Peripheral Vascular Disease

Question 1

What is peripheral vascular disease? What contributes to its pathogenesis?

Answer 1

• Arterial syndromes caused (generally) by arterial obstruction
  
  • Atherosclerosis, degenerative disease, dysplasia, inflammation, thrombosis

Question 2

What are risk factors for the development of peripheral vascular disease?

Answer 2

• Smoking
• Diabetes
• Hyperlipid/homocysteinaemia
• Hypercoagulable states
• Age > 40
• CAD/CVD history

Question 3

What are the likely findings on history and examination in a patient with peripheral vascular disease?

Answer 3

• Claudication (in legs/thighs/buttocks)
• Sudden onset pain/numbness/weakness/coldness/night pain (acute!)
• Erectile dysfunction
• Diminished pulses
• Ulceration/gangrene

Question 4

What might the investigative trail for a patient suspected to have peripheral vascular disease include?

Answer 4

• FBE (exclude anaemia)
• BGL (exclde dabetic neuropathy)
• Ankle-brachial index (0.9-0.5 or less in PAD)
• ECG/echo (exclude cardiac thrombosis)

Question 5

What are the management prinicples for a patient with peripheral vascular disease?

Answer 5

• Acute
  
  • Immediate anticoagulation +/- thrombolysis
  • Angiogram +/- revascularisation
• Chronic
  
  • Risk factor modification
  • Anticoagulation (clopidogrel)
  • Stenting/bypass (severe)