Peripheral Vascular disease Flashcards
Define Peripheral Vascular disease
Obstruction or narrowing of arteries distal to the aorta and not within the coronary or brain circulation
How is Peripheral Vascular disease classified
I aspymptomatic
II intermittent claudication
IIa pain with walking more than 200m
IIb pain with walking less than 200m
III rest/nocturnal pain
IV Necrosis and gangrene
Epidemiology of Peripheral Vascular disease
Affects 4-12% of people aged 55-70yrs
15-20% of people aged >70yrs
7% of middle aged men
4.5% of middle aged women
strongly age related
Signs of Peripheral Vascular disease
6 Ps of acute limb ischaemia
Pallor - redness may return on lowering leg
Pulslessness - absent femoral, popliteal, or foot pulses
Pain
Paralysis
Parasthesia - pins and needles
Perishing with cold
Symptoms of Peripheral Vascular disease
Cramping felt in calf, thigh or buttock after walking for a given distance
Pain resolves with rest
Pain at night resolving by hanging leg out of bed
Male impotence - Leriche syndrome
Painful ulcer with well defined edges and necrotic tissue
Gangrene
What is Leriche syndrome
It is when there is buttock pain and male incompetence in PVD
Obstruction of flow as its transition to the common illiacs
Differential diagnosis of Peripheral Vascular disease
Sciatica
Spinal cord claudication
DVT
vascular claudication vs spinal cluadication
vascular claudication - worse going uphill and improves when standing still
spinal cluadication - worse when going down hill
Investigations of Peripheral Vascular disease
Ankle brachial pressure index (ABPI), can perform on exercise
Duplex USS - if ABPI abnormal, to assess extent of atherosclerosis
MR/CT angiography - if intervention is required
How to interpret ABPI
Right ABPI = Highest of right ankle pressure/ Highest of arm pressure
Left ABPI = Highest of left ankle pressure/ Highest of arm pressure
<1 = circulatory problems
> 0.9 = Borderline - higher prognosis
0.5-0.9 = PAD
<0.5 critical limb ischaemia - low prognosis
Conservative Management of peripheral vascular disease
Risk factor modifications:
Smoking cessation
Treat HTN and high cholestrol
lose weight
DM control
Exercise to point of maximal pain
supervised exercise programme
Medicine Management of peripheral vascular disease
Clopidogrel to reduce MI/stroke 1st line
Vasoactive drugs Naftidrofuryl oxalate
Surgical management of peripheral vascular disease
Percutaneous translumanal angioplasty
Surgical reconstruction - bypass graft
Amputation - <3% require it within 5 years, knee should be preserved wherever
Acute ischemic leg
embolectomy via fogarty catheter
