Peripheral vascular disease

Question 1

Percentage of people >70 affected

Answer 1

20%

Question 2

Aetiology of PVD

Answer 2

Atherosclerosis

Less commonly - artery spasm

Question 3

Symptoms of PVD, according to the 2 methods of staging

Answer 3

• Asymptomatic (up to 50%)
  
  • Fontaine Stage I
  • Rutherford Grade 0
• Intermittent claudication
  
  • Fontaine Stage II
  • Rutherford Grade 1
• Ischaemic rest pain
  
  • Fontaine Stage III
  • Rutherford Grade 2
• Gangrene
  
  • Fontaine Stage IV
  • Rutherford Grades 3-4

Question 4

Signs of PVD (4)

Answer 4

• Ulcers
• Peripheral cyanosis
• Hair loss
• Cold skin

Question 5

Investigations for PVD (3)

Answer 5

• Ankle-brachial index (ABI) <0.90
  
  • Systolic bp at the ankle / systolic bp at the arm
• Ultrasound (assess atherosclerosis)
• Angiography/CTA/MRA (TASC classification)

Question 6

Management of PVD (including special drug for intermittent claudication)

Answer 6

• Lifestyle (SNAP)
• Pharmacological
  
  • Statins
  • ACE inhibitors
  • Cilostazol - phosphodiesterase III inhibitor, induces vasodilation in the treatment of uncomplicated intermittent claudication
• Surgical
  
  • Revascularisation (bypass grafting, angioplasty, atherectomy)
  • Amputation (for gangrene)

Question 7

Complications of PVD (2)

Answer 7

• Infection
• Ischaemia