Peripheral Vascular Disease

Question 1

What are risk factors?

Answer 1

Smoking
Personal or FH of IHD, Stroke, Vascular disease
Diabetes
Obesity

Question 2

What are the causes?

Answer 2

Atherosclerosis= most common
Buerger disease- acute inflammation of lower limb veins/arteries (heavy smoking RF)
Fibromuscular dysplasia

Question 3

What are clinical features?

Answer 3

Symptoms depend on affected site
Aorto-iliac= buttocks/thighs
Femoro-popliteal= thighs and calves
Infra-popliteal= calves/feet

Question 4

What are the different levels of disease?

Answer 4

Intermittent claudication
- pain on exertion, esp uphill improves with rest

Ischaemic rest pain
-pain at rest or at night
- foot pain may be improved by hanging leg out of bed

Very severe
- tissue loss
-gangrene
- wet= dry with infection

Question 5

What investigations are needed?

Answer 5

ABPI
- <0.9 indicates PAD
- worsens with severity

Duplex US- 1st line imaging

CT/MRI angio
- plan revascularisation

Gold standard- digital subtraction arteriography
-rarely used only if stenting

Question 6

What is the management?

Answer 6

Conservative
- risk factor modification
- foot care

Medical
- optimise other conditions
- symptomatic
– Atorvastatin 80mg OD
–Clopidogrel 75mg OD

Surgery
-Critical limb ischaemia
- pain at rest
-tissue loss
- failed medical management