Arterial Disease

Question 1

Features of peripheral artery disease

Answer 1

[1] Intermittent claudication (chronic limb ischaemia)
[2] Critical limb ischaemia / CLI (S/S including ≥1 of):
- Ankle artery pressure <40mmHg
- Symptoms for >2 weeks
- Rest pain or tissue loss → ulceration/ gangrene (irreversible tissue death from poor vascular supply)
[3] Acute limb-threatening ischaemia (6Ps)

Question 2

Investigations for peripheral artery disease

Answer 2

1st: ABPI (± exercise treadmill – if intermittent claudication)
- >1.2 : Abnormal calcification (stiff arteries) in PAD with advanced age for example
- 1: Normal (cannot exclude if DM)
- 0.9-0.6: Claudication
- 0.6-0.3: Rest pain
- <0.5: critical limb ischaemia
- <0.3: Impending
2nd: Duplex USS
3rd: MRA > CTA, catheter angiography

Question 3

Management for asymptomatic, intermittent claudication

Answer 3

Conservative:
- QUIT SMOKING
- Weight loss
- exercise training programme
- foot care

Medical:
- statin + anti-platelet
(1st line: atorvastatin 80mg, clopidogrel 75mg)
Drug treatment [not often used] → naftidrofuryl oxalate(vasodilator, used in patients with a poor QoL)

Question 4

Management for symptomatic arterial disease

Answer 4

1st: angioplasty, stenting, bypass, embolectomy
2nd: Amputation
Dead (PVD/PAD severe, Thrombangiitis obliterans)
Dangerous (sepsis / NF, malignancy)
Damaged (trauma, burns, frostbite)
Damned nuisance (pain, neurological damage)

Question 5

Types of bypass

Answer 5

Anatomical: aorto-bifemoral, femoral-popliteal, femoral-distal (past popliteal area)
Extra-anatomical: axillo-femoral, fem-fem crossover

Question 6

Describe embolectomies

Answer 6

use fogarty embolectomy catheter; inserted to femoral artery at the groin and passed distal to the embolus and the balloon is inflated and withdrawn

Question 7

Fontaine classification of arterial disease

Answer 7

I: asymptomatic
IIa: mild claudicatio
IIb: moderate-severe claudication
III: ischaemic rest pain
IV: ulceration or gangrene