PAD

Question 1

What are the 3 clinical features PAD

Answer 1

Intermittent Claudication to critical limb ischaemia (rest pain) to ulceration and gangrene

Question 2

Characterise intermittent claudication

Answer 2

Pain on exertion
Pain that is completely reproducible
Pain that is relieved by short rest

Question 3

4 commonest sites for arterial occlusion

Answer 3

Superficial femoral artery (commonest)
Tibial vessels
Aortic and carotid bifurcation

Question 4

What is leriche syndrome

Answer 4

Characterised by claudication of buttocks, impotence, absent distal pulse

These are manifestations of atherosclerosis

Question 5

What are non invasive measures of investigating a patient for PAD. Name the gold standard

Answer 5

Gold standard: CTA and MRA- excellent for large arteries but may have difficulty with tibial vessels

ABI

Question 6

Explain what is known by the ankle brachial index

Answer 6

Highest brachial pressure and highest ankle pressure (dorsalis pedis or posterior tibial) for each side and the ratio estimates the degree of ischaemia

Abi > .9-1.2 is normal
.7-.9 mild ischaemia
.4-69 moderate ischaemia
<.4 severe obstruction and possible critical limb ischaemia

Patient with rest pain typically has an Abi of <.4

Question 7

What may cause an Abi to be greater than 1.2

Answer 7

Possible wall calcification typically seen with diabetics and patients with renal failure

Question 8

General treatment for those with mild to moderate claudication

Answer 8

No active treatment
Diet and exercise
Statin and Asa
Lose weight

Balloon angioplasty explored

Question 9

Non invasive conservative management of a patient with pad

Answer 9

Nb: critical limb ischaemia can’t be managed this way

Control risk factors such as stop smoking, diet and exercise, treat htn, treat Hyperlipidemia with statins,

Foot care esp in diabetics

Burgers exercise: walk to point of claudication and told to continue walking through pain as this encourages collateral vessel formation

Question 10

Non invasive pharmacological management of patients with pad

Answer 10

Antiplatelet: clopidogrel

Cilostazol- has Antiplatelet and vasodilatory effects- improves walking distance

Lumbar sympathectomy

Question 11

What are the invasive and operative options for a patient with pad

Answer 11

Percutaneous transluminal angioplasty

Endoluminal stenting

Bypass graft- biological such as with autogenous vein graft and prosthetic as with ptfe graft or Dacron

Question 12

What four factors must be considered when considering bypass graft

Answer 12

Inflow
Outflow(most important)
Conduit(graft)
Patient