Acute Peripheral Vascular Disease

Question 1

Three main patterns of presentation seen in patients with peripheral arterial disease

Answer 1

Intermittent claudication, critical limb ischaemia, acute limb threatening ischaemia

Question 2

What are the symptoms of acute limb threatening ischaemia

Answer 2

Pale, pulseless, painful, paralysed, paraesthetic and perishing (cold)

Question 3

Initial investigations into PVD

Answer 3

Doppler examination, then ABI.

Question 4

Factors suggesting thrombotic cause

Answer 4

Pre-existing claudication with sudden deterioration, no obvious sources of emboli, reduce or absent pulses in contralateral limb, evidence of widespread vascular disease (MI, TIA)

Question 5

Factors suggesting embolic cause

Answer 5

Sudden onset of painful leg, no history of claudication or PVD. Obvious source of embolus (AF, recent MI), evidence of proximal aneurysm (abdominal or popliteal)

Question 6

Initial management of acute limb ischaemia

Answer 6

ABC approach, analgesia (opioids), IV unfractioned heparin, vascular review

Question 7

Definitive management of acute limb-threatening ischaemia

Answer 7

Intra-arterial thromblysis, surgical embolectomy, angioplasty, bypass surgery, amputation for those with irreversible ischaemia

Question 8

Symptoms of critical limb ischaemia

Answer 8

Rest pain in foot for more than 2 weeks, ulceration, gangrene

Question 9

What are the results of ABPI suggestive of

Answer 9

1 = normal
0.6-0.9 = claudication
0.3-0.6 = rest pain
<0.3 = impending

Question 10

Symptoms of intermittent claudication

Answer 10

Aching or burning in the leg muscles following walking, typically walk for a predictable distance before symptoms start, relieved within minutes of stopping, not present at rest

Question 11

Options for vascular repair

Answer 11

Endovascular rebascularisation or surgical revascularisation