Arterial Disease

Question 1

A patient with arterial disease will have widespread arterial disease. What specific parts of the arterial system should you cover on history?

Answer 1

• Cortical - TIAs
• Retinal - amaurosis fugax
• Coronary - chest pain, SOB
• Abdominal - pulsations, gut claudication after meals
• Renal - hypertension
• Gonadal - erectile dysfunction
• Peripheral - claudication (determine location to localise blockage), rest pain
• Risk factors

Question 2

Outline the vascular examination

Answer 2

• Examine leg for skin dryness, hair loss, ulceration, nail dystrophy
• Carotid pulses and auscultation
• Radial, radio-radial, radio-femoral pulses and delays
• AAA palpation
• Renal artery auscultation
• Femoral, popliteal, dorsalis pedis pulses
• Ankle-brachial index
• Buerger’s test

Question 3

You’ve performed an ankle-brachial index in a vascular patient. What do the results tell you?

Answer 3

• >1 normal
• <0.6 claudication
• <0.4 rest pain
• <0.2 gangrene

Question 4

Define clinical claudication

Answer 4

• Calf pain on exertion (+/- thigh, +/- buttock)
  
  • Onset and severity related to workload
  • Relieved with rest
  • Reproducible

Question 5

What are the clinical features of ischaemic rest pain?

Answer 5

• Pain in distal extremity
  
  • Awake with burning pain
  • Relief with gravity