Peripheral Arterial Disease

Question 1

Risk factors for chronic lower limb ischaemia

Answer 1

• Smoking
• Diabetes
• Hypercholesterolaemia
• Hypertension

Question 2

Fontaine classification of PAD

Answer 2

• Stage I- asymptomatic
• Stage II- intermittent claudication
• Stage III- rest pain/ nocturnal pain
• Stage IV- necrosis/gangrene

Question 3

What is rest pain?

Answer 3

Severe, unremitting pain n the foot which stop a patient from sleeping.

Question 4

What is intermittent claudication

Answer 4

Exertional discomfort, most commonly in the calf which is relieved by rest
Patient with aorto-iliac disease may experience pain in the buttock, hip or thigh

Question 5

What are the primary features of critical lower limb ischemia?

Answer 5

Necrosis and gangrene

Question 6

Differential diagnosis of chronic lower limb

Answer 6

• Spinal canal claudication
• osteoarthritis hip/knee
• Peripheral neuropathy
• popliteal artery entrapment
• venous claudication
• Fibromuscular dysplasia
• Buerger’s disease

Question 7

ABPI

Answer 7

Measurement of the cuff pressure at which blood flow is detectable by Doppler in the posterior tibial or anterior tibial arterial

Question 8

ABPI with intermittent claudication

Answer 8

0.5-0.9

Question 9

Critical limb ischaemia ABPI

Answer 9

<0.5

Question 10

Falsely elevated ABPI causes

Answer 10

Heavy calcification and renal disease

Question 11

Pharmacological management of PAD

Answer 11

Cilostazol - is a phosphodiesterase III inhibitor that increases levels of cAMP, produces vasodilation and reversibly inhibits platelet aggregation.

Naftidrofuryl is a vasodilator agent that inhibits vascular and 5-HT2 receptors and can reduce lactic acid levels.

Oxpentifylline, inositol nicotinate and cinnaraizine

Question 12

Surgical and radiological management for PAD

Answer 12

Percutaneous transluminal angioplasty
Bypass procedures- using Dacron, PTFE or autologous veins
Amputation

Question 13

Acute lower limb ischemia- symptoms

Answer 13

Five P’s

• Pain
• Pallor
• Parasthesia
• Paralysis
• Perishingly cold

Question 14

ALI features

Answer 14

Embolic disease

Thrombus may also form in normal vessels in hypercoagulable patients because of malignancy or thrombophilia defects

Question 15

Side effects of revascularization

Answer 15

Reperfusion injury, with release of toxic metabolites into the circulation

Question 16

Acute aortic syndrome- diseases involved

Answer 16

• Aortic dissection
• Intramural haematoma
• Penetrating aortic ulcers

Question 17

Management of acute aortic syndromes

Answer 17

Antihypertensive emdication - labetalol, metoprolol and vasdilators

Question 18

Signs of Acute aortic syndromes

Answer 18

Sudden onset of severe and central chest pain that often radiates to the back and down the arms, mimicking MI.

Tearing in nature and may be migratory to the back

Shocked patient
Aortic regurg, coronary ischaemia and cardiac tamponade

Question 19

Type A and B aortic dissection

Answer 19

Type A - aortic arch and aortic valve proximal to Left subclavian artery- worse prognosis
Type B- involves descending throracic aorta- distal to the left subclavian artery - worse prognosis

Question 20

Raynaud’s phenomenon- features

Answer 20

consists of spasm of digital arteries- usually precipitated by cold and relieved by heart- affects more women than men
Pallor, cyanosis due to sliugish blood flow, redness secondary to hyperaemia

Question 21

Management of Raynaud’s

Answer 21

Vasodilators but they cause severe headaches

Sympathectomy or prostacyclin infusion- ILOPROST

Question 22

Beurger’s disease features

Answer 22

Small vessels of the lower limbs- young men who smoke
Pathological inflammation of the arteries and veins
Presents with severe claudication and rest pain- gangrene
Thrombophlebitis is sometimes present