Vascular: Peripheral arterial disease Flashcards
What is peripheral arterial disease?
Significant narrowing of arteries distal to the arch of aorta, usually due to atherosclerosis
What are the RF of peripheral arterial disease?
Smoking, DM, hypertension, hyperlipidaemia, physical inactivity and obesity.
What are the symptoms of peripheral arterial disease?
Walking impairment, pain in buttocks and thighs relieved at rest.
What are the signs of peripheral arterial disease (PAD)?
Pale, cold leg
Hair loss
Ulcers
Poor wound healing
Weak or absent pulses
What are the investigations for PAD?
Full CVS risk assessment incl BP, FBC, blood glucose, lipids and ECG.
Ankle-brachial pressure index- uses doppler probe to find the systolic brachial blood pressure of the arms and comparing to ankle blood pressures
How do you non-surgically manage a patient with PAD?
Non-surgical: RF modification, supervised exercise program, smoking cessation and weight management
Managing CVS risk- clopidogrel 75mg, atorvastation 80mg, diabetes and HTN should be well controlled
Managing pain- Naftidrofuryl oxalate- vasodilator, only if exercise is ineffective and the pt does not want angioplasty or bypass
How do you surgically management a patient with PAD?
Intermittent claudication: endovascular revascularisation or surgical revascularisation, when RF modification has not improved sx
Critical limb ischaemia (rest pain, tissue loss etc.), referral to vascular MDT. Endovascular methods for small stenosis, surgical bypass for larger and more extensive stenosis and amputation if there no other option.
What is Leriche syndrome?
A term given for a group of symptoms caused by PAD of legs.
Occlusion in the distal aorta or proximal common illiac artery
What is the triad in Leriche syndrome?
thigh / buttock claudication, impotence and absence of femoral pulses.
How is Leriche syndrome managed?
Surgical revascularisation
Surgery - aortofemoral bypass or axillofemoral bypass with or without endartectomy (removing the plaque)
Describe the pathophysiology of Leriche syndrome
Severe atherosclerosis affecting the distal abdominal aorta, iliac arteries and femora-popliteal vessels. Can be bilateral depending on where the occlusion is.
What can PAD lead to?
Intermittent claudication.
What is Buerger’s disease?
Non atherosclerotic vasulitis in small and medium sized arteries. Usually young male, smoker, Mediterranean origin
How does Buerger’s disease present
Acutely ischaemic limb without peripheral claudication
