Peripheral Vascular Disease Flashcards Preview

Long Case - Cardiovascular > Peripheral Vascular Disease > Flashcards

Flashcards in Peripheral Vascular Disease Deck (7)
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1
Q

PVD is what?

A

Usually refers to peripheral arterial disease (=atherosclerosis)

Peripheral venous disease = chronic venous insufficiency (=valvular incompetence or obstruction of deep veins)

2
Q

Arterial and venous questions?

A

Arterial:

  • How far can you walk? What causes relief? etc
  • Do you ever get pain at rest?
  • Physical changes - cool, pale, ulcers?
  • CVD risk factors

Venous:

  • Risk factors = pregnancy, past Hx of trauma/fractures/surgery, hormones, obesity, smoking
  • Personal or family hx of thrombophilia, DVT/PE
  • Varicose veins
  • physical changes - swelling, eczema, pigmentation, ulcers
3
Q

Socrates for arterial versus venous?

A
Arterial: 
S = calves, thighs, buttocks 
O = while walking (claudication) or at rest (critical limb ischaemia) 
C = tight cramp/pain
R = ?angina
A = pallor, paraesthesia, paralysis, cold
T = predictable 
E = activity and relieved by rest 
Venous: 
S = calves, ankles 
O = gets worse as the day goes on 
C = aching or throbbing 
R = groin 
A = swelling of feet and ankles 
T = below
E = exacerbated by long periods on feet, relieved by elevation
4
Q

On Exam:

A

Arterial:

  • pallor, mottling, gangrene
  • scars, hair loss
  • ulcers = punched out, deep, regular, painful, minimal exudate

Venous:

  • varicose veins
  • hemosiderosis (red/brown deposit)
  • oedema, eczema
  • lipodermatosclerosis (shiny and red above ankles)
  • ulcers = irregular, shallow, painless, lots of exudate

PALPATION:

  • temp and cap refil
  • skin texture
  • calf tenderness
  • varicose veins, pitting oedema

PULSES:
- rate, rhythm, character, symmetry

AUSCULTATION:
- carotid, abdominal, renal and femoral

SPECIAL TESTS:
art - leg lift test 15-30 degrees till leg goes white then drop below bed for reactive hyperaemia

ven - cough impulse

5
Q

Differential Diagnosis

A

arterial:
- neurogenic claudication (spinal stenosis)
- Osteoarthritis of hip/knee
- Peripheral neuropathy

Venous:
- HF, liver cirrhosis, nephrotic syndrome, GI

6
Q

Ix

A

Basic bloods: FBC, Lipids, UEC, BGLs

Arterial:
Ankle-Brachial Pressure Index (ABPI) = 1-1.2 normal, < 0.9 is arterial disease, > 1.2 is calcified arteries
Duplex ultrasound
CT angio/MR angio if considering intervention

Venous:
Duplex USS
CT and MR venography reserved for complex abnormalities
ABPI to rule out concurrent arterial insufficiency

7
Q

Management:

A

Arterial:

  • risk factor management (smoking cessation), regular exercise)
  • Anti-platelet (clopi =1st line)
  • Statin
  • Surgical = revascularisation or amputation

Venous:

  • weight loss, exercise
  • Compression stocking
  • education about prolonged standing and elevating when possible
  • endovascular surgery