Peripheral Vascular Disease (NC)

Question 1

What is PVD

Answer 1

Abnormal narrowing of arteries (other than those going to the heart and or brain)
Most cases asymptomatic until 70% lumen obstruction (occlusion)

Question 2

What can the narrow artery lead to

Answer 2

Pain, ulceration, gangrene

Question 3

What is the most common presentation of PVD

Answer 3

Intermittent claudation
-> pain, discomfort, numbness, tiredness in legs when walking or standing
-> relieved by rest

Question 4

When there is a decrease in limb perfusion there is continuous pain during rest. What makes this pain worse/better?

Answer 4

Worse -> elevation and lying down
Better -> sitting or standing

Question 5

What is the most severe stage of PVD

Answer 5

Critical limb ischemia/ limb threat
-> painful ischemic ulcers

Question 6

What can non-healing ulcers from critical limb ischemia lead to?

Answer 6

Gangrene -
Usually occurs in distal toes/fingers
Clear demarcation between viable and black necrotic tissue

Question 7

If PVC is suspected, what is the first test carried out?

Answer 7

Ankle-brachial index -
1-1.40 > normal
0.91-0.99 > borderline
<0.90 > PVD

Question 8

What is the second step in diagnosis PVD?

Answer 8

Lower limb Doppler ultrasound
- to determine location and severity of obstruction

Question 9

When diagnosis is uncertain, what tests are used?

Answer 9

Advanced vascular imaging techniques:
- conventional arteriography
- CT angiography
- MR angiography

Question 10

What management is used for individuals with few/no symptoms or are unable to undergo aggressive treatment (e.g elderly or those with co-morbidities)?

Answer 10

Conservative management:
- cessation of smoking (stop)
- weight loss
- regular exercise
- long term antiplatelet therapy (aspirin or clopidogrel)
- lipid lowering therapy (statins)
- management of diabetes and hypertension