Peripheral Arterial Disease

Question 1

What is it

Answer 1

Narrowing of the arteries supplying the limbs and periphery

Question 2

What is intermittent claudication

Answer 2

Ischaemia to the limb occurring during exertion and relieved by rest

Question 3

What is critical limb ischaemia

Answer 3

End stage of PAD. Limb can’t function at rest due to inadequate blood supply.

Question 4

What are the features of critical limb ischaemia?

Answer 4

Pain at rest
Pain worse at night
Non-healing ulcers
Gangrene

Question 5

What are non-modifiable risk factors of atherosclerosis?

Answer 5

older age
family history
male

Question 6

What or modifiable risk factors of atherosclerosis

Answer 6

smoking
alcool
poor diet
low exercise
obesity
poor sleep
stress

Question 7

What medical comomrbidities increase the risk of atherosclerosis?

Answer 7

Diabetes
HTN
CKD
Inflammatory conditions
Atypical antipsychotics

Question 8

What are the features of acute limb ischaemia

Answer 8

6 Ps

Pain
Pallor
Pulseless
Paralysis
Paraesthesia
Perishingly cold

Question 9

What is Leriche syndrome? What are the features?

Answer 9

Occlusion in distal aorta or proximal common iliac artery
Features:
1. Thigh/buttock claudication
2. Absent femorals
3. Male impotence

Question 10

What are the signs on exam of atherosclerosis?

Answer 10

Risk factors:
Tar staining of fingers
Xanthomata

sIGNS OF cvd:
Missing limbs or digits
Midline sternotomy scar
Scar on inner calf
Focal weaknesss suggesting previous stoke

Question 11

What are signs of arterial disease?

Answer 11

Skin pallor
Cyanosis
Dependent rubor - deep red colour when the limb is lower than the rest of the body
Muscle wasting
hair loss
ulcers
poor wound healing
gangrene

Question 12

What is Buerger’s test?

Answer 12

1. Pt lies on back, lift leg to an angle of 45 degrees for 1 minute. Leg going pale indicates arterial supply isn’t good enough to overcome gravity.
2. Sit pt up with legs hanging over Side of the bed. Blood flows back into legs assisted by gravity. In PAD leg goes blue then dark red

Question 13

What are the features of arterial ulcers?

Answer 13

Small, deep
Well defined border
Punched out apperance
Occur peripheral
Reduced bleeding
Painful

Question 14

Give features of venous ulcers

Answer 14

occur after minor injury
large
superficial
irregular border
affect gaiter area of the leg
less painful
cronic venous insufficiency signs - haeosiderin staining and venous eczema

Question 15

What are investigations?

Answer 15

ABPI
Duplex USS
Angiography

Question 16

What is a normal ABPI

Answer 16

0.9-1.3

Question 17

What does a level of ABPI >1.3 indicate

Answer 17

Can indicate calcification of the arteries as they are difficult to compress

Question 18

What does a ABPI of 0/6-0.9 indicate

Answer 18

mild PAD

Question 19

What does an ABPI of 0.3-0.6 indicate

Answer 19

Moderate to severe PAD

Question 20

What does an ABPI of <0.3

Answer 20

Severe disease to critical ischaemia

Question 21

What are medical treatments of PAD?

Answer 21

Atorvastatin 80mg OD
Clopidogrel 75mg OD
Naftidrofuryl oxalate

Question 22

What are surgical options for management of PAD?

Answer 22

Endovascular angioplasty and stenting
Endarterectomy - cutting the vessel open and removing the plaque
Bypass surgery

Question 23

What is management of critical limb ischaemia?

Answer 23

Urgent referral to vascular team for urgent revascularisation

Question 24

What are management options of acute limb ischaemia?

Answer 24

Endovascular thrombolysis – inserting a catheter through the arterial system to apply thrombolysis directly into the clot
Endovascular thrombectomy – inserting a catheter through the arterial system and removing the thrombus by aspiration or mechanical devices
Surgical thrombectomy – cutting open the vessel and removing the thrombus
Endarterectomy
Bypass surgery
Amputation of the limb if it is not possible to restore the blood supply