Peripheral Vascular Disease

Question 1

Describe peripheral artery disease, what it’s caused by and what it’s influenced.

Answer 1

• Reduced circulation of blood to body part other than brain or heart
• Cause is atherosclerosis
• Influenced by genetic and environmental factors

Question 2

What sorts of people have peripheral artery disease?

Answer 2

• Ischemic Heart Disease
• Age - Eldery more than young
• Male - more than female
• Tobacco use extremely common
• Hypertensive / High Cholesterol
• Diabetic

Question 2

Describe the pathophysiology of peripheral artery disease.

Answer 2

• Formation of atherosclerotic plaques
• Decreased blood flow to extremities

Question 3

Describe the rise in degree of severity of lower limbs affected by occlusive arterial disease.

Answer 3

• Intermittent claudication
• Progresses to critical ischaemia - if falls below specific pressure, can lead to necrosis

Question 3

SYMPTOMS AND SIGNS OF PERIPHERAL ARTERIAL DISEASE

Describe intermittent claudication.

Answer 3

• Pain - comes on with exercise
• Relatively consistent
• Relief when standing
• Worse when going uphill

Question 4

What are 2 effects of critical ischaemia?

Answer 4

Rest pain
Tissue loss

Question 5

What are the signs used to test for compartment syndromes?

Answer 5

• Pain
• Pallor
• Pulse
• Parasthesia
• Paralysis

Question 6

What vascular studies can be used to investigate occlusive disorders? How would you interpret the results of these studies?

Answer 6

• ABPIs and Venous/Arterial Duplexes
• When ABI > 0.9, indicates normal and usually no symptoms
• When ABI 0.5-0.9, indicates mild-moderate severity and present with claudication
• When ABI < 0.5, very severe and present with rest pain

Question 7

What radiological techniques are used to test for occlusive disorders?

Answer 7

• Angiogram
• MR Angiogram

Question 8

What should be accounted for during management of chronic arterial disorders?

Answer 8

• Nature of Symptoms
• General state of health for patients
• Social Circumstances e.g loneliness, psychosocial factors that become mental/physical detriment to patients
• Quality of Life

Question 9

Name 3 methods of management for chronic arterial disorders.

Answer 9

• Medical interventions
• Endovascular interventions
• Open surgery

Question 10

Describe some medical interventions that can be used for management of chronic arterial disease.

Answer 10

• Lifestyle changes
• Anti-platelet therapy
• Statins
• PDE Inhibitors

Question 10

Describe endovascular interventions that can be used for management of chronic arterial disease.

Answer 10

• Percutaneous angioplasty
• Stents

Question 11

Describe an example of open surgery that can be used for management of chronic arterial disease.

Answer 11

• Femoro Popliteal Bypass
• Amputation

Question 12

Describe factors that can lead to acute limb ischaemia.

Answer 12

• Thrombus on a pre existing atherosclerotic lesion
• Patient has previous bypass
• Patient has a history of intermittent claudication
• Vascular trauma

Question 13

What factors are considered when deciding best course of treatment for acute limb ischaemia?

Answer 13

• Location of lesions
• Anatomy of lesions
• Individual risk factors
• Procedural risk
• Clinical presentation of symptoms
• Duration of symptoms

Question 14

Give 2 surgical procedures used to treat acute limb ischaemia.

Answer 14

• Thromboembolectomy
• Bypass