Peripheral vascular disease

Question 1

Presenting features of chronic limb ischaemia?

Answer 1

Intermittent claudication (exercise-related pain in the legs relieved by rest)
Non-healing wounds on legs

Question 2

Appearance of the skin in chronic lower limb ischaemia?

Answer 2

Shiny, thin, hairless, cool to tough, elevation pallor and dependent rubor (Buerger’s test)

Question 3

Why is it important to check eGFR as part of the initial assessment of chronic limb ischaemia?

Answer 3

PVD is associated with renal artery stenosis

Question 4

ABPI value for diagnosis of

a) PAD
b) PAD with ulceration risk
c) PAD with critical ischaemia?

Answer 4

a) < 0.9
b) < 0.8
c) < 0.5

Question 5

Why is ABPI unable to exclude PVD in diabetic patients?

Answer 5

Diabetes causes increases vessel calcification and falsely elevates ABPI

Question 6

Management of intermittent claudication? (3)

Answer 6

Programme of supervised exercise if available
(Consider unsupervised exercise if not)
Address risk factors e.g. lipids, BP, diabetes, weight, smoking
Antiplatelet monotherapy

Question 7

Drug options + monitoring for intermittent claudication?

Answer 7

Naftidrofuryl oxidate- assess in 3-6 months, discontinue if no benefit

Question 8

Critical limb ischaemia is suggested by..

Answer 8

Rest/nocturnal pain- patients often hang leg out of bed when sleeping

Question 9

Features of purely arterial ulceration?

Answer 9

Distal; painful; “punched-out”

Question 10

Specialist investigation/management of peripheral arterial disease? (3)

Answer 10

Angiography to assess extent/position of disease
Angioplasty +/- stenting
Surgery e.g. aortobifemoral bypass graft