Peripheral Vascular disease 1

Question 1

What are the types of limb ischaemia?

Answer 1

• Chronic lower limb ischaemia

- Intermittent claudication & critical limb ischaemia

Question 2

What is intermittent claudication?

Answer 2

Cramping of the leg induced by exercise, due to restricted blood flow in the arteries.

Question 3

What are some common vessels found in the pelvis and lower limb?

Answer 3

1. Common & external iliac–> internal iliac
2. Common & superficial femoral–> deep femoral
3. Popliteal, tibioperoneal trunk, peroneal–> anterior + posterior tibial

Question 4

When does intermittent claudication occur?

Answer 4

Exercise induced pain. patient pain free once at rest and normal.

Question 5

What are some risk factors for IC?

Answer 5

• Age
• Male
• Smoking
• Alcohol
• Hypertension
• Cholesterol
• Fibrinogen

Question 6

List the peripheral pulses

Answer 6

1. Femoral
2. Popliteal
3. Posterior tibial
4. Dorsalis pedus

Question 7

What are some non invasive investigations?

Answer 7

• ABPI: ankle brachial pressure index. divide pressure in the ankle by pressure in the brachial. Lower BP in leg than arm= atherosclerosis
• Duplex ultrasound scanning- Ultrasound that allows you to see the blood vessels and the direction of blood flow.

Question 8

Invasive investigations?

Answer 8

• magnetic resonance angiography
• CT angiography
• catheter angiography.

Question 9

What are some normal/abnormal ABPI values?

Answer 9

Normal- 0.9
Claudication- 0.4-0.8
Severe-0-0.4

Question 10

What are the treatment guidelines for lower limb ischaemia?

Answer 10

1. Slowing progression
   - STOP SMOKING
   - Anti platelets
   - Anti coagulants
   - lipid lowering
   - anti hypertensive
   - Diabetes
   - life style
2. Information

Question 11

What role does exercise in treatment?

Answer 11

Walking and supervised exercise program can be v beneficial.

Cilostazol- anti-platelet used in IC.

Question 12

What is a surgical treatment option in IC (v common)

Answer 12

Angioplasty +/- stent

Question 13

What are some major surgical interventions?

Answer 13

1. Infow- Endarterectomy- removing an atheromatous plaque in an artery
   Bypass- autologous (vein) or prosthetic (dacron)

Question 14

What happens in chronic limb ischaemia?

Answer 14

1. Pain at rest- toe/foot ischaemia. Nerve ending pain. lying/ sleeping
2. Ulcers/ Gangrene- severe ischaemia + damage. Trauma, footwear.

Question 15

What are the symptoms of critical limb ischaemia?

Answer 15

• Rest pain
• Sore toe/forefoot
• Needs strong analgesics
• Worsens at night
• Better by sitting, putting leg in dependent position
• Better by standing + walking

Question 16

What are the associated risk factors that may result in amputation?

Answer 16

1. Smoking

2. Diabetes