Chronic Peripheral Arterial Occlusive Disease Flashcards Preview

CLP - Vascular > Chronic Peripheral Arterial Occlusive Disease > Flashcards

Flashcards in Chronic Peripheral Arterial Occlusive Disease Deck (11):
1

progression of chronic lover limb peripheral arterial disease

asymptomatic
intermittent claudication
ischaemic rest pain
ulceration/gangrene

2

causes

atherosclerosis
fibromuscular dysplasia (non-inflammatory artery wall thickening)
Buerger's disease (acute inflammation and thrombosis of lower limb aa and vv, common in young heavy smokers)

3

what is intermittent claudication

angina of the leg
narrowing or blocking of femoral artery due to atherosclerosis
calf, thigh, buttocks

management - strengthen collaterals

4

symptoms of intermittent claudication

ischaemic cramping muscle pain on walking
relieved by rest
claudication distance
most common in calf = femoral disease
pain in thigh/buttocks = ileac disease (often bilateral) - ask about penile function

5

signs of intermittent claudication

absent pulses
cold, pale legs
atrophic, hairless, shiny skin
Beurger's angle <20 degress
- look for reactive hyperaemia
arterial ulcers

6

what is ischaemic rest pain and critical limb ischaemia?

occurs at night in forefoot
- R gravity and R BP
pain wakes from sleep
- relief by swinging leg over side of bed or cold floor
Hx of IC and signs of arterial insufficiency
impaired healing
gangrene
dependent rubor
pallor on elevation
delayed cap refill

7

ABPI

ABPI = BPleg/BParm
0.8-1 normal
1.2 diabetes
0.5-0.8 ischaemia
<0.5 critical ischaemia

8

if severe ABPI, what management?

PTA
surgical reconstruction
sympathectomy
amputation

9

peripheral neuropathy effects

sensory neuropathy (reduced awareness of symptoms)
autonomic neuropathy (reduced sweating)
motor neuropathy (muscle wasting, pressure areas)

10

difference between ischaemic rest pain and neuropathy

PN - stabbing pain, pulses, red/warm, tingling and numbness, not relieved by swinging leg, stocking glove distribution, hyperalgesia, allodynia
IRP - worse on raising leg, Buergers test

11

differential diagnosis to intermittent claudication

spinal stenosis:
spinal osteophyte
lumbar nerve root/cauda equina compression
pain relieved by sitting down or flexing spine
variable timing of symptoms
numbness, tingling
present pulses
venous claudication:
gradual onset from moment walking starts
pain affects all leg
leg elevation can relieve pain
OA/RA
peripheral neuropathy
popliteal artery entrapment (young pts, normal pulses)