Peripheral vascular disease

From Ganfyd

Usually used in the sense of atheromatous disease in the periphery. Some prefer the more precise term peripheral occlusive arterial disease.

Peripheral arterial disease

Found mostly in smokers, and those with diabetes, hyperlipaedemias or the very old. The underlying pathogenesis is atherosclerosis of the arterial tree, usually distal to the bifurcation of the aorta. It can result in critical limb ischaemia which has a worse prognosis that stable coronary heart disease or cerebrovascular disease.

Symptoms

• Claudication
• Rest pain
• Gangrene
• Leriche's syndrome

Fontaine Stages

1. Asymptomatic
2. Intermittent claudication
3. Ischaemic rest pain in limbs
4. Necrosis and gangrene in limbs

Investigation

• Ankle-brachial pressure index (ABPI)
• Ultrasound duplex
• CT angiogram
• MRI angiogram

Treatment

• Secondary prevention of atherosclerosis

Drugs

• Aspirin, other antiplatelet agents and statins are standard
• Anticoagulation may buy time for surgical intervention in in critical limb ischaemia
• Vasodilators are generally ineffective
  • Even non-viral 1 fibroblast growth factor does not work in critical limb ischaemia^[1]
• Naftidrofuryl oxalate has current evidence of resource effectiveness in intermittent claudication^[2]
• Unproven drugs in intermittent claudication include^[2]:
  • Cilostazol
  • Pentoxifylline
  • Inositol nicotinate

Surgery

• Revascularisation
• Stents