Peripheral Artery Disease Flashcards Preview

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Flashcards in Peripheral Artery Disease Deck (20)
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1
Q

What are the risk factors for peripheral artery disease?

A
Smoking
Diabetes
Hypertension
Age
Hyperlipidaemia
History of coronary artery disease / cerebrovascular disease
Low levels of exercise
2
Q

What is the most common aetiology of peripheral vascular disease?

A

Atherosclerosis

3
Q

Atherosclerosis is the most common cause of peripheral vascular disease. Give examples of some rarer causes of PAD?

A
Aortic coarctation
Arterial fibrodysplasia
Arterial tumour
Arterial dissection
Arterial embolism
Thrombosis
Vasospasm
Trauma
4
Q

Describe the American cardiology society classification of peripheral artery. disease?

A

Asymptomatic
Claudication - inadequate blood flow during exercise causing fatigue, discomfort or pain
Critical limb ischaemia - compromise of blood flow to extremity causing limb pain at rest
Acute limb ischaemia - a sudden decrease in limb perfusion that threatens limb viability

5
Q

What is the main diagnostic test for peripheral artery disease?

A

Ankle brachial index

6
Q

Other than ankle brachial index, what diagnostic tests can be used in peripheral artery disease?

A
Segmental pressure examination
Duplex ultrasound
Pulse volume recording
Continuous wave doppler ultrasound
Exercise ABI
Angiography
7
Q

What are the signs and symptoms of peripheral artery disease?

A

Calf or foot cramping with walking that is relieved with rest
Thigh or buttock pain with walking that is relieved with rest
Erectile dysfunction
Pain worse in one leg
Diminished pulse

8
Q

What are the signs and symptoms of critical limb ischaemia?

A
Leg pain at rest
Gangrene
Non-healing wound / foot ulcer
Muscle atrophy
Dependent rubor
Pallor when the leg is elevated
Loss of hair over the dorsum of the foot 
Thickened toenails
Shiny / scaly skin
9
Q

What are 6 Ps which are the signs of acute limb ischaemia?

A
Pain
Paralysis
Paraesthesia
Pulselessness
Perishingly cold
Pallor
10
Q

How is the ankle brachial reflex measured?

A

Measure the systolic pressure of the left and right brachial arteries and the left and right posterior tibial and dorsals pedis arteries pressure
ABI is the highest of the dorsals pedis and posterior tibial arteries pressure divided by the higher of the left and right arm brachial artery pulse pressure

11
Q

All patients with peripheral artery disease require aggressive risk factor modification. What does this entail?

A
Control of blood pressure <130/80
Lipid control LDL <2.59 mol/l
Smoking cessation
Diabetes control
Antiplatelet therapy.
12
Q

Once the diagnosis is established, patients should be started on what drug for systemic anticoagulation?

A

Heparin

13
Q

What drug(s) should be used for analgesia in the management of acute limb ischaemia?

A

Paracetamol and an opioid

14
Q

What is the definitive management for patients with a non-viable limb with acute limb. ischaemia?

A

Amputation

15
Q

Patients with. acute limb ischaemia with a viable limb should undergo revascularisation. What techniques can be used for revascularisation?

A

Percutaneous catheter directed thrombolysis therapy
Percutaneous mechanical thrombus extraction
Thrombo-aspiration
Surgical thrombectomy
Bypass
Arterial repair

16
Q

What drugs should be used for anti platelet therapy in. the management of mild to moderate claudication?

A

Aspirin alone or clopidogrel alone

17
Q

In addition to pharmacological therapy, what treatment should patients with claudication receive?

A

Supervised exercise programme

18
Q

What drugs can be used for symptom relief in claudication?

A

Pentoxifylline
Cilostazol
Naftidrofuryl

19
Q

How should critical limb ischaemia be treated?

A

Revascularisation

Amputation. if this is not possible

20
Q

What are the possible complications of peripheral artery disease?

A

Leg / foot ulcers
Gangrene
Permanent limb weakness or numbness
Permanent limb pain