Peripheral Artery Disease

Question 1

what is peripheral artery disease?

Answer 1

any artery disease that isn’t intracranial or cardiac

Question 2

3 peripheral artery diseases

Answer 2

lower limb artery disease
extra cranial carotid artery stenosis
abdominal aortic aneurysm

Question 3

patterns of large artery disease

Answer 3

stenosis
thrombosis
embolus
dissection
aneurysm (true and false)

Question 4

what is the aorto iliac segment

Answer 4

distal aorta, common and external iliac arteries

Question 5

aorto iliac segment affected by atherosclerosis

Answer 5

common, particularly in younger patients (<60yo) with claudication

Question 6

aorto iliac segment affected by atherosclerosis

Answer 6

common, particularly in younger patients (<60yo) with claudication
femoral pulses may be reduces or absent although foot pulses may be detectable if there is only stenosis of the iliac artery

Question 7

superficial fermoral artery occlusion

Answer 7

most common cause of claudication, especially in 60-80 year old patients
may be asymptomatic if the patient does little walking
the femoral pulse is palpable but the popliteal and foot pulses are usually absent

Question 8

tibial artery disease is often called

Answer 8

distal disease

Question 9

distal disease usually seen in patients with

Answer 9

diabetes or the very elderly (80+years)

Question 10

symptoms of distal disease

Answer 10

femoral and popliteal pulses are palpable but no foot pulses are felt

Question 11

is PAD more common in men or women

Answer 11

men

Question 12

what comorbid condition should you be concerned about in a patient with PAD

Answer 12

coronary artery disease
stroke
renovascular

Question 13

dominant risk factor for PAD

Answer 13

smoking

Question 14

modifiable risk factors associated with PAD

Answer 14

smoking, diabetes, hypertension, dyslipidaemia

Question 15

DDx of leg pain while walking

Answer 15

osteoarthritis of hip or knee
vascular claudication
spinal stenosis
peripheral neuropathy

Question 16

rest pain

Answer 16

usually occurs at night
located in foot, not leg

Question 17

rest pain is typically relieved by

Answer 17

hanging foot of the edge of the bed
walking around

Question 18

rest pain indicates

Answer 18

severe ischamia

Question 19

points of examination of lower limb PVD

Answer 19

peripheral pulses
check pressure areas for ulceration/gangrene
buergers test
colour, temp, capillary return are not always reliable

Question 20

investigation for lower limb PVD

Answer 20

bloods - U&E, FBC, fasting BSL and lipids
ankle:brachial index (ABI)
duplex scan
angiogram if severe enough to need treatment

Question 21

ankle:brachial index

Answer 21

Question 22

ankle:brachial index is unreliable in

Answer 22

diabetes - due to incompressible arteries

Question 23

what does the ankle:brachial index indicate?

Answer 23

Question 24

duplex scan

Answer 24

cross sectional image that gives flow velocity
safe, painless accurate
time consuming
difficult if the artery is calcified

Question 25

treatment of PAD

Answer 25

always treat rest pain or tissue loss because this means the limb is at risk
treat claudication if it is disabling

Question 26

non-medical treatment to improve leg symptoms

Answer 26

smoking cessation
weight loss (no evidence)
exercise (effective)
drugs (often ineffective, use cilostazol or statins)

Question 27

non-medical treatment to prevent systemic complications

Answer 27

smoking cessation
weight control
BP control
lipid control
aspirin, ACE inhibitors

Question 28

surgical interventions for PAD

Answer 28

angioplasty (+- stent)
bypass
endarterectomy
amputation

Question 29

balloon angioplasty

Answer 29