Peripheral Vascular Disease

Question 1

When does intermittent claudication occur?

Answer 1

When there is insufficient blood flow to the muscles in the legs during exercise

Question 2

What is intermittent claudication?

Answer 2

Ischaemic pain in the legs exacerbated or brought on by exercise due to the muscles requiring more oxygen than the vasculature can supply

Question 3

What are the four main pulses in the lower limbs?

Answer 3

1. Femoral 2. Popliteal 3. Posterior tibial 4. Dorsalis pedis

Question 4

Which two general approaches to investigation could be taken for suspected lower limb ischaemia?

Answer 4

1. Non-invasive investigation 2. Invasive investigation

Question 5

Give two examples of non-invasive investigation in relation to lower limb ischaemia

Answer 5

1. Measurement of ABPI (ankle-brachial pressure index) 2. Duplex ultrasound scanning

Question 6

Give three examples of invasive investigation in relation to lower limb ischaemia

Answer 6

1. Magnetic resonance angiography 2. CT angiography 3. Catheter angiography

Question 7

What is angiography?

Answer 7

Radiography of blood/lymph vessels after introduction of a radiopaque substance (contrast).

Question 8

Why is a normal ankle-brachial pressure index (ABPI) very close to 1?

Answer 8

ABPI is calculated by dividing ankle blood pressure over brachial pressure. Ideally, blood pressure should be the same at both locations (giving ABPI of 1) In PVD, blood flow is reduced to the lower limbs so blood pressure is lower, which gives a lower ABPI

Question 9

What is the normal ABPI range?

Answer 9

0.9-1.2

Question 10

What is the ABPI range for someone with claudication

Answer 10

0.4-0.85

Question 11

What is associated with diabetes that can lower ABPI?

Answer 11

Calcified vessels - lowers peripheral artery blood pressures

Question 12

How does exercise impact ABPI?

Answer 12

Normally it will increase, but in patients with claudication it will decrease

Question 13

Which two elements are incorporated into duplex ultrasound scanning?

Answer 13

1. Grayscale - visualises structure, plaques and cross sections of narrowed vessles
2. Colour - Allows for visual representation of blood flow

Question 14

What does magnetic resonance angiography allow viewing of?

Answer 14

Occulsions and aneurysms

Question 15

How does CT angiography work?

Answer 15

A range of X-rays are beamed froma rotating device to create a 3D image.

Contrast is added to vessels

Question 16

What is a key use for catheter angiography?

Answer 16

Visualisation of coronary arteries

Question 17

How is lower limb ischaemia slowed?

Answer 17

1. Smoking Cessation
2. Lowering lipids
3. Antiplatelets
4. Hypertension management
5. Good diabtetic management
6. Good lifestyle choices e.g. diet/physical exerise

Question 18

How can symtoms for lower leg ischaemia be improved?

Answer 18

1. Exercise training (lowers oxygen tolerance)
2. Drugs - Cilostazol
3. Angioplasty or stenting incraeses lumen diameter
4. Surgery - endarterectomy (removes plaque) or bypass (uses prosthetic vein)

Question 19

Which symptoms indicate severe ischaemia and tissue damage?

Answer 19

1. Ulcers
2. Gangrene
3. Pain at rest

Question 20

What are the main risk factors for critical limb ischaemia?

Answer 20

1. Smoking
2. Diabetes

Question 21

How can critical limb ischaemia be treated?

Answer 21

1. Painkillers
2. Angioplasty/stenting
3. Surgical reconstruction
4. Amputation