Peripheral vascular disease (acute and chronic limb ischaemia)

Question 1

Define peripheral vascular disease

Answer 1

Occurs due to atherosclerosis causing stenosis of arteries via a multifactorial process involving modifiable and non-modifiable risk factors

Question 2

Explain the aetiology/risk factors of peripheral vascular disease

Answer 2

Occurs due to ATHEROSCLEROSIS in peripheral arteries

Types of PVD include:
Intermittent claudication - calf pain on exercise

Critical limb ischaemia - pain at rest
(NOTE: this is the MOST SEVERE manifestation of peripheral vascular disease)

Acute limb ischaemia - a sudden decrease in arterial perfusion in a limb, due to thrombotic or embolic causes

Arterial ulcers

Gangrene

Risk Factors are same as the risk factors for any other atherosclerotic disease

Question 3

Summarise the epidemiology of peripheral vascular disease

Answer 3

55-70 yrs = 4-12% affected

70+ yrs = 15-20% affected

More common in MALES

Incidence increases with AGE

Question 4

Recognise the presenting symptoms of peripheral vascular disease

Answer 4

Intermittent claudication -cramping pain in the calf, thigh or buttock after walking a given distance (claudication distance) and relieved by rest

Calf claudication = femoral disease
Buttock claudication = iliac disease

Features of Critical Limb Ischaemia
Ulcers
Gangrene
Rest pain
Night pain (relieved by dangling leg over the edge of the bed)

Leriche Syndrome (aortoiliac occlusive disease)
Buttock claudication
Impotence
Absent/weak distal pulses

Fontaine Classification of Peripheral Vascular Disease
Asymptomatic
Intermittent Claudication
Rest pain
Ulceration/gangrene

Question 5

Recognise the signs of peripheral vascular disease on physical examination

Answer 5

Acute Limb Ischaemia
6 Ps
Pain
Pale
Pulseless
Paralysis
Paraesthesia
Perishingly Cold

Other symptoms:
Atrophic skin
Hairless
Punched-out ulcers (often painful)
Colour change when raising leg (to Buerger's angle)

Question 6

Identify appropriate investigations for peripheral vascular disease

Answer 6

Full cardiovascular risk assessment
Blood pressure
FBC- anaemia will worsen ischaemia
Fasting blood glucose
Lipid levels
ECG-check for pre-existing coronary artery disease
Thrombophilia screen - for patients < 50 yrs

Colour Duplex Ultrasound - FIRST-line
Shows site and degree of stenosis

MRI/CT - Assesses extent and location of stenoses

ABPI (Ankle-Brachial Pressure Index)
Marker of cardiovascular disease
ABPI < 0.8 = do NOT apply a pressure bandage because this will worsen ischaemia