Peripheral Vascular Disease

Question 1

what is peripheral vascular disease

Answer 1

significant narrowing of arteries distal to the arch of the aorta, most often due to atherosclerosis.

Question 2

what causes peripheral vascular disease

Answer 2

atherosclerosis

Question 3

what are the types of peripheral vascular disease

Answer 3

intermittent claudication- calf pain on exercise

critical limb ischaemia- pain at rest

acute limb ischaemia- sudden decrease in arterial perfusion in a limb (due to thromboembolic events)

arterial ulcers

gangrene

Question 4

risk factors

Answer 4

modifiable; smoking, obesity, T2DM, hypertension, hyperlipidaemia, lack of exercise

non-modifiable; age, ancestry, family Hx

Question 5

presenting symptoms of peripheral vascular disease

Answer 5

walking impairment, pain in buttocks and thighs at rest

intermittent claudication

features of critical limb ischaemia; gangrene, ulcer, night pain

Question 6

fontaine classification of peripheral vascular disease

Answer 6

1. asymptomatic
2. intermittent claudication
3. rest pain
4. ulceration/ gangrene

Question 7

signs of acute limb ischaemia

Answer 7

6Ps- pain, pulseless, pale, paralysis, paraesthesia, perishingly cold

Question 8

investigations for peripheral vascular disease

Answer 8

cardiovascular risk assessment; BP, FBC, fasting blood glucose, lipid profile, ECG, thrombophilia screen

colour duplex ultrasound (FIRST LINE)

MRI/ CT

ABPI

Question 9

interpreting ABPI

Answer 9

Marker of cardiovascular disease

ABPI < 0.8 = do NOT apply a pressure bandage because this will worsen ischaemia

Question 10

treatment of peripheral vascular disease

Answer 10

antiplatelet- clopidogrel

statins

glycaemic control

antihypertensives

weight loss, smoking cessation and exercise

SURGICAL; revascularisation or amputation