Peripheral Vascular Disease

Question 1

What is acute peripheral vascular disease?

Answer 1

Acute limb ischaemia

Question 2

What is chronic peripheral vascular disease?

Answer 2

1. Intermittent claudication

2. Critical limb ischaemia

Question 3

What are RF for peripheral vascular disease?

Answer 3

1. Smoking
2. Old age >40
3. Man
4. High BP
5. Diabetes
6. Hyperlipiademia

Question 4

What is the patho of peripheral vascular disease?

Answer 4

atherosclerosis leads to stenosis

Question 5

What is Leriche Syndrome?

Answer 5

aortoiliac occlusive disease – iliac artery narrowed by plaque

Question 6

What are symptoms of Leriche syndrome?

Answer 6

1. Buttock claudication (cramping on movement)
2. Impotence
3. Absent/weak distal pulses

Question 7

What ALI?

Answer 7

sudden decrease in limb perfusion

Question 8

What is intermittent caludication?

Answer 8

pain on exertion: calf, pain or buttocks – how far until pain comes on

Question 9

What is critical limb ischaemia?

Answer 9

1. pain at rest

2. woken up and hanging legs off bed helps

Question 10

What are symptoms of acute limb ischaemia?

Answer 10

1. Pain
2. Pale
3. Pulselesses
4. Paralysis
5. Parasthesia
6. Perishingly cold

Question 11

What are symptoms of chronic limb ischaemia?

Answer 11

1. Asymptomatic
2. Hair loss
3. Numbness in feet/legs
4. Brittle, slow growing toenails
5. Ulcers
6. Absent pulses
7. Atrophic skin

Question 12

What is Beurger’s test?

Answer 12

1. Lie patient flat on bed and lift up to 45 degrees
2. Limb developing pallor indicates arterial insufficiency
3. <20 degrees is Beruger’s angle and indicates severe limb ischaemia
4. Patient then swings leg over bed, reactive hyperaemia is seen

Question 13

How should you do a full cardiovascular risk assement?

Answer 13

1. BP, HR
2. Bloods, GBC, fasting glucose, lipids)
3. ECG

Question 14

What is the gold standard Ix for peripheral vascular disease?

Answer 14

Ankle-brachial pressure index (ABPI): gold standard)

Question 15

What is normal ABPI?

Answer 15

Normal range: 0.9 to 1.2

Question 16

What is bad ABPI?

Answer 16

Less than 0.9 abnormal and less than 0.5 CLI

Question 17

What other Ix are done in PVD?

Answer 17

• Colour duplex US scan: to find sight of stenosis

- Magnetic resonance angiogram

Question 18

What is the management of claudication?

Answer 18

1. Supervised exercise programmes
2. Vasoactive drugs e.g. natftidrofuryl
3. RF modification

Question 19

What surgery is used in claudication?

Answer 19

1. Percutanous transluminal angioplasty
2. Surgical restruction
3. Amputation

Question 20

How do you treat acute limb ischaemia?

Answer 20

• If occlusion is embolic: surgical embolectomy or local thrombolysis
• Anticoagulate with heparin after either procedure

Question 21

What are complications of acute limb ischaemia treatment?

Answer 21

Beware of post op reperfusion injury and subsequent compartment syndrome