Peripheral Vascular Disease

Question 1

What is the difference between peripheral vascular and peripheral arterial disease? (PVD, PAD)

Answer 1

Vascular - disease of the blood vessels outside of the heart and brain
Arterial - buildup of fatty deposits in peripheral arteries -> reduced blood flow to the extremities

Question 2

What are the two types of peripheral vascular disease and what are they?

Answer 2

Organic (occlusive) PAD - structural changes in blood vessels due to blockage or damage
Functional - short term/intermittent, spasms often is response to a trigger e.g. cold

Question 3

What is PAD most commonly caused by?

Answer 3

Atherosclerosis - buildup of fatty streaks

Question 4

What are the sub-types of PAD?

Answer 4

• Intermittent claudication (IC) - pain in lower limb on walking, relieved by rest - cramp like pain
• Critical limb Ischaemia (CLI) - risk of limb loss
• Chronic limb-threatening ischaemia (CLTI) - rest pain
• Acute limb ischaemia (ALI) - sudden decrease in limb perfusion

Question 5

What are the additional investigations for CV risk/secondary prevention?

Answer 5

Blood tests (fasting glucose/FLP/LFT/renal)
Blood pressure
BMI

Question 6

When would you suspect acute limb ischaemia?

Answer 6

Sudden onset/deterioration and any of the 6 P’s:
Pain
Pulseness
Pallor
Power loss
Paraesthesia
Perishing with cold

Question 7

What is the first line antiplatelet for the management of CV risk factors?

Answer 7

Clopidpgrel 75mg daily preferred OR aspirin 75mg OD if CI/not tolerated
(Note: if at high risk of side effects -> PPI, not Omeprazole/Esomeprazole with clopidogrel)

Question 8

What is the first line statin for the management of CV risk factors?

Answer 8

High intensity statin - Atorvastatin 80mg OD unless C/I

Question 9

What is the first line drug for hypertension for the management of CV risk factors?

Answer 9

ACE (e.g. lisinopril) or ARB are recommended first line in PAD

Question 10

What is the lifestyle advice for the management of CV risk factors?

Answer 10

Healthy diet
Alcohol
Healthy weight
Smoking

Question 11

What is the duration of the supervised exercise programme (SEP)?

Answer 11

2 hours a week for a 3 month period, encouraging exercising to the point of maximal pain.

Question 12

What drug should be considered as a trial if exercise has not worked and patient does not want surgery?

Answer 12

Naftidrofuryl oxalate 100-200mg TID for 3-6 months

Question 13

What are the three steps for the management of critical/chronic limb ischaemia?

Answer 13

1. Urgently refer to vascular multidisciplinary team
2. Manage CV risk factors as mentioned
3. Manage pain

Question 14

What is the management of acute limb ischaemia?

Answer 14

1. Emergency assessment by vascular specialist (999) for surgery
2. Patient follow up with management of CVD