PERIPHERAL VASCULAR DISEASE
Peripheral artery disease (PAD) = narrowing of the arteries supplying the limbs and periphery, reducing blood supply to
these areas. Results in symptoms of claudication.
Acute limb ischaemia ® rapid onset of ischaemia in a limb, usually due to thrombus blocking arterial supply of a distal
limb.
Chronic limb ischaemia ® PAD that results in a symptomatic reduced blood supply to the limbs.
Critical limb ischaemia ® advanced form of chronic limb ischaemia.
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Presentation
§ Pain in the legs ® cramping, burning, worse during activity or at night when legs elevated
§ Weak peripheral pulses
§ Skin pallor
§ Cyanosis
§ Dependent rubor ® deep red colour when limb is lower than rest of body
§ Muscle wasting
§ Hair loss
§ Ulcers
§ Poor wound healing
§ Gangrene
§ Reduced skin temperature and sensation
§ Prolonged CRT (>2 seconds)
Suggestive features of risk factors on examination:
§ Tar staining
§ Xanthoma
§ Missing limbs/digits after previous amputations
§ Midline sternotomy scar, saphenous vein harvesting scar
§ Focal weakness (previous stroke).
Features of acute/critical limb ischaemia can be remembered by ‘6 P’s’ pneumonic:
Pain, Pallor, Pulselessness, Paralysis, Paraesthesia, Perishing cold.
Table 1 - Leg Ulcers
Arterial Ulcers Venous Ulcers
Caused by ischaemia 2nd to inadequate blood supply Caused by impaired drainage and pooling of blood in the
legs
§ Smaller than venous § Occur after minor injury to leg
§ Deeper than venous § Large than arterial
§ Well defined borders § More superficial than arterial
§ Have a punched out appearance § Irregular, gently sloping borders
§ Occur peripherally (on toes) § Affect the gaiter area of the leg (mid-calf down to
§ Have reduced bleeding ankle)
§ Are painful § Less painful than arterial ulcers
§ Occur with signs of chronic venous insufficiency (e.g.
haemosiderin staining and venous eczema)
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Pathophysiology
Narrowing of arteries supplying the limbs and periphery causing reduced blood supply.
§ Occurs due to atherosclerosis ® development of atheromas in artery walls
§ Atherosclerotic plaques cause:
o Stiffening of artery walls ® hypertension and strain on heart
o Stenosis and reduced blood flow
o Plaque rupture and thrombus blocking a distal vessel ® ischaemia.
Peripheral artery disease (PAD) = narrowing of the arteries supplying the limbs and periphery, reducing blood supply to
these areas. Results in symptoms of claudication.
Acute limb ischaemia ® rapid onset of ischaemia in a limb, usually due to thrombus blocking arterial supply of a distal
limb.
Chronic limb ischaemia ® PAD that results in a symptomatic reduced blood supply to the limbs.
Critical limb ischaemia ® advanced form of chronic limb ischaemia.
-----------------------------------------------------------------------------------------------------------------------------------------------------
Presentation
§ Pain in the legs ® cramping, burning, worse during activity or at night when legs elevated
§ Weak peripheral pulses
§ Skin pallor
§ Cyanosis
§ Dependent rubor ® deep red colour when limb is lower than rest of body
§ Muscle wasting
§ Hair loss
§ Ulcers
§ Poor wound healing
§ Gangrene
§ Reduced skin temperature and sensation
§ Prolonged CRT (>2 seconds)
Suggestive features of risk factors on examination:
§ Tar staining
§ Xanthoma
§ Missing limbs/digits after previous amputations
§ Midline sternotomy scar, saphenous vein harvesting scar
§ Focal weakness (previous stroke).
Features of acute/critical limb ischaemia can be remembered by ‘6 P’s’ pneumonic:
Pain, Pallor, Pulselessness, Paralysis, Paraesthesia, Perishing cold.
Table 1 - Leg Ulcers
Arterial Ulcers Venous Ulcers
Caused by ischaemia 2nd to inadequate blood supply Caused by impaired drainage and pooling of blood in the
legs
§ Smaller than venous § Occur after minor injury to leg
§ Deeper than venous § Large than arterial
§ Well defined borders § More superficial than arterial
§ Have a punched out appearance § Irregular, gently sloping borders
§ Occur peripherally (on toes) § Affect the gaiter area of the leg (mid-calf down to
§ Have reduced bleeding ankle)
§ Are painful § Less painful than arterial ulcers
§ Occur with signs of chronic venous insufficiency (e.g.
haemosiderin staining and venous eczema)
-----------------------------------------------------------------------------------------------------------------------------------------------------
Pathophysiology
Narrowing of arteries supplying the limbs and periphery causing reduced blood supply.
§ Occurs due to atherosclerosis ® development of atheromas in artery walls
§ Atherosclerotic plaques cause:
o Stiffening of artery walls ® hypertension and strain on heart
o Stenosis and reduced blood flow
o Plaque rupture and thrombus blocking a distal vessel ® ischaemia.
