Peripheral Vascular Disease

Question 1

When does PVD occur

Answer 1

When there is a narrowing of distal arteries normally caused by atherosclerosis

Question 2

What are the risk factors for PVD

Answer 2

>55
Smoking
Diabetes Mellitus
HTN
Hyperlipideamia
Sedentary life
Obesity

Question 3

What are the symptoms of PVD

Answer 3

Butt pain relieved with rest (intermittent claudication)

High limb pain esp. foot @night (severe claudication)

Question 4

What are the signs of PVD

Answer 4

ABPI <0.9 /Weak leg pulse
Skin change = cool/ ulcer and colour change
Bruits
Positive Buerger test (Pallor then reactive hyperaemia )
6 Ps in Critical limb ischemia
CT Angiogram (Invase so use ABPI)

Question 5

What causes PVD

Answer 5

Atherosclerosis
Embolus
Vasospasm

Question 6

What would you check for in a cardiovascular risk assessment

Answer 6

Blood Pressure
FBC
Blood Glucose
Lipids 
ECG

Question 7

What first line investigation would you do for PVD

Answer 7

ABPI (compare systolic brachial pressure against ankle with doppler probe)
<0.5 = severe
>1.2 = diabetes

Question 8

What are the follow up investigations after ABPI

Answer 8

Duplex Ultrasound (find site, severity and length)
Auscultation = Whoosh at iliac arteries
CT Angiogram

Question 9

What is the non medical management of PVD

Answer 9

Smoking cessation and weight control

Question 10

What is the medical management of PVD

Answer 10

Clopidogrel (Anti-platelet)
Atorvastatin (lipid lower)
Gylcaemic control
BP control

Question 11

What is the surgical intervention for PVD

Answer 11

EVAR
Surgical Bypass
Amputation

Question 12

What is the gold standard investigation for PAD/PVD

Answer 12

Coronary Angiogram

-Use ABPI as less invasive

Question 13

What is the pathology for Intermittent claudication

Answer 13

Partial lumen occlusion by atherosclerosis causing pain on exertion

Question 14

What is the pathology of critical limb ischemia

Answer 14

Major lumen occlusion causing insufficient blood supply causing pain at rest
-Risk of gangrene and infection

Question 15

What is the difference of pain exertion between Intermittent claudication and critical limb ischemia

Answer 15

IC = Pain on exertion
CLI = Pain at rest

Question 16

What is the main complication of Peripheral vascular disease

Answer 16

Acute limb schema

-Total vessel occlusion by thrombosis at the site of critical limb ischemia lesion

Question 17

What are the 6 Presentation Ps of Acute limb ischema

Answer 17

Pulseless
Pain
Pallor
Perishing Cold
Paralysis
Parasthesia

Question 18

What is the physiology of BV occlusion to a region

Answer 18

<6hs = Irreversible nerve damage
6-10hrs = Irreversible muscle damage
Last = Gangrenous/Infective skin change

Question 19

What is the beurger test

Answer 19

Raise leg 45 degrees for 1 minute

Skin change = Pallor to hyperaemia

Question 20

What is the Fontaine Classification of PVD

Answer 20

1=Asymptomatic
2=Intermittent claudication
3=Chronic limb ischemia
4=Ulcers and gangre

Question 21

In the Fontaine Classification what can intermittent claudication be split into

Answer 21

2a = 200m pain free walking
2b = <200m

Question 22

What is the ABPI and its results

Answer 22

Compare Blood between tibial and brachial aretery w/ Doppler ultrasound
0.5-0.9 = Intermitten claudication
<0.5 = Critical limb ischemia
Absent = Acute limb Ischemia

Question 23

How is Intermittent claudication managed

Answer 23

RF Managaement

Question 24

How is critical and Acute limb Ischemia managed

Answer 24

PCI or Amputation