CV: Peripheral vascular disease

Question 1

What are the two types of peripheral vascular disease?

Answer 1

Occlusive (Intermittent Claudication) in which occlusion of the peripheral arteries is caused by atherosclerosis, or vasoplastic (e.g. Raynaud’s syndrome).

Question 2

Naftifrofuryl oxalate can alleviate the symptoms of what type of peripheral vascular disease? intermittent claudication or Raynaud’s?

Answer 2

BOTH:
Intermittent claudication. IT can improve pain-free walking distance in moederate disease.

Patients taking naftidrofuryl oxalate should be assessed for improvement after 3-6 months.

Question 3

Cilostazol is licensed for use in what? intermittent claudication or Raynaud’s?

Answer 3

Cilostazol is licensed for use in intermittent claudication to improve walking distance in patients without peripheral tissue necrosis who do not have pain at rest; use is restricted to second-line treatment where lifestyle modifications and other appropriate interventions have failed to improve symptoms.

Question 4

Patients receiving cilostazol for intermittent claudication should be assessed for improvement after how long?

Answer 4

3 months; consider discontinuation of treatment if there is no clinically relevant improvement in walking distance.

Question 5

What is a treatment option for critical limb ischaemia in patients unsuitable for surgery? (Off-label use)

Answer 5

Intravenous iloprost.

Question 6

What does the management of Raynaud’s syndrome comprise of? (2)

Answer 6

1. Avoidance of exposure to cold.

2. Stopping smoking.

Question 7

Which CCB is useful for reducing the frequency and severity of vasospastic attacks in Raynaud’s?

Answer 7

Nifedipine.

Question 8

What are alternatives to nifedipine for the treatment of Raynaud’s?

Answer 8

Naftidofuryl oxalate may produce symptomatic improvement;

Inositol nicotinate (a nicotinic acid derivative) may also be considered.

Pentoxifylline, prazosin and moxisylyte are not established as being effective for the treatment of Raynaud’s syndrome.