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Peripheral Vascular Disease- Chronic Limb Ischaemia (Aetiology (standard…
Peripheral Vascular Disease- Chronic Limb Ischaemia
Define: Peripheral Vascular disease is a condition characterised by significant dilatation of the arteries distal to the Aorta
Critical Limb Ischaemia
is the most common and severe clinical manifestation of PAD
Defined as ischaemic lesions,
presence of ischemic rest pain (continuous pain in the legs) or gangrene which is attributable to
arterial occlusive disease
Acute limb ischaemia
is a sudden decrease in arterial perfusion in the limb due to a thrombus or an embolic cause
Aetiology (standard CHD causes)
High blood pressure
Diabetes mellitus
Alcohol
Hyperlipidaemia
Smoking
Physical inactivity
Obesity
Epidemiology
This is a condition that affects more men than women
It is present in 7.5% of the male and 4.5% of the female population
Pathophysiology
This happens in a chronic setting due to atherosclerosis
This happens in an acute setting due to emboli/thrombi
Most common site is the bifurcation of the femoral artery
Clinical Presentation
Chronic Lower Limb Ischaemia
Stage II- i
ntermittent claudication (inadequate blood flow to muscles). Patients will present with
exertional discomfort
in the calf and also in the thigh, hip or buttock
Stage III- r
est pain/nocturnal pain. This is a severe unremitting pain in the foot and stops the patient from sleeping.
It is relieved by dangling food over an edge or standing on a cold floor
Stage I - asymptomatic
Stage IV-
Necrosis/gangrene. The lower limbs are cold and have a
lack of hair/are cold.
There may be diminished pulses or absent pulses. The toes may be darkly discoloured or gangrened
Abdomen should be examined for a possible abdominal aneurysm
Differential Diagnosis
PERIPHERAL NEUROPATHY
OSTEOARTHRITIS OF THE HIP/KNEE
SPINAL CORD COMPRESSION
DIAGNOSIS
Duplex US
CT
Severity is determined using an ankle/brachial pressure index. Intermittent claudication= ABPI of 0.5-0.9. Values of <0.5 are associated with critical limb ischaemia
Magnetic Resonance Angiography
Treatment
Aspirin to reduce MI risk
Reduce RF
Naftidrofuryl- a vasodilator agent that inhibits vascular and platelet receptor (5 HT2 receptors so reduces lactic acid .
Cilostazol is a phosphodiesterase inhibitor that increases the levels of cyclic AMP and the products of vasodilation and reversibily inhibits platelet aggregation
Bypass Procedure
Percutaneous transluminal angioplasty (cathether in the femoral artery)
Upper extremity artery disease
Subclavian and brachiocephalic trunk are the most common locations for atherosclerotic lesions
Pulse defecit, arm pain, pallor paraestheia, coldness and unequal arm pressures (more than 15mmHg) are all signs
Investigations: blood pressures on both arms, duples US, CT angiography and MR angiography
Control risk factors
Revascularisation