Topic: Peripheral ar
Peripheral arterial disease (PAD) is emerging as being particularly important in terms of cardiovascular risk but its importance as a clear marker for serious underlying vascular disease goes largely unrecognised, with PAD being the only cardiovascular disease not included in the Quality and Outcomes Framework. PAD is often detected late, because patients tend to think that pain in their legs is simply a part of ageing. In this article, we discuss how to recognise and treat people with, or at risk of, PAD using both pharmacological and non-pharmacological interventions. We will also consider when referral to secondary care is appropriate.
Over the years, many of the conversations I have had with patients and nurses have been about leg ulcers. It seems that there is a fear or stigma about leg ulcers, as if labelling a wound on the lower leg an ulcer will somehow make it harder to heal. In a busy practice it may seem pointless to perform a full assessment on a patient presenting with a small traumatic wound on their lower leg. But it is important to acknowledge the risk of progression from a simple wound to chronic leg ulceration and to assess patients fully for any problems that may influence wound healing or may have contributed to the tissue damage.
A new study questions the feasibility and value of primary care screening for peripheral arterial disease (PAD). The PIPETTE study is the first UK study of PAD prevalence for nearly a decade.
The direct factor Xa inhibitor rivaroxaban has been showing promise in trials in venous thromboembolism (VTE) and peripheral arterial disease (PAD). We provide details from the EINSTEIN CHOICE and COMPASS trials.
It is Friday afternoon and, checking your screen, you see your last free appointment has been given to a patient you have seen in the past for routine blood tests. This time when she enters the room you observe that her legs are covered with what looks like kitchen roll, and she is wearing supermarket carrier bags over her feet to protect her shoes. For many of us, this is a 'heart sink' patient – with heavy, wet and oedematous legs that are difficult to manage. To be able to manage this type of condition we first need to understand the possible causes of oedema, to identify patients who may be at risk for developing the problem, and to be aware when early intervention could be of benefit.
Peripheral arterial disease (PAD) forms part of the same generalised vascular disease as coronary heart disease and cerebrovascular disease. Recent National Institute for Health and Clinical Excellence (NICE) guidelines emphasise the importance of a standardised approach in primary care. The aims of this article are to provide an update for practice nurses, and to highlight the importance of asymptomatic PAD as an independent risk factor for cardiovascular morbidity and mortality.
The arteries that supply the penis are very small and may be more prone to atherosclerosis than larger vessels. This means that the penis may be the first area in a man's body to suffer from a reduction in blood flow and so signal cardiovascular disease.
Erectile dysfunction (ED) and vascular disease share the same risk factors and commonly co-exist. The presence of ED in otherwise asymptomatic men is, therefore, often a useful early warning sign of silent vascular disease. This fundamental concept highlights the importance of 'looking beyond the penis' in the evaluation of the ED patient, and challenges practice nurses to consider ED and sexual activity as part of their routine evaluation of patients. Once diagnosed, there is a range of effective treatments for ED, and guidance on how to use them safely in patients with cardiovascular disease (CVD).
Chronic leg ulcers are a major health problem in the UK, affecting many older people and costing the NHS up to £600 million per year. Chronic leg ulcers are generally managed in primary care: more than 80% of chronic leg ulcers are cared for in the community. Healing rates are currently low and recurrence rates are higher than 67%. However, appropriate use of available treatments can reduce recurrence rates to between 20% and 30%. In this article, we review the causes of venous ulceration, how to spot the problem early and how to optimise leg ulcer healing.