Peripheral arterial disease

Question 1

Examination findings in peripheral arterial disease

Answer 1

1) Thin, shiny, discoloured skin
2) Dependent rubor/elevation pallor
3) Tissue loss on heel/between toes
4) Reduced pulses - foot, popliteal, foot
5) Reduced CRT

Question 2

How do you measure ABPI?

Answer 2

Highest ankle BP/highest arm BP (either arm)

Question 3

ABPI measurement and interpretation

Answer 3

< 0.5 - severe arterial disease

0.5-0.8 - arterial or mixed arterial & venous

0.8-1.3 - no significant arterial disease

> 1.3 - arterial calcification - DM/RhA/vasculitis/atherosclerosis/CKD

Question 4

How may limb ischaemia from an embolus present differently to a thrombus?

Answer 4

Embolus - sudden, may affect 1 leg

Thrombus - gradual, often affects both legs

Question 5

Intermittent claudication: symptoms & management

Answer 5

Symptoms: pain on walking, relieved by rest

Management:
1) Supervised exercise programme - 2h/week for 3 months or unsupervised walking for 30 minutes 3-5x/week until pain, then resting
2) Refer for angioplasty/bypass if no improvement after exercise
3) If no improvement after exercise programme and does not want surgery, trial naftidrofuryl oxalate for 3-6 months - stop if no improvement

Question 6

Chronic/critical limb ischaemia

Answer 6

Symptoms: rest pain at night, history of IC, dependent rubber & elevation pallor, ulcers, non-healing wounds, gangrene, toe tissue loss, absent pulses, > CRT

Management:
1) Analgesia: paracetamol/opiods
2) Advice: daily foot inspection, well-fitting shoes, avoid bare feet

Question 7

Naftidrofuryl oxalate: indication, advice & CI

Answer 7

Indication: intermittent claudication where there has been no improvement with exercise programme and does not want surgery.

Advice: take with full glass of water and with meals to reduce risk of oesophagitis & remain hydrated.

CI: calcium renal stones, hyperoxalateuria