Arterial Disease

Question 1

Types

Answer 1

Acute Limb Ischaemia (ALI)

Critical/Chronic Limb Ischaemia (CLI)

Question 2

Disease proesses that exacerbate chronic arterial ischaemia

Answer 2

DM,HBP,Smoking,Hyperlipidemia, previous limb injury/surgery

Question 3

CAI

Answer 3

May be modified by collateral blood flow
Adequate to supply resting limb
Insufficient to meet additional requirements in moderate exercise

Question 4

Hallmarks of Chronic lower limb ischaemia

Answer 4

Recurring ischarmic rest pain >2wks and requiring regular analgesics
Ankle systolic pressure <50mmHg
Toe systolic <30mmHg
Ulceration/gangrene of foot and toes

Question 5

Chronic PVD presenting complaints

Answer 5

Claudication
Rest pain
Reduced sensation
Discolouration - Buergers rest
Ulceration/poor healing/ Tissue necrosis
Night pain in food relieved by dependency or walking
Skin,shiny and scaly

Question 6

Clinical investigation of Chronic PVD

Answer 6

Blood tests - renal and liver FTs - exclude anaemia, polycythaemia, hyperglycemia thrombocythaemia, hyperlipidemia
Ankle -Brachial pressure Index ABPI - normal 1, 0.9 arterial disease, <0.5 severe arterial insufficiency
Duplex Ultrasound
Digirl subtraction angiography
MR A or CTA

Question 7

Treatement of Chronic PVD

Answer 7

Prevention of progresion
Smoking cessation
Statims
Anticoagulants -aspirin
Beta blockers

Question 8

Causes of Acute arterial ischaemia of lower limb

Answer 8

Embolic
Thrombotic
Traumatic
Iatrogenic

Question 9

Clinical features of acute PVD

Answer 9

Occlusion - 6p's
Pallor
Pain
Perishing cold
Pulselessness
Paralysis
Paresthesia

Severe constant ache
Progression - blotchy areas of cyanosis and further discolouration

Question 10

Clinical investigation acute PVD

Answer 10

Doppler US
CXR, ECG
MR Angiogram’s - very good at detecting distal arterial clots,
CT angiogram would be better at detecting more proximal clots

Question 11

DDx for acute PVD

Answer 11

Compartment syndrome
Baker's cyst
Cellulitis
CVA
MI 
Neuorological disorders

Question 12

Management of Acute PVD

Answer 12

if viable
Urgent revascularisation - if neurological deficit ; surgery thrombectomy, thrombo-aspiration and thrombus extraction
Percutaneous catheter dilated thrombolytic therapy
Amputation if limb unsalvageable

Follow up -
Smoking management
Diet, weight
pipid modification 
Diabetes maintenance
HBP management
Antiplatelet therapy

Question 13

Management of Critical limb ischaemia

Answer 13

Refer to vascular multidisciplinary team
Manage pain - paracetamols, opiods depending on pain - laxatives and anti-emetics
Offer advise on the disease
Manage cardiovascular risk