Peripheral Artery Disease

Question 0

Causes of PVD?

Answer 0

Atherosclerosis
Thrombosis
Embolism
Vasculitis

Question 1

Risk factors for PVD?

Answer 1

Atherosclerosis

• diabetes
• smoking
• obesity
• high cholesterol
• FHx

Question 2

What are types of embolisms?

Answer 2

Thromboembolisms - embolism of a thrombus (blood clot)
Fat embolus - bone fracture or day droplets
Air embolism - embolism of air bubbles
Septic embolism - embolism of pus containing bacteria

Question 3

S + S PVD?

Answer 3

• intermittent claudication (if in butt/thigh/hip -> aorticilliac)
• muscle atrophy
• critical limb ischemia : rest pain, arterial ulcers, gangrene
• acute symptoms : 5Ps (pallor, parasthesia, pain, pulselessness, paralysis, poikilothermia)

Question 4

What is fontaines classification?

Answer 4

Method to clinically classify PAD

1 - asymptomatic
2 - intermittent claudication
3 - ischemic rest pain
4 - ulceration/gangrene (critical ischemia)

Question 5

What investigations for arterial disease?

Answer 5

ABI
CBE EUC LFTs CRP
RAD - duplex US to record blood flow from distal arteries, MRA and CTA (not routine but for surgical planning)

Question 6

What is ABI?

Answer 6

The systolic BP of ankle / systolic BP of brachial.

Make sure they’ve rested for 15 minutes prior to measuring ankle pressure.

> 1.3: abnormally calcified vessels
.9-1.3: normal
<.4: ischemic rest pain, multilevel artery disease

Question 7

How do you treat PAD?

Answer 7

Non-pharm:

• cessation of smoking
• exercise regularly till pain, then rest and resume.
• self-care of limbs: keep clean, moisturised

Pharm:
Atherosclerotic RF modification
Antiplatelet, usually aspirin

Surgical revascularisation if disabling, severe.

• perform MRA, CTA or conventional contrast angiography to plan surgery
• percutaneous transluminal angioplasty
• bypass for those with aortoilliac or femoral-popliteal disease.

If acute limb ischemia e.g. From embolus

• urgent open surgery or angioplasty
• for embolus: embolectomy or thrombolysis