Peripheral vascular disease

Question 1

Intermittent claudication

Answer 1

Insufficient blood reaches the exercising muscle.
Ischaemic pain on/during exertion
Pail relieves with rest

Question 2

Lower limb ischaemia - Clinical features

Answer 2

6P’s

Pain, Pallor, Pulseless, Perishingly cold, Paresthesia, Paralysis

Question 3

Lower limb ischaemia - Causes

Answer 3

Sudden: embolism, trauma, arterial dissection, extrinsic compression

Question 4

Lower limb ischaemia - Investigations

Answer 4

Non invasive:

• measure ABPI
• Duplex US

Invasive:

• CT angiography
• Catheter angiography

Question 5

Lower limb ischaemia - Management

Answer 5

Lifestyle advice 
Exercise 
Anticoagulation
Antiplatelets 
Angioplasty +/- stent

Question 6

Critical limb ischaemia - Clinical features

Answer 6

Pain occurs at rest
Worse at night when lying down (horizontal)
Hang leg out edge of bed helps
Pain relieved by sitting, standing, walking

Question 7

Critical limb ischaemia - Risk factors

Answer 7

Smoking
Diabetes
Hypertension
Hypercholesterolaemia

Question 8

Critical limb ischaemia - Management

Answer 8

Analgesia
Angioplasty
Surgery (if limb salvageable)
Amputation (if limb not salvageable)