Peripheral arterial Disease

Question 1

What is peripheral arterial disease?

Answer 1

Narrowing of the arteries supplying the limbs and the periphery.

Question 2

What part of the body is most commonly affected?

Answer 2

the lower limbs

Question 3

what is the most common symptom in PAD?

Answer 3

intermittent claudication

Question 4

What does claudication suggest?

Answer 4

Ischaemia to the limb. Usually gets worse on exercise and better on rest.

Question 5

What is critical limb ischaemia?

Answer 5

End stage peripheral arterial disease.

Question 6

What are the signs and symptoms of critical limb ischaemia?

Answer 6

When the lack of blood causes pain at rest, gangrene and non healing ulcers.

SYMPTOMS AT REST.

Question 7

What is the risk with critical limb ischaemia?

Answer 7

Amputation

Question 8

What is acute limb ischaemia?

Answer 8

Rapid ischaemia of the limb usually caused by a thrombus or clot blocking arterial supply.

Question 9

What is ischaemia?

Answer 9

Inadequate supply of oxygen

Question 10

What is necrosis?

Answer 10

Death of a tissue

Question 11

What is gangrene?

Answer 11

Localised death of body tissue due to inadequate blood supply or bacteria.

Question 12

What are the modifiable risk factors of peripheral arterial disease?

Answer 12

Poor diet
alcohol
smoking
sedentary lifestyle
obesity
poor sleep
increase stress

Question 13

What are the modifiable risk factors of peripheral arterial disease?

Answer 13

Poor diet
alcohol
smoking
sedentary lifestyle
obesity
poor sleep
increase stress

Question 14

What are the non modifiable risk factors of peripheral arterial disease?

Answer 14

Male
Older
family history

Question 15

Which diseases can lead to peripheral arterial disease?

Answer 15

Chronic kidney disease
diabetes
rheumatoid arthritis
antipsychotic medications

Question 16

What is atherosclerosis?

Answer 16

Lipids are deposited into the artery wall followed by fibrous atheromatous plaques. This causes hypertension and a strain on the heart. Can cause thrombosis leading to ischaemia.

Question 17

Which blood vessels are affected by atherosclerosis?

Answer 17

Medium and large blood vessels

Question 18

what are the complications of atherosclerosis?

Answer 18

Angina
Myocardial infarction
Transient ischaemic attacks
stroke
chronic mesenteric ischaemia 
peripheral arterial disease

Question 19

What are the 6 Ps of critical limb ischaemia?

Answer 19

Pain (burning pain)
Pallor
Perishingly cold
pulseless
paralysis
parasthesia (pins and needles, burning or pricking sensation)

Question 20

What is the most common symptom of peripheral arterial disease?

Answer 20

Intermittent claudication (mostly in calves)

Question 21

What are signs of arterial disease?

Answer 21

Dependant rubor (deep red colour of limb when lower than the rest of the body)
Skin pallor
cyanosis
poor wound healing
gangrene
muscle wasting 
hair loss 
ulcers
reduced skin sensation
prolonged capillary refil
buergers test 
reduced skin temperature

Question 22

what is buergers test?

Answer 22

• patients leg is lifted to 45 degrees and held for 1-2 mins, if the leg goes cold then the arterial supply isn’t strong enough to overcome gravity
• when the patient sits with their leg hanging off the chair below then, if peripheral arterial disease is present then the leg will first go blue then a dark red (rubber).

Question 23

What is buegers angle?

Answer 23

The angle of which the leg needs to be raised to to become pale.

You should usually be able to hold the leg at a right angle and still have an arterial blood supply.

Question 24

what are the signs of arterial ulcers?

Answer 24

Small
well defined borders 
occur more peripherally 
reduced bleeding 
painful

Question 25

what are the signs of venous ulcers?

Answer 25

``` larger more superficial irregular border less painful occur with other signs (venous eczema) ```

Question 26

What are investigations for peripheral arterial disease?

Answer 26

``` Hand held dopplers ABPI Duplex ultrasound Angiography CT MRI angiogram ```

Question 27

What is ABPI?

Answer 27

Ankle : Brachial pulse ratio. | the ratio of the systolic blood pressures.

Question 28

What are the ratios seen in ABPI?

Answer 28

normal = 0.9-1.3 mild arterial disease = 0.6-0.9 moderate arterial disease = 0.3-0.6 severe disease to critical ischaemia = <0.3 >1.3 can suggest calcification of the arteries making them difficult to compress

Question 29

which disease commonly causes cllficiation of arteries?

Answer 29

Diabetes

Question 30

How is intermittent claudication managed?

Answer 30

``` Atorvostatin 80mg Clopidogrel 75mg (aspirin if can't tolerate clopidogrel) Naftidrofuryl oxalate (peripheral dilator) ```

Question 31

What is the treatment for peripheral arterial disease?

Answer 31

Endovascular angioplasty and stending Endartectomy (removing plaque from vessel) Bypass

Question 32

What is the treatment for critical limb ischaemia?

Answer 32

``` Urgent vascular referral Analgesia urgent revascularisation endovascular surgery endarterectomy bypass amputation ```

Question 33

what is the treatment for acute limb ischaemia?

Answer 33

``` urgent referral to vascular endovascular thrombolysis endovascular thrombectomy surgical thrombectomy endarterectomy bypass amputation ```

Question 34

at which ABPI is claudication experienced?

Answer 34

0.4-0.9

Question 35

At which ABPI is rest pain experienced?

Answer 35

0.2-0.4

Question 36

At which ABPI is tissue loss, ulcers and gangrene seen?

Answer 36

0.0-0.4

Question 37

What is the difference between chronic and acute limb ischaemia?

Answer 37

Chronic limb-threatening ischemia is distinguished from acute limb ischemia by a duration of symptoms that is longer than two weeks Critical limb ischemia is an advanced form of peripheral arterial disease (PAD) affecting blood flow in the extremities, while acute limb ischemia is a sudden and rapid decrease in, or loss of, lower limb blood flow