Peripheral vascular disease

Question 1

PVD

Answer 1

characterised by narrowing and in final stages occlusion of the peripheral arteries due to atherosclerotic plaques most commonly affects the legs

Question 2

aetiology

Answer 2

• Atherosclerosis
• Common risk factors are smoking, diabetes, hypercolesterolaemia and hypertension, older age

Question 3

clinical presentation

Answer 3

intermittent claudication

Question 4

intermittent claudication

Answer 4

• Occurs when insufficient blood reaches exercising muscle due to atherosclerosis in the arteries
• Classic presentation is exertional discomfort, most commonly in the calves, relieved by rest

Question 5

risk factors of intermittent claudication

Answer 5

• Older age can increase risk, but also increase risk of similar pain-causing disorders
• No threat to limb, treating IC will not prevent limb loss

Question 6

severe PVD

Answer 6

Obstruction to blood flow in the artery is compromised to the point where the blood is unable to maintain oxygenation of the tissue at restc

Question 7

clinical presentation of severe PVD

Answer 7

pain at rest, ulceration, tissue necrosis, diminished/absent peripheral pulses and poor tissue nutrition
difficulty sleeping due to pain

Question 8

clinical examination

Answer 8

• Foot cool to touch
• Absence of peripheral pulses
• Colour change
• Buerger test
• Poor tissue nutrition
• Venous guttering
• Ulcers
• Gangrene

Question 9

investigations

Answer 9

check pulses
ABPI
imaging

Question 10

check pulses

Answer 10

• Femoral
• Popliteal
• Posterior tibial
• Dorsalis pedis → 1/10th of people have an absent dorsalis pedis pulse
• ALWAYS compare pulses between legs and take simultaneously

Question 11

ABPI

Answer 11

• ABPI = ankle pressure/brachial pressure
• Measures systolic blood pressure at brachi and ankle, then divides them
• Normal = 0.9 - 1.2
• Claudication = 0.4 - 0.85
• Severe claudication = 0 - 0.4

Question 12

imaging

Answer 12

Duplex Ultra Sound
CT/MRI/catheter angiography
CT angiography are routinely used for severe PVD

Question 13

management

Answer 13

We are treating the symptoms, not curing the disease. Atherosclerosis is a progressive disease

Question 14

IC treatment

Answer 14

• No threat to limb loss
• Improving quality of life
• Invasive treatments could potentially increase risk of limb loss
• Treatments should be non-invasive
• Lifestyle advice should be offered, if it does not work then consider vasodilator therapy

Question 15

severe PVD treatment

Answer 15

• Threat to limb loss
• More invasive treatments may be preferred to prevent limb loss
• Angioplasty or a graft may be required
• If significant tissue damage has occurred then amputation will be required

Question 16

lifestyle

Answer 16

• SMOKING CESSATION, supervised exercise program, advised to lose weight
• Control risk factors - diabetes, hypertension

Question 17

surgical

Answer 17

• Angioplasty or bypass graft in patients with very severe symptoms or if tissue damage present
• inflow bypass→ anatomic, prosthetic vein
• Outlfow bypass → autologous, prosthetic vein
• In severe critical limb ischaemia - amputation

Question 18

pharmaceutical

Answer 18

• Vasodilator therapy should be considered for a trial period of 3–6 months
• Antiplatelet drugs and Statin therapy