Flashcards in Peripheral Vascular Disease (PVD) Deck (19)
What causes peripheral vascular disease?
Atherosclerosis builds up in arteries of the limbs (mostly legs) and causes stenosis. This leads to decreased blood supply and oxygen to the muscle causing ischaemia. Ischaemia releases adenosine which causes nerve pain = claudication.
Name risk factors of peripheral vascular disease
Family history of PVD
What is claudication?
limb pain (including aching, cramping and tired feelings of legs) upon exertion
What is claudication distance?
The distance a patient can walk before they experience symptoms
Symptoms of peripheral vascular disease in the legs and feet can be divided into 2 categories. What are they?
Mild - intermittent claudication
Severe - critical limb ischaemia (ulceration, gangrene and claudication/foot pain at rest and night - made better by hanging leg over side of bed)
peripheral vascular disease in the iliac and femoral arteries cause pain where?
Iliac artery - buttocks pain
Femoral artery - calf pain
What are the 5P's of arterial occlusion?
What is Leriche syndrome?
Buttock claudication +/- impotency (erectile dysfunction)
What is the name of the classification system for peripheral vascular disease and what are the stages?
Fontaine stages for chronic limb ischaemia
1 - asymptommatic
2 - intermittent claudication
3 - critical ischaemia
4 - necrosis, gangrene, ulceration
What Investigations would you do for a patient with peripheral vascular disease?
Bedside - Buergers test, ABPI, BM, ECG
Bloods - FBC (anaemia, polycythaemia), U&Es (renal disease), ESR/CRP (arteritis), lipids
Imaging - 1st line = colour duplex ultrasound scan, MR/CT angio if considering intervention
What is Buergers test?
Angle that the leg goes pale when raised off the couch lying down.
What Buergers angle and capillary filling time are found in severe ischaemia?
Buergers angle <20 degrees and >15seconds filling time
How do you perform and calculate an ABPI?
1. Blood pressure on both arms - take the highest reading
2. BP in both ankles - take highest reading
All using ultrasound device
3. Divide ankle systolic BP over brachial systolic BP
Explain ABPI scores and meanings
0.9-1.2 = normal
0.9-0.5 = peripheral arterial disease
<0.5 = critical ischaemia
>1.3 = calcified vessels give fasely high results
Management of peripheral vascular disease?
1. Conservative - stop smoking, loose weight, supervised exercise programmes
2. Control risk factors - diabetes, HTN, antiplatelet agents (clopidogren)
3. symptom management - raise pillow under legs at night can help with pain, foot care
4. Surgery: PTA (percutaneous transluminal angioplasty), surgical reconstruction and bypass graft, amputation.
What are the two main causes of acute limb ischaemia?
Thrombus - previously diseased arterial tree
Emboli - previously healthy arterial tree i.e. AF
- compartment syndrome
- angioplasty occlusion
What are the 6P's of acute limb ischaemia?
What is the Management for acute limb ischaemia?
It is an emergency! Must get revascularisation surgery within 4-6hours
1. Call vascular reg
2. bloods - FBC, U&Es, coagulation studies,Group and save
3. other Ix: ECG, CXR
4. Analgesia, commence IV heparin, call radiology for angiography if limb is still viable