PVD/Chronic Limb Ischaemia Flashcards
What is PVD/chronic limb ischaemia?
PVD or chronic limb ischaemia is a long term reduction in blood supply to a limb
What limbs are most commonly affected by PVD?
Legs
What causes PVD?
Exposure to a number of risk factors over time increases likelihood of PVD
What are some risk factors for PVD?
- Diabetes
- Hyperlipidaemia
- Hypertension
- Smoking
- Obesity
- Lack of exercise
What is the most important risk factor for PVD?
Smoking
How can the clinical presentation of PVD be classified?
Fontaine’s Classification
How many stages are there in Fontaine’s classification of PVD?
4
What is the presentation of a person with Stage 1 PVD?
Asymptomatic
What is the presentation of a person with Stage 2 PVD?
Intermittent claudication
What is the presentation of a person with Stage 3 PVD?
Ischaemia at rest (critical limb ischaemia)
What is the presentation of a person with Stage 4 PVD?
Ulceration or gangrene
What bedside test can be used to assess the extent of PVD?
Buerger’s Test
How is Buerger’s test performed?
The patient lays supine and their leg is rasied until the leg goes pale.
What result of Buerger’s tests indicates severe ischaemia?
Pale at <20º
What is critical limb ischaemia?
An advance form of PVD
How is critical limb ischaemia defined?
Any one of:
- Ischaemic rest pain >2 weeks
- Ischaemic lesions/gangrene
- ABPI <0.5
How will a patient’s limb appear if they have critical limb ischaemia?
- Lack of pulses
- Cold to the touch
How is a diagnosis of critical limb ischaemia confirmed?
Using ABPI (ankle brachial pressure index)
How is ABPI calculated?
ABPI = Pressure leg/Pressure arm
What does an ABPI of >0.9 mean?
Normal
What does an ABPI of <0.9 mean?
Diseased arteries
What does an ABPI <0.5 mean?
Severely diseased arteries
How else should PVD be investigated?
- Doppler or CT angiogram
- If young get a clotting screen
- Do a cardiovascular risk assessment
How is PVD managed?
Mostly medically but can be surgically in more severe cases
