Peripheral Artery Disease

Question 1

What is the underlying pathology for peripheral artery disease (PAD)?

Answer 1

Atherosclerosis of peripheral arteries, most commonly affecting the lower extremities.

Question 2

What is the most commonly affected site in PAD?

Answer 2

Lower extremities, particularly the femoral and popliteal arteries.

Question 3

What is the number one risk factor for PAD?

Answer 3

Smoking.

Question 4

What are the major risk factors for PAD?

Answer 4

Smoking, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, and history of coronary artery disease.

Question 5

What is the most common initial symptom of PAD?

Answer 5

Intermittent claudication, which is induced by walking and relieved with rest.

Question 6

What should be on the differential diagnosis list with “claudication?”

Answer 6

• Atherosclerosis
• Neurogenic
• Venous thrombosis

Question 7

What muscle groups are most commonly affected by claudication in PAD?

Answer 7

Calves, quadriceps, and gluteal muscles.

Question 8

What are signs of severe PAD?

Answer 8

• Pain rest
• Dependent rubor (redness)
• Hairless legs
• Shiny skin
• Muscle atrophy
• Ulcerations

Question 9

Peripheral artery disease (PAD) causes ischemic ulcers that most commonly develop at … ?

Answer 9

toes, heels, and lateral malleolus.

Question 10

What is Buerger’s sign?

Answer 10

Elevation of the leg causes pallor, and dangling the leg causes bright red coloration due to reactive hyperemia.

Question 11

What is the ADSON or scalene maneuver?

Answer 11

Radial pulse diminishes or disappears with turning chin to same side due to a decrease in space between scaleneus anterior and medius.

Question 12

What is Rutherford’s classification for PAD?

Answer 12

A scale from 0-6, with 0 being asymptomatic and 6 being major tissue loss.

Question 13

What are the symptoms associated with Leriche syndrome?

Answer 13

Aortic iliac obstruction leading to bilateral thigh and gluteal claudication, erectile dysfunction, and absent femoral pulses.

Question 14

Which vasculitis is strongly associated with PAD?

Answer 14

Takayasu arteritis, which affects large vessels and can cause ischemic symptoms in the extremities.

Question 15

What is the first diagnostic test for PAD?

Answer 15

Ankle-brachial index (ABI).

Question 16

What ABI value is considered abnormal?

Answer 16

ABI <0.9 is diagnostic of PAD.

Question 17

What ABI value indicates severe PAD?

Answer 17

ABI <0.4, which suggests severe ischemia requiring intervention.

Question 18

What is the next step if ABI is equivocal?

Answer 18

Exercise ABI testing to assess functional limitations.

Question 19

What imaging tests can be used for further evaluation of PAD?

Answer 19

Doppler ultrasound, CT angiography, MR angiography, or conventional angiography.

Question 20

What is the first-line management for PAD?

Answer 20

1) Lifestyle modifications including smoking cessation
2) Exercise therapy
3) risk factor control (statins, antihypertensives, diabetes control).

Question 21

What antiplatelet medications are recommended for PAD?

Answer 21

Aspirin or clopidogrel.

Question 22

What medication is used for persistent claudication despite exercise therapy?

Answer 22

Cilostazol (a phosphodiesterase inhibitor that improves walking distance).

Question 23

What are the indications for revascularization in PAD?

Answer 23

Disabling claudication refractory to medical therapy or limb-threatening ischemia.

Question 24

What are the revascularization options for PAD?

Answer 24

Endovascular angioplasty with stenting or surgical bypass.

Question 25

What complication can PAD lead to if untreated?

Answer 25

Critical limb ischemia and possible amputation.

Question 26

What is the recommended algorithm for working up PAD?

Answer 26

Start with ABI, then perform CT/MR angiography if needed, followed by angioplasty with stenting or bypass if severe.