Peripheral arterial

Question 1

What trophic changes do you expect to see in a pt w/ PAD?

Answer 1

pale skin
hair loss
onychogryphosis
fungal infections (skin/nails)

Question 2

What are the causes of claudication in presence of NORMAL peripheral pulses?

Answer 2

neurogenic claudication (spinal stenosis)
anemia
beta-blockers

Question 3

What would you expect to see in a critically ischemic limb?

Answer 3

pain 
pallor
pulseless
perishingly cold
parasthesia
paralysis (best indicator of danger)

Question 4

ABPI measurements?

Answer 4

> 1 - normal
0.5-1 - intermittent claudication
0.3-0.5 - rest pain/critical limb ischemia
<0.3 - gangrene + ulceration

Question 5

What is Leriche’s syndrome?

Answer 5

Bilateral buttock pain & erectile impotence due to common iliac disease

Question 6

What are the features of an arterial ulcer?

Answer 6

Hx - intermittent claudication; rest pain
sites: feet/toes; ankle (lateral malleolus)
punched out lesion (edges)
little exudate
sloughing at the base
painful
edema uncommon
assoc w/ trophic changes; gangrene

Question 7

If this pt w/ ulcer presented in your clinic, would you let him home? or Rx him on the spot?

how to Rx?

Answer 7

Rx on the spot - urgent

1) angioplasty (endovascular revascularisation)
2) bypass surgery (surgical revascularisation )
- fem-pop bypass
- fem-distal bypass
- axillo-fem bypass
- aorto-bifemoral graft
3) amputation
- note: amputation ALWAYS leave the joint