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Peripheral Vascular Disease (Risk Factors (Hypercholesterolaemia,…
Peripheral Vascular Disease
Anatomy
Aorta > Common Iliac > External Iliac > Internal Iliac > Common femoral > Superficial femoral > Popliteal > Anterior tibial > Posterior tibial > Peroneal
Pathophysiology
The peripheral vessels are blocked by an atherosclerotic plaque/thrombus
There is insufficient perfusion of the lower limb resulting in lower limb ischaemia
Risk Factors
Hypercholesterolaemia
Hypertension
Diabetes
Obesity
Smoking
Age
Male gender
Family history
Symptoms
Cramping pain in calf, thigh, buttock after exercise which is relieved by rest =
intermittent claudication
Ulceration, gangrene and foot pain at rest =
critical ischaemia
Burning foot pain at night relieved by hanging legs over side of the bed
Fontaine classification for peripheral arterial disease:
Asymptomatic
Intermittent claudication
Ischaemic rest pain
Ulceration/gangrene
Claudication Distance
= Distance you can walk before pain starts
Signs
Punched out ulcers
Postural colour change
Atrophic skin
Capillary refill time >12 seconds
Cold, white legs
Absent femoral, popliteal or foot pulses
Investigations
Thrombophilia screen and serum homocystein
Ankle-brachial pressure index from Doppler
FBC to test for anaemia
MRI/CT angiography
Exclude diabetes mellitus and arteritis (ESR/CRP)
Colour duplex ultrasound
Treatment
Risk Factor Modification
Control BP and cholesterol
Clopidogrel/aspirin to thin blood + prevent clots
Smoking cessation
Manage Claudication
Supervised exercise programmes - reduce symptoms by improving collateral blood flow. Patient should exercise to the point of maximal pain
Vasoactive drugs if revascularization is not an option
Revascularization
Percutaneous transluminal angioplasty - balloon is inflated in narrowed vessel with a stent to maintain patency
Surgical reconstruction via an arterial bypass graft - autologous vein grafts are superior to prosthetic grafts