Peripheral Arterial Disease and Abdominal Aortic Aneurysm
Learning Outcomes
- Describe initial assessment of a patient with peripheral vascular disease and
AAA (history and physical examination)
- Recognize the most common symptoms of peripheral arterial disease and AAA
- List most common complications of peripheral arterial disease and AAA,
including acute limb ischemia
- Choose appropriate investigations relevant to a patient with suspected peripheral
arterial disease and AAA
- Explain the principles of conservative and surgical treatment of peripheral arterial
disease and AAA
- Use effective strategies (e.g. communication, collaboration, interventions) as part
of a multidisciplinary and interprofessional team to manage patient with
peripheral arterial disease and AAA
Arterial Ulcers
- Also known as ischemic ulcers
- Occurs due to insufficient blood supply as a result of
peripheral arterial disease (think of it as a complication)
- Ischemia -> necrosis -> ulcer formation
- Usually occur in areas prone to pressure or injury and in distal
sites
- Location: commonly on toes, feet, and lateral malleoulus
- Appearance:
o Well-defined and punched out edges
o Dry necrotic base
- Surrounding skin:
o Cool (makes sense cuz no blood is reaching and
blood is warm)
o Pale (makes sense cuz no blood is reaching)
o Shiny
o Possible hair loss
- Signs and Symptoms
o Pain
o Decreased pulses in affected limb
o Delayed capillary refill
Peripheral Arterial Disease (PAD)
- Chronic condition causing reduced blood flow to
the extremities
- Primary cause is atherosclerosis
- Less common causes include vasculitides e.g.
Buerger's disease
, - Acute Arterial Occlusion: Sudden blockage of an artery, often from an
embolism or thrombosis, leading to tissue ischemia and ulceration
- Risk factors include:
o Sedentary Lifestyle
o Smoking
o Diabetes Mellitus
o Hypertension
o Hyperlipidemia
o Age
o Gender: males generally but females risk increases post-menopause
o Obesity
o Genetic Predisposition: family history of cardiovascular disease or PAD
may increase susceptibility to arterial ulcers
o Prior Arterial Disease
o Trauma or injury
Diagnosing Peripheral Arterial Disease
- Ankle-Brachial Index (ABPI)
o Measures the ratio of the blood pressure in the ankle to that in the arm
(brachial artery) to assess blood flow
o Ankle pressure / Arm pressure = ABPI
o Normal = >0.9
o Mild = 0.8-0.9
o Moderate = 0.5-0.8
o Severe = <0.5
- Doppler Ultrasound
- Angiography
o Considered in severe cases to visualize arterial occlusions and plan for
revascularization
Management
- Conservative treatment
o Wound care
● Debridement: Removal of necrotic tissue to promote healing.
● Dressings: Use of non-occlusive dressings to maintain a dry
environment.
o Pain Management: Use of analgesics, particularly for rest pain
- Medical management
o Pharmacotherapy
● Antiplatelet Agents: Aspirin or clopidogrel to prevent further arterial
occlusion.
● Vasodilators: Medications like cilostazol to improve blood flow.
o Lifestyle Modifications
Learning Outcomes
- Describe initial assessment of a patient with peripheral vascular disease and
AAA (history and physical examination)
- Recognize the most common symptoms of peripheral arterial disease and AAA
- List most common complications of peripheral arterial disease and AAA,
including acute limb ischemia
- Choose appropriate investigations relevant to a patient with suspected peripheral
arterial disease and AAA
- Explain the principles of conservative and surgical treatment of peripheral arterial
disease and AAA
- Use effective strategies (e.g. communication, collaboration, interventions) as part
of a multidisciplinary and interprofessional team to manage patient with
peripheral arterial disease and AAA
Arterial Ulcers
- Also known as ischemic ulcers
- Occurs due to insufficient blood supply as a result of
peripheral arterial disease (think of it as a complication)
- Ischemia -> necrosis -> ulcer formation
- Usually occur in areas prone to pressure or injury and in distal
sites
- Location: commonly on toes, feet, and lateral malleoulus
- Appearance:
o Well-defined and punched out edges
o Dry necrotic base
- Surrounding skin:
o Cool (makes sense cuz no blood is reaching and
blood is warm)
o Pale (makes sense cuz no blood is reaching)
o Shiny
o Possible hair loss
- Signs and Symptoms
o Pain
o Decreased pulses in affected limb
o Delayed capillary refill
Peripheral Arterial Disease (PAD)
- Chronic condition causing reduced blood flow to
the extremities
- Primary cause is atherosclerosis
- Less common causes include vasculitides e.g.
Buerger's disease
, - Acute Arterial Occlusion: Sudden blockage of an artery, often from an
embolism or thrombosis, leading to tissue ischemia and ulceration
- Risk factors include:
o Sedentary Lifestyle
o Smoking
o Diabetes Mellitus
o Hypertension
o Hyperlipidemia
o Age
o Gender: males generally but females risk increases post-menopause
o Obesity
o Genetic Predisposition: family history of cardiovascular disease or PAD
may increase susceptibility to arterial ulcers
o Prior Arterial Disease
o Trauma or injury
Diagnosing Peripheral Arterial Disease
- Ankle-Brachial Index (ABPI)
o Measures the ratio of the blood pressure in the ankle to that in the arm
(brachial artery) to assess blood flow
o Ankle pressure / Arm pressure = ABPI
o Normal = >0.9
o Mild = 0.8-0.9
o Moderate = 0.5-0.8
o Severe = <0.5
- Doppler Ultrasound
- Angiography
o Considered in severe cases to visualize arterial occlusions and plan for
revascularization
Management
- Conservative treatment
o Wound care
● Debridement: Removal of necrotic tissue to promote healing.
● Dressings: Use of non-occlusive dressings to maintain a dry
environment.
o Pain Management: Use of analgesics, particularly for rest pain
- Medical management
o Pharmacotherapy
● Antiplatelet Agents: Aspirin or clopidogrel to prevent further arterial
occlusion.
● Vasodilators: Medications like cilostazol to improve blood flow.
o Lifestyle Modifications
