Peripheral Vascular Disease Flashcards
Pathophysiology
What is acute limb ischaemia and how quickly does it need to be treated?
What are some risk factors?
Atherosclerosis of peripheral arteries
Total occlusion of artery due to long-standing disease
Necrosis at 6 hrs if untreated
Smoking DM Advanced age High BP Excess weight A FH High cholesterol
Chronic PVD:
What is the triad of symptoms you should ask about?
Name of classifications used
Examination:
- What signs may you see with PVD?
What happens if you elevate the leg for a minute?
What 4 pulses should you feel in the feet?
Arterial pulse exam:
- What is the 0, 1, 2, 3, 4 stages when classifying the pulse?
Buerger’s test - this tests for chronic arterial insufficiency:
- What degree do you raise the legs?
- How long should they be in that position?
- What should be measured?
- What should this normally be?
- How long does it take for the veins to fill up?
Pain
Claudication
Rest pain
Claudication - Predictable, reproducible pain on exertion caused by ishcaemia of the muscle which is relieved by rest.
Fontaine classification
Absent/diminished femoral or pedal pulses Arterial burits Hair loss Poor nail growth (brittle nails) Dry, scaly, atrophic skin
Pallor with leg elevation after 1 minute at 60 degrees?
Femoral
Popliteal
Dorsalis pedis
Post-tibial
0 = absent pulse 1 = faint 2 - reduced - can count pulse 3 = normal pulse 4 - bounding
90 degress for 2 minutes
The time it takes for normal pinks to appear - 10 seconds
Filling of the veins takes about 15 secs
Intermittent Claudication:
What does the exertion pain feel like?
How is it received?
Acute limb ischaemia - 6P’s
Fatigue
Cramping
Tightness
Relief with standing Pain at rest Pulseless Pale - pallor Parasthesia - no sensation Perishingly cold Paralysis - late and irreversible damage
Ddx for leg pain:
MSK - 1
Vascular - 2
Neurospinal - 2
Neuropathic - 2
Osteoarthritis
PVD
DVT
DIsc degeneration
Spinal stenosis
Diabetes
Alcoholic neuroprathy
Investigations:
Initial - ABPI - what does it stand for? what is it? how is it measured?
CV investigations??
Ankle-brachial pressure index
Ratio of systolic BP at ankle and arm
Doppler US
ECG, lipids, glucose, BP
Imaging
Duplex US - what is it?
When is angiography used?
Ct angiography - what is a disadvantage of this?
MR angiography - what is a disadvantage of this?
What is the ABI?
What other tests can be used to assess severity of claudication?
Colour doppler so you can visualise flow
Helps determine site of disease
If surgery is being considered
Both - No angioplasty/stenting
Ankle-brachial index - the lower it is, the worse it is
Treadmill test - exercise tolerance
Management:
Conservative:
- advise given
- what are they referred for?
- CVD prevention med? - c
- what should be done with the foot?
- what does the vasodilator naftidrofuryl do?
Advise patients to remain active
Exervise rehabilitation programme
Clopidogrel
Foot care
Increases walking distance
Revascularisation:
Indications
Options - 4
What should be given IV for acute limb ischaemia?
Repurfusion injury - what is it?
Treatment resistant disease
Critical limb or acute limb ischaemia
Surgical bypass
Surgical endarterectomy
Radiological angioplasty - In angioplasty, x-ray fluoroscopy or other imaging is used to guide a balloon-tipped catheter (a long, thin plastic tube) into an artery or vein to where it is narrowed or blocked. The balloon is inflated to open the vessel, then deflated and removed.
Stenting
Heparin
Systemic release of substances in the damaged tissue such as potassium
What is the last resort to manage this condition?
Complications
Amputation if gangrenous
Arterial ulcers
Gangrene
Amputation
LOOK AT GANGRENE ON PAGE 660
TAO/Beurger’s Disease:
This is a type of vasculitis.
How does this disease affect the vessel?
What sized arteries does it affect?
What part of the body does it affect?
What demographic of people is this common in?
Presentation:
- What are 3 cardinal symptoms?
Treatment:
- smoking cessation
- digit protection
- arterial pumping
- non-surgical candidate
- wound care
- auto-amputation
Thromboangiitis obliterans (TAO), an inflammatory vasculopathy also known as Buerger disease, is characterized by an inflammatory endarteritis that causes a prothrombotic state and subsequent vaso-occlusive phenomena. The inflammatory process is initiated within the tunica intima.
Causes NONartherosclerotic segmental inflmammatory disease affecting small and medium-sized arteries/veins in UPPER/lower extremes
If its also upper, then it isn’t going to be common PVD from atherosclerosis
Foot claudication
Rest pain/digital ulcers
Superficial phlebitis
Young men with heavy tobacco use
Raynauds Disease:
Primary RD:
- What symptoms do they have? - 2
- What colour may the fingers turn?
- What symptoms may they have when they attempt to warm it?
- What colour do they turn?
- What may you notice when you examine the toes?
- What age group does this tend to affect?
- What sex?
- There is no inflammatory process on the skin. What do you expect to be normal?
Secondary PD:
- What extra thing may you see on examination?
- What age group does this tend to affect?
Cold fingers and toes
Numbness and tingling
Blue/white
Stinging or throbbing pain upon warming or stress relief and fingers turn bright pink or red
A rash, or thickening, or hardening of the skin
Young people - female - ESR
Takayasu arteritis:
Pulseless disease of asian young females
Termporal/giant arteritis - headache with temporal arterial thickening and rinsed ESR
Dx using biopsy
Takayasu arteritis:
Pulseless disease of asian young females
Termporal/giant arteritis - headache with temporal arterial thickening and rinsed ESR
Dx using biopsy
