI = BP ankle/BP arm
CT angiogram
Bloods

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what are different ABI measurements in PVD?

o Normal >1
o PVD diagnosis <0.9
o Pain at rest <0.6
o High risk of gangrene <0.3

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what blood tests should be carried out in PVD?

HbA1c, lipids, U&Es, ESR/CRP, platelets and clotting

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what classification system is used for PVD?

Fontaine

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what is the definition of Fontaine I (PVD)?

asymptomatic lower limb arterial disease

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what is the definition of Fontaine IIa (PVD)?

claudication > 200m

what is the definition of Fontaine IIb (PVD)?

claudication < 200m

what is the definition of Fontaine III (PVD)?

rest pain

what is the definition of Fontaine IV (PVD)?

ulceration and/or gangrene

what are the different categories of management of PVD?

Lifestyle
Medical
Surgical

what is the medical management of PVD?

o	Statin (atorvastatin 40mg)
o	Control hypertension – ACE or calcium channel blocker
o	Antiplatelet

what is the surgical management of PVD?

o Percutaneous transluminal Angioplasty – guided wire balloon
o Infra-inguinal Bypass
o Aorta-femoral/iliac bypass

what is the definition of critical limb ischaemia?

limb with rest pain of at least 2 weeks duration or tissue loss caused by arterial disease

what are the limbs systolic pressures in critical limb ischaemia?

ankle systolic >50mmHg | toe pressure >30mmHg

what are the symptoms of critical limb ischaemia?

rest pain, gangrene, ulceration

what are the two types of gangrene?

dry and wet

what is wet gangrene?

gangrene with infection | spreads rapidly, severe compromised limb, systemic sepsis

what are the causes of acute limb ischaemia?

* Thrombus in situ * Emboli * Graft/angioplasty occlusion * Trauma * IV drug users * Compartment syndrome * Can be acute on chronic

what are the clinical features of acute limb ischaemia? (6Ps)

* Pulseless * Paraesthesia * Pain – muscles also become tender to palpation after about 6-8hours * Paralysis * Pallor * Perishing cold

how is acute limb ischaemia diagnosed?

clinically

what is the 1st line management of acute limb ischaemia?

o Analegesia (parenteral) o Full anticoagulation with heparin or LMWH if immediate treatment is not planned o Optimise CVD status

what is the 2nd line management of acute limb ischaemia>

Find source of emboli - arteriography

if possible, how can revascularisation be achieved in acute limb ischaemia?

o Thrombolysis - tissue plasminogen factor most effective when given via local arterial catheter (Fogarty Catheter), streptokinase o Embolectomy/bypass/PTA o A combination

when should revascularisation not be attempted in PVD management?

o In bedridden patients o In a functionally useless limb o In patients with life-threatening sepsis o Where revascualarisation is technically impossivle o Where there is extensive muscle necrosis

what is a reperfusion injury?

Release of toxic metabolites and oxygen free radicals into the systemic circulation from the ischaemic limb. This can cause a profound cardiovascular collapse with renal and sometimes respiratory failure.

when is amputation considered in limb ischaemia?

when revascularisation is inappropriate If revascularisation fails Also: calf tenderness, a raised CK and prolonged, profound paralysis or sensory loss

what are the two types of amputation?

major and minor

what are the two types of major amputation?

Above the knee (AKA) | Below the knee (BKA)

what are the features of BKA?

can become independently mobile because knee joint is preserved and a lighter prosthesis is used

what are the features of AKA?

o Above knee amputation (AKA) or transferomal amputation has poorer outcome o Although more likely to heal rehab is less successful o Patients are often more unwell than below knee amputation

what are the features of post amputation management?

Antibiotic prophylaxis analgesia early fitting of prosthesis and mobilisation