Peripheral Vascular Disease

Question 1

What is it

Answer 1

narrowing of arteries supplying the limbs/ peripheral areas

reducing blood flow

resulting in symptoms of claudication

Question 2

what are the two types of claudication caused by peripheral vascular disease and how do they present

Answer 2

intermittent claudication

• presents with pain during exertion
• aching or burning- can usually walk a predictable distance before symptoms start

critical limb ischaemia
- presents with pain during rest (6Ps)
pain, pallor, pulselessness, paralysis, paraesthesia, perishingly cold

Question 3

what are the 6 P’s of critical limb ischaemia

Answer 3

Pain
Pallor
Pulselessness
Paralysis
Paraesthesia (abnormal sensation e.g. p and n)
Perishingly cold

if 3,4 and 5 are present then surgical emergency

Question 4

what is the cause peripheral vascular disease

Answer 4

atherosclerosis

causing blockage of arteries to the lower limbs

Question 5

what are the risk factors for PVD

Answer 5

smoking!!

alcohol, low exercise

hypertension
diabetes
CKD

age
male

Question 6

what signs OE indicate peripheral vascular disease

Answer 6

Tar stained fingers

xanthomata

claudication

Arterial Leg Ulcers (painful punched out ulcers with well defined borders)

Question 7

how do you investigate PVD

Answer 7

Duplex USS is first line

Ankle Brachial Pressure Index using Doppler USS (compares BP in lower calf with BP in arm)

Buerger’s Test

Question 8

how do you manage PVD that presents with intermittent claudication

Answer 8

ACNE

Atorvastatin
Clopidogrel/ aspirin (antiplatelet)
Naftidrofuryl Oxalate (vasodilator)
Endovascular angioplasty (stent)

Question 9

what is the result of Buerger’s test in people with PVD

Answer 9

patient supine
lift legs up 45 degrees- pallor indicates ischaemia

then hand legs over end of bed

if PVD:

• blue first as the ischaemic tissue deoxygenates the blood
• then dark red due to vasodilation in response to the wate products of anaerobic resp in the ischaemic tissue

Question 10

how do you manage a patient with critical limb ischaemia

Answer 10

endovascular angioplasty and stent

endovascular thrombolysis

endartorectomy (removes atheroscleorsis from artery wall)