Peripheral

Question 1

2 examples of peripheral vascular disease

Answer 1

1. Intermittent claudication
2. Critical limb ischaemia (severe)

Question 2

What can occur during ABPI test?

Answer 2

falsely high reading fir diabetes > take a droplers test

Question 3

Scale for Severe claudication

Answer 3

0-0.4

Question 4

Scale for normal Claudication

Answer 4

0.9-1.2

Question 5

What imaging would you use for intermittent claudication and
critical limb ischaemia?

Answer 5

Intermittent claudication- MR angiography

Critical limb ischaemia - CT angiography

Question 6

What is Foam sclerotherapy?

Answer 6

involves injecting a foam-like substance into varicose veins to collapse them. Minimally invasive.

Question 7

What is Endovenous Ablation

Answer 7

Endovenous Ablation is another minimally invasive treatment option for varicose veins. It involves using heat energy or laser energy to close off the diseased vein. During the procedure, a thin catheter is inserted into the vein through a small incision. The catheter delivers heat energy (radiofrequency ablation) or laser energy (endovenous laser ablation) to the vein wall, causing it to collapse and seal shut. Blood flow is then redirected to healthy veins

Question 8

0.8 - 0.9 on ABPI

Answer 8

mild

Question 9

0.5 - 0.8 on ABPI

Answer 9

moderate

Question 10

<0.5 on ABPI

Answer 10

Severe disease

Question 11

Management - cardiovascular risk

Answer 11

clopidogrel 75mg once daily (asprin alternative)
atorvastatin 80mg once nightly

Question 12

Pain mangement

Answer 12

Naftidrofuryl oxalate, a vasodilator, can alleviate pain in PAD. It should only be prescribed if supervised exercise is ineffective and the patient does not want to be referred for angioplasty or bypass surgery.

Question 13

A 58 year old man presents to his GP complaining of pain in the right calf when he walks. He states that it improves when he rests. His past medical history includes hypercholesterolaemia, ischaemic heart disease and hypertension. He smokes 40 cigarettes per day. On examination he is obese, and his pulses are difficult to palpate in both feet. What is the most appropriate initial test to perform on this patient?

Answer 13

Ankle Brachial Pressure Index (ABPI)

Question 14

A 65 year old gentleman presents with a 2 month history of intermittent calf pain. He describes the pain as better in the morning and worse following prolonged physical activity. He is only able to walk 200 metres before the pain begins. He is otherwise asymptomatic. He has a past medical history of hypertension, type 2 diabetes and peripheral neuropathy.

On examination, his dorsalis pedis and posterior tibial pulses are equal bilaterally, and there are no obvious abnormalities. His observations are normal.

What investigation would be most appropriate to confirm the diagnosis?

Answer 14

Duplex ultrasound of femoral arteries

Question 15

A 65-year-old gentleman presents to the emergency department with a 12-hour history of severe pain in his left leg present at rest. He has a past medical history of type 2 diabetes, hypertension and a previous below-knee amputation of his right leg 2 months ago. The leg appears well-healed on the right side with no obvious complications.

On examination, there is significant wet gangrene of the left foot. His posterior tibial and dorsalis pedis pulses are not palpable. The limb is cold to touch and tender to palpation. There is irreversible ischaemic ulceration present over the mid-shin.

What is the most appropriate management?

Answer 15

Below knee amputation

Question 16

A 55-year old man presents to his general practitioner with pain in his left calf. The pain only occurs when he is walking and is relieved by rest. It has been getting worse for the past 2 years, such that the pain occurs after walking for 100 metres on flat ground or 50 metres uphill. He has a background of type 2 diabetes mellitus and hypertension. He is a smoker of 20 years.

On examination, he has weak popliteal, dorsalis pedis and posterior tibial pulses on the left foot and normal pulses on the right.

What is the most likely diagnosis?

Answer 16

Chronic limb ischaemia

Question 17

A 75-year old man presents to the emergency department with a painful and tingling right leg. The pain is 10/10 and unlike anything he has experienced previously. He has a history of type 2 diabetes mellitus, hypertension, hyperlipidaemia, ischaemic heart disease and narrowing of the femoral arteries bilaterally.

On examination, the right limb is pale and cold below the knee, his dorsalis pedis and posterior tibial pulses are not palpable and the patient cannot perform active movements of the ankles and toes.

What is the most likely diagnosis?

Answer 17

Acute limb ischemia

Question 18

The ABPI for chronic limb ischaemia is typically between what?

Answer 18

0.6-0.9

Question 19

The ABPI for critical limb ischaemia is what?

Answer 19

<0.5

Question 20

A 68-year-old man presents to his GP for surgery complaining of pain in his left calf. He reports that 3 months ago he could walk 2 km without tiring, but now needs to stop after walking 400–600 m on level ground. This is largely because of a cramping pain in his calf. The pain is relieved spontaneously after resting for 30 minutes.

He denies any rest pain, any change in sensation or motor control, or any skin changes.

Based on the history alone, what is the most likely site of peripheral artery disease causing this patient’s symptoms?

Answer 20

Femoral artery

Question 21

What are the risk factors for varicose veins?

Answer 21

obesity, family history, pregnancy, previous leg injury and prolonged standing

Question 22

A 60 year old male complains of worsening cramping pain in his buttocks and legs. He used to be able to walk to the grocery store, but now has to stop intermittently due to pain. He also reports that he has difficulty getting erections these days. His past history is significant for hypertension and hyperlipidaemia.

Examination shows loss of hair and decreased temperature in the lower legs. The femoral pulses are not felt. The genital examination reveals no abnormalities. What is the most likly cause?

Answer 22

Aortoiliac artery stenosis

Question 23

A 59-year-old gentleman presents to the vascular clinic for a review of his varicose veins. He reports continued pain in his left leg varicosities but otherwise no other symptoms of note. He is currently being managed with compression stockings. He has no other past medical history of note.

On examination there is a single tortuous varicosity present on the postero-lateral aspect of the lower left leg. His BMI is 24.5.

What is the most appropriate next step in management?

Answer 23

Stripping of short saphenous vein