Peripheral Vascular Disease

Question 1

What are the categories of risk factors for PAD. (2)

Answer 1

Modifiable.

Non-modifiable.

Question 2

What is the chief complaint in PAD.

Answer 2

Intermittent claudication.

Question 3

What is the prevalence of intermittent claudication.

Answer 3

10%.

Question 4

What is PAD due to.

Answer 4

Due to atherosclerosis causing stenosis of arteries via a multifactorial process.

Question 5

What percentage of patients with PAD have co-existing cerebral or coronary artery disease.

Answer 5

65%.

Question 6

What are the symptoms of PAD. (6)

Answer 6

Cramping pain is felt in the calf, thigh, or buttock after walking for a given distance. 
The pain is relieved by rest. 
Ulceration. 
Gangrene. 
Foot pain at rest. 
Impotence.

Question 7

What are the critical signs of limb ischaemia. (3)

Answer 7

Gangrene.
Foot pain at rest.
Ulceration.

Question 8

What are the features of Leriche’s syndrome. (2)

Answer 8

Buttock claudication.

Impotence.

Question 9

Who is at risk of developing Buerger’s disease.

Answer 9

Young, heavy smokers.

Question 10

What classification system is used in PAD.

Answer 10

Fontaine.

Question 11

What are the classifications of the fontaine classification of PAD. (4)

Answer 11

Asymptomatic.
Intermittent claudication.
Ischaemic rest pain.
Ulceration/gangrene (critical ischaemia).

Question 12

What are the physical signs of severe limb ischaemia. (7)

Answer 12

Absent femoral, popliteal or foot pulses. 
Cold, white leg. 
Atrophic skin. 
Punched out ulcers (often painful). 
Postural/dependent colour change. 
A vascular angle of 15s.

Question 13

What are the test that should be done in a patient presenting with PAD. (9)

Answer 13

Eclude DM, arteritis. 
FBC 9anaemia, polycythaemia). 
UandEs. 
Lipids. 
ECG. 
Thrombophilia screen. 
Serum homocysteine if

Question 14

What imaging should be done in a patient with PAD. (2)

Answer 14

Colour duplex ultrasound is 1st line.

MR/CT angiography if intervention is being considered.

Question 15

What is the treatment for PAD. (3)

Answer 15

Risk factor modification.
Management of claudication.
Amputation.

Question 16

What are the aspects of treatment to manage the claudication. (5)

Answer 16

Supervised exercise programmes (improve symptoms by increasing collateral blood flow).
Vasoactive drugs (naftidrofuryl oxalate).
Percutaneous transluminal angioplasty (used for disease limited to single arterial segment).
Surgeical reconstruction (if atheromatous disease is extensive but distal run off is good).
Amputation (

Question 17

What are the 6 Ps of acute limb ischaemia. (6)

Answer 17

Pale. 
Pulseless. 
Painful. 
Paralysed. 
Paraesthetic. 
Perishingly cold.

Question 18

What is acute limb ischaemia.

Answer 18

A surgical emergency.

Question 19

What is the first step in acute limb ischaemia.

Answer 19

Revascularization is required within 4-6h to save the limb.

Question 20

What is acute limb ischaemia due to. (4)

Answer 20

Thrombosis in situ (40%).
Emboli (38%).
Graft/angioplasty occlusion (15%).
Trauma.

Question 21

What is the mortality rate in acute limb ischaemia.

Answer 21

22%.

Question 22

What is the amputation rate in acute limb ischaemia.

Answer 22

16%.

Question 23

How do you manage acute limb ischaemia. (2)

Answer 23

Surgical embolectomy or tissue plasminogen activator.

Anticoagulate with heparin after either procedure and look for the source of injury.

Question 24

What are some potential complications after treatment of acute limb ischaemia. (2)

Answer 24

Reperfusion injury.

Compartment syndrome.