Peripheral vascular disease

Question 1

What is intermittent claudication

Answer 1

Pain or discomfort in legs during activity that subsides with rest

Question 2

What can confirm PAD

Answer 2

ABPI and US duplex

Question 3

Presenting features of PAD with intermittent claudication

Answer 3

Pain - cramp or burn
Location - calf muscles. can occur anywhere in leg
Duration - lasts a few minutes and go with rest - worsens over time
Distance - claudication distance
Numb, tingle or wekaness also

Question 4

How can measure PAD severity

Answer 4

Claudication distance

Question 5

Commorbidities with PAD

Answer 5

Strong link with smoking
hypertension
diabetes mellitus
obesity

Question 6

Management of PAD

Answer 6

Clopidogrel first line
Statin
Exercise training

Question 7

Management of severe PAD or critical limb ischaemia

Answer 7

endovascular revascularization
surgical revascularization

Question 8

endovascular revascularization options

Answer 8

percutaenous transluminal angioplasty +/- stent placement

Question 9

surgical revascularization options

Answer 9

surgical bypass with an autologous vein or prosthetic material
endarterectomy

Question 10

when use endovascular vs surgical vascularisation

Answer 10

endovascular - short segment stenosis (e.g. < 10 cm), aortic iliac disease and high-risk patients
open surgical - long segment lesions (> 10 cm), multifocal lesions, lesions of the common femoral artery and purely infrapopliteal disease

Question 11

Amputation when done in PAD

Answer 11

patients with critical limb ischaemia who are not suitable for other interventions such as angioplasty of bypass surgery.

Question 12

Drugs licensed in PAD

Answer 12

Naftidrofuryl oxalate (QOL)
Colostazol - PDE3 inhibitor (not recommended by NICE)

Question 13

What is critical limb ischaemia characterised by

Answer 13

chronic ischemic rest pain, non-healing wounds, and gangrene.

Question 14

What is acute limb threatening ischaemia characterised by

Answer 14

Sudden onset of pain, pallor, pulselessness and paralysis in the affectee limb

Question 15

Management of acute limb threatening ischaemia

Answer 15

thrombolysis, angioplasty, or surgical bypass.
Pain management

Question 16

6 Ps of acute limb ischaemia

Answer 16

pale
pulseless
painful
paralysed
paraesthetic
‘perishing with cold’

Question 17

What causes PAD

Answer 17

Atheromatous plaquws
Stiffening of the artery walls, leading to hypertension (raised blood pressure) and strain on the heart (whilst trying to pump blood against increased resistance)
Stenosis, leading to reduced blood flow (e.g., in angina)
Plaque rupture, resulting in a thrombus that can block a distal vessel and cause ischaemia (e.g., in acute coronary syndrome)

Question 18

Risk facotrs

Answer 18

Non-modifiable risk factors:

Older age
Family history
Male

Modifiable risk factors:

Smoking
Alcohol consumption
Poor diet (high in sugar and trans-fat and low in fruit, vegetables and omega 3s)
Low exercise / sedentary lifestyle
Obesity
Poor sleep
Stress

Question 19

Atherscleroiss other manifestations

Answer 19

Angina
Myocardial infarction
Transient ischaemic attack
Stroke
Peripheral arterial disease
Chronic mesenteric ischaemia

Question 20

What is leriche syndrome and triad

Answer 20

Occlusion in distal aorta or proximal common iliac artery
Thigh/buttock claudication
Absent femoral pulses
Male impotence

Question 21

Signs of PAD

Answer 21

Skin pallor
Cyanosis
Dependent rubor (a deep red colour when the limb is lower than the rest of the body)
Muscle wasting
Hair loss
Ulcers
Poor wound healing
Gangrene (breakdown of skin and a dark red/black change in colouration)

On examination, there may be:

Reduced skin temperature
Reduce sensation
Prolonged capillary refill time (more than 2 seconds)
Changes during Buerger’s test

Question 21

What is buergers test

Answer 21

Patient lying lift legs to 45 degree angle for 1-2 mins
Look for pallor
Buergers angle = angle where legs go pale

Part 2 - hang legs off bed
INitially blue as ischaemic tissue deoxygenates blood then dark red - vasodilation due to anaerobic respiration products

Question 22

What is rubour

Answer 22

Dark red colour in PAD legs

Question 23

What treatment is contraindicated in PAD

Answer 23

Compression stockings

Question 24

What is score for limb viability in ischaemia

Answer 24

Rutherford score

Question 25

What condition can give a falsely hihg.normal ABPI

Answer 25

T2DM

Question 26

When does spinal stenosis imorive

Answer 26

Positional change

Question 27

What heart arrhythmia resolves with exercise

Answer 27

Mobitz type I