Chronic Limb Ischaemia/Peripheral Artery Disease (PAD/PVD)

Question 1

What are patients with PVD/PAD at high risk of developing or dying from?

Answer 1

• CHD

Question 2

Who should patients with PVD/PAD be treated in the same way?

Answer 2

• Patients who have established CHD because they are so at risk of it

Question 3

What is the cardinal sign of PVD/PAD?

Answer 3

• Intermittent claudication

Question 4

What is intermittent claudication?

Answer 4

• Cramp like pain in muscles of the leg occuring on exercise (usually walking)

Question 5

What relieves intermittent claudication?

Answer 5

• Rest

Question 6

What three muscles are mostly affected by intermittent claudication?

Answer 6

• Buttocks
• Thigh
• Mostly the calfs

Question 7

What are the requirements for severe limb ischaemia?

Answer 7

• Rest pain for more than 2 weeks a year
• Tissue loss
• ABPI (ankle brachial pressure index) under 0.5

Question 8

What is the ankle brachial pressure index?

Answer 8

Ratio of blood pressure in ankle vs blood pressure in the upper limb

Question 9

What is critical limb ischaemia?

Answer 9

• Absolute ankle pressure <50mmHg

Question 10

What is the treatment for critical limb ischaemia?

Answer 10

• Same prevention methods as severe ischaemia

- May require amputation

Question 11

What can result from critical limb ischaemia?

Answer 11

• Gangrene
• Ulceration
• Rest pain
• Sleep disturbances

Question 12

What are the 6 P’s?

Answer 12

• Pain
• Pallor
• Pulseless
• Parasthesia
• Paralysis
• Poikilothermia

Question 13

What are the risk factors?

Answer 13

• Lipids
• Smoking
• Hypertension
• Diabetes
• Exercise

Question 14

What conditions may increase the likelihood of developing chronic limb ischaemia?

Answer 14

• Atherosclerosis
• Diabetes mellitus
• Beurgers disease
• Hyperhomocysteinaemia

Question 15

What is beurgers disease?

Answer 15

• Inflammation and thrombosis in small and medium blood vessels of the legs leading to gangrene

Question 16

What are the initial investigations of chronic limb ischaemia?

Answer 16

• History
• Examination
• Ankle brachial pressure index (ABPI)
• Screen for diabetes

Question 17

What is the ABPI?

Answer 17

• Ankle pressure/brachial pressure

- If below 0.5 then severe limb ischaemia

Question 18

What is the first line of treatment for claudication/critical limb ischaemia?

Answer 18

• Try and prevent CHD

Question 19

What 3 drug treatments should be used to prevent CHD?

Answer 19

• Anti platelets
• Statins
• ACEi
• SMOKING CESSATION

Question 20

What anti platelets should be started?

Answer 20

• Aspirin

- Clopidogrel

Question 21

What patients should be started on a statin?

Answer 21

• Those with LDL level of >3.5mmol/L

Question 22

What should the ACEi be used for?

Answer 22

• Treating hypertension

Question 23

What is the BP target when using ACEi?

Answer 23

• 140/85

Question 24

What other levels in the blood should be controlled?

Answer 24

• Glucose levels

Question 25

What does reducing glucose levels prevent?

Answer 25

• Microangiopathy

Question 26

What surgical options are available?

Answer 26

• Angioplasty

- Amputation

Question 27

When are surgical options explored?

Answer 27

• When pharmacotherapy fails

Question 28

What patients can have surgery?

Answer 28

• Those with good control of risk factors
• Poor quality of life
• Acceptable co morbidity
• Informed consent

Question 29

What angioplasty technique is used?

Answer 29

• Percutaneous transluminal angioplasty

Question 30

What is PTA?

Answer 30

• Revascularisation

Question 31

Why is PTA rarely used in CLI?

Answer 31

• Only suitable for minority of individuals

Question 32

What are the initial investigations in severe limb ischaemia?

Answer 32

• ECG
• CxR
• Routine bloods
• Crossmatch