Peripheral Artery Disease

Question 1

Chronic limb ischemia

Answer 1

Thin skin
Diminished hair
Loss of SC
No peripheral pulses
Shiny
Trophic nail changes

No pain, gangrene or ulcer
Stable claudication, still getting supply from peripheral

Question 2

Causes

Answer 2

Atherosclerosis - symptomatic at 75%+
Vasculitis
Arterial trauma

ALL LEAD TO OCCLUSION

Question 3

Investigations

Answer 3

Ankle Brachial pressure index
-compare brachial pressure to dorsalis pedis pressure

Duplex US scan - visualise direction of blood flow

CT Angiography

ECHO - for suspected cardiac cause

Question 4

Critical limb ischemia

Answer 4

Pain at rest, esp at night
Ulcers, gangrene

Revascularisation

• angioplasty + stent
• endarterectomy
• bypass
• amputation

Question 5

Diabetic foot

Answer 5

Neuropathic + ischemic disease
-no pain

Often with infection

Attempt to revascularise
High likelihood of amputation + prosthesis

Must do MSK, neuro exam, assess for infection

Question 6

Acute limb ischemia

Answer 6

Sudden worsening of limb perfusion - SURGICAL EMERGENCY

Is it embolic, thrombotis, traumatic, iatrogenic?

Pain out of proportion to presentation
Pallor
Pulseless
Parasthesia
Paralysis
Particularly cold

Thrombolysis
Thrombectomy
Bypass

Question 7

Complications of ischemia

Answer 7

Compartment syndrome => fasciotomy
Ischemia reperfusion syndrome
Amputation

Question 8

Progression of disease

Answer 8

Claudication
Pain at rest
Gangrene (critical limb ischemia)