Peripheral vascular disease Flashcards
Peripheal arterial disease is casued by
atherosclerosis
peripheral arterial disease progresses in stages (3):
asymptomatic— intermittant claudication—- rest pain—– acute ischaemia
what is peripheral arterial disease strongly associated with?
vascular disease of other body systems
which other areas of arteries other than legs can be affected
abdomen and neck——- ischaemic bowel, acute abdominal
DVT presents as
acutely painful
swollen leg
Venous insufficiency
very common
causes varicose veins, swelling and skin changes
what is the peripheral vascular system
blood vessels of the body aside from the head and chest
oedema
swelling caused by excessive fluid in the tissues
atherosclerosis
the build up of fats to form plaques inside arteries
ischaemia
blood and oxygen flow is insufficient to meet the metabolic demands of the body
necrosis
messy unprogrammed cell death
extravasation
things that are normally present in a blood vessel leaking into the surrounding tissues
thrombosis in situ
blockage of a vessel by a clot arising from an existing narrowed area of atherosclerosis
thromboembolism
blood clot blocking a vessel that started in one place and broke off to move to another
embolus usually from the left atrium, associated w atrial fibrillation from DVT
aneurysm
bulge in a blood vessel, caused by a weakness in its walls and or excessive pressure in the vessel
peripheral arterial disease
- occurs whwn there is significant narrowing of the arteries, usually due to atherosclerosis
- 8x more common in legs than arms
- PAD causes limb ischaemia and progresses in stages
risk factors for PAD
>50 year olds most affected
CV risk factors: smoking, hypertension, dyslipidaemia, diabetes
risk of CV event is sigmificantly increased by
heart attacks
most people with PAD actually die from ehart attacks and strokes
progressive stages of lower limb ischaemia
- ischaemia
- intermittent claudication
- night/rest pain
- tissue loss
asymptomatic nature of PAD
patients may not be healthy enough to walk to bring on symptoms
intermittent claudication
- pain in the legs on walking due to ischaemia
- tighten/ cramp, worse uphill, goes on rest but restarts when walking
- often has a predictable ‘claudication distance’
- claudication itself doesn’t cause damage to the limb, but is a marker of extensive atherosclerotic disease
claudication distance
how far can you walk before pain gets too bad so you have to stop
Night/ rest pain in atherosclerosis
severe enough atherosclerosis that blood flow isn’t good enough to meet the normal demands of the tissues at rest.
may be ‘unmasked’ at night:
when you sleep HR and BP decrease
lose aid of gravity in perfusing the feet
indicates severe prorgession of disease- refer to vascular surgeon
tissue loss stage of atherosclerosis
ulcers and or necrosis
starts distally and works proximally
often starts with a proximal wound that doesnt heal
can be caused by emboli that block downstream capillaries
arterial ulcers
lower legs tops of feet and toes
painful
symmetrical in shape
cool/ pale bluish surrounding skim that appears shiny
loss of leg hair
faint or absent pulses
what is acute limb ischaemia
sudden drop in BP that threatens the viability of a limb may cause irreversible tissue death and limb amputation
6 P’s of limb ischaemia
painful
pale
pulseless
perishingly cold
paraesthesia- numbness due to comprimised nerve function
paralysis- indicates comprimised muscle function
examples of diseases that casue Abdominal pain
mesenteric artery disease
mesenteric ischaemia
acute ischaemic bowel
abdominal aortic aneurysm
mesenteric ischaemia
abdominal pain brought on by eating
uncommon as the gut has many sources of blood flow so several vessels would need to be significantly affected by atherosclerosis
acute ischaemic bowel
usually an embolus from the left atrium of the heart or by thrombosis in situ of mesenteric artery
lack of BF– portion of bowel dies – leaky – passage for microbiota tp enter abdominal cavity– severe sepsis– high mortality
severe pain wo abdominal tenderness
carotid artery disease
carotid atherosclerosis is a main risk factor for stroke and TIA
stroke
neurological deficit attributed ti acute focal injury of the CNS by a vascular cause
TIA
temporary lack of BF to a part of the brain giving symptoms and signs of a stroke but lasting less than 24 hours
Raynaud’s
ischaemia of digits caused by a spasm or blockage of arteries in response to cold
pallor- as arterial BF is blocked
cyanosis- as oxygen is used up
hyperaemia- when blockage is relieved and there is a sudden influx of O2 rixh blood
raynaud’s sydrome is when there is smething else underlying e.g., blood clotting disorder
What are the superficial veins if the leg
long and short saphenous veins
where in the leg is the long saphenous vein found
superficially inthe middle of the leg
where is the short saphenous vein found
lateral + posterior + superficial aspect of calf
deep vein thrombosis
a blood clot in a deep vein
usually in the lower leg or thigh but can be in the arm or pelvis
signs and symptoms of deep vein thrombosis
limb pain and or tenderness
swelling of the calf/ thigh
pitting oedema
distension of the superficial veins
red/ warm skin
risk factors for dVT
previous hitsory of DVT/PE (collectively called venous thromboembolism)
immobilisation- e.g., during hospital admission
cancer
pregnancy
severe dehydration
thrombophilia
oral oestrogen (combined contraceptive pill)
smoking
obesity
chronic venous insuficiency and varicose veins
you can have cvi with or w/o varicose veins
- dilated superficial veins
- tortuous veins
- superficial veins
look at the inner aspct of the calf but anywhere on the leg
usually due to incompetent valves or previous DVT leading to chronic high pressure in the venous system
pain, itch, swelling, skin changes
haemodiserin
varicose eczema
red, dry, scaly sometimes blistered
lipodermatsclerosis
-fat -skin -hard -process
core presenting complaints and differentials for peripheral diseases
leg pain- intermittent claudication/ acute sichaemic limb/ DVT/ varicose vein insuffiency
leg swelling- DVT, venous insuffiency
ulcers- arterial disease, venous insuffiency
finger colour changes- reynaudes, peripheral arterial disease of arm
abdominal pain- mesenteric ischaemia/ ischameic bowel/ AAA
