Table of Contents
Learn the focussed examination too…
The peripheral arterial focussed examination covered here!
Clinical features
Acute limb ischaemia
- Occurs due to thrombus (acute on chronic) or emboli
- 6 P’s: Pale, Pulseless, Paraesthesia, Paralysis, Pain, Perishingly cold
Intermittent claudication
- Calf pain on exertion which is relieved by rest (check claudication distance)
Critical ischaemia
- Chronic rest pain (often at night, relieved by hanging legs over bed)
- Tissue loss (e.g. arterial ulcers, gangrene)
Investigations
- Ankle-brachial pressure index
- <0.9 = intermittent claudication
- <0.6 = rest pain
- <0.3 = critical ischaemia
- NB: ABPI may be falsely elevated in patients with calcified arteries.
- Imaging
- Duplex ultrasound (first line imaging)
- MR or CT angiography (second line imaging, MR preferred but CT more widely available)
- Catheter angiography (third line)
- Bloods: lipid levels, fasting glucose, FBC (rule out anaemia), U&Es (to check renal function prior to contrast), coagulation screen
- ECG: to look for AF as a cause of emboli
Management
- Risk factor control
- Antiplatelet therapy (aspirin or clopidogrel)
- Lipid lowering therapy (statin)
- Smoking cessation
- Diet, weight management and exercise
- BP and diabetes control
- Supervised exercise regimen (for intermittent claudication)
- Naftidrofuryl oxalate (for intermittent claudication) – rarely successful
- Revascularisation for acute ischaemia
- Percutaneous catheter-directed thrombolytic therapy
- Percutaneous transluminal angioplasty (stent)
- Surgical embolectomy
- Revascularisation for chronic ischaemia
- Percutaneous transluminal angioplasty (stent) – if possible (i.e. short segment, not at knee joint, good run-off)
- Vascular bypass grafting
- Debridement/amputation for gangrene or non-viable limbs
Reference: NICE ‘CG147 Peripheral arterial disease: diagnosis and management’ 2020
Vascular bypass procedures
Some questions
What are the risk factors for peripheral arterial disease?
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What is Leriche syndrome?
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