Peripheral Arterial Disease

Question 1

ABPI

Answer 1

Measure in patients suspected of LEAD (Symptoms or signs), at risk due to ASCVD/CKD/HF/AAA, >65/<65 with 1 RF or >50 with FHx

<0.9 abnormal
>1.4 abnormally high

If non compressible arteries or ABPI >1.4 - use toe brachial index, doppler or pulse volume recording

ABPI first line in suspected LEAD.
To confirm, duplex USS
dUSS and or CTA and/or MRI to characterise stenoses prior to revasc

Question 2

Antiplatelets in Carotid disease / intervention and LEAD/ intervention

Answer 2

Asymptomatic - SAPT (aspirin or clopidogrel)

Carotid Stenting - DAPT for 1month, then SAPT (Aspirin or Clopidogrel) for 1 year

Carotid Surgery - - SAPT (aspirin or clopidogrel)

Question 3

Anticoagulation in LEAD

Answer 3

Question 4

Imaging in carotid disease

Answer 4

Duplex USS firstline

If considering carotid stenting, get CTA or MRA to assess arch

If considering CEA, get CTA or MRA to confirm stenosis, or repeay dUSS in expert lab

Question 5

Carotid Intervention

Answer 5

Average surgical risk, asymptomatic, 60-99% stenosis, imaging consistent with increased stroke risk, perioperative stroke/death risk <3% and life expectancy >5years - consider CEA

High surgical risk - as above, consider carotid stenting. May consider CAD in average risk patient

Question 6

Carotid Intervention 2 - Flow Diagram

Answer 6

Question 7

Screening for carotid disease in patients undergoing CABG

Answer 7

Question 8

Recommendations for carotid disease in patients awaiting CABG

Answer 8

Question 9

Anti-thrombotic therapy in PAD

Answer 9