1. Peripheral vascular disease

Question 1

How common is it?

Answer 1

10% prevalence

15-20% of >70s

Question 2

Who does it affect?

Answer 2

Patients with pre-existing risk factors
Uncommon in the young, increased with age
M>F

Question 3

How does it present?

Answer 3

Cramping pain in calf, thigh, buttock after exertion - relieved on rest
Ulceration, gangrene etc are signs of critical limb ischaemia

Question 4

What risk factors are there?

Answer 4

Cardiovascular risk factors

Coronary artery disease

Question 5

What causes it?

Answer 5

Atherosclerosis of arteries supplying lower limbs most commonly
Rarely caused by vasculitis
Res

Question 6

What other conditions might present similarly?

Answer 6

Diabetes

Arteritis

Question 7

How would you investigate?

Answer 7

FBC, U+E, lipids, HbA1c, ECG (cardiovascular risk assessment)
ABPI (PVD = 0.5-0.9)
Doppler US, CT / MR angiography

Question 8

What treatments are there?

Answer 8

Risk factor modification
Clopidogrel
Statins
Supervised exercise programs
In severe cases : percutaneous transluminal angioplasty, surgical reconstruction, amputation

Question 9

What complications are there?

Answer 9

Gangrene –> sepsis
Psychosocial consequences
Critical limb ischaemia –> amputation
Compartment syndrome

Question 10

What are the stages of chronic limb ischaemia according to the Fontaine classification?

Answer 10

Stage I = asymptomatic
Stage II = intermittent claudication
Stage III = ischaemic rest pain
Stage IV = ulceration and / or gangrene