(Endocrine & Metabolic) (GP)

Overview

• Disease characterised by narrowing and occlusion of the peripheral arteries due to atherosclerotic plaques
• More common in males, incidence increases with age
• Risk Factors → smoking (main RF), diabetes, hypertension, hyperlipidaemia, physical inactivity, obesity, hx/FH of coronary artery disease
• Fontaine Classification of PVD
• Claudication → pain on exertion. Inadequate blood flow during exercise, causing fatigue, discomfort, or pain.
• Critical Limb Ischaemia → compromise of blood flow to an extremity, causing chronic limb pain at rest (worse at night) for at least 2 weeks. Patients can develop arterial ulcers or gangrene.
• Acute Limb Ischaemia → sudden decrease in limb perfusion that threatens limb viability. Associated with the "6 Ps": pain, paralysis, paraesthesia, pulseless, pallor, and perishingly cold. AF = major risk factor. Tx with IV Heparin.

Buerger’s Disease ⇒ young male smoker with symptoms similar to limb ischaemia. Symptoms include paraesthesia/cold sensation in fingers or limbs and raynaud’s phenomenon.

Making Diagnosis

Clinical Features:

• Most patients are asymptomatic, and diagnosis is based on risk factors
• Intermittent Claudication → cramping pain of leg which is worse upon exertion, relieved by rest
• Thigh or Buttock pain when walking → relieved by rest
  • Femoral Artery ⇒ calf pain
  • Iliac Artery ⇒ buttock pain
• Diminished or absent pulse