Peripheral vascular disease

Question 1

What is claudication

Answer 1

Lower limb muscle pain elicited by walking and as rapidly relieved by rest

Question 2

Common sites of atherosclerosis causing claudication

Answer 2

80% superficial femoral
15% aorta and iliac arteries
Posterior tibial in diabetics

Question 3

Pathology of Leriches syndrome

Answer 3

Aorta or common iliac atherosclerosis

Leads to:
Thigh pain
Buttocks pain
Erectile dysfunction

Question 4

What do you need to cover in history

Answer 4

When it started
Where is the pain 
Relieved by rest?
Progression
Exercise tolerance
Impact on ADLs
Risk factors
PMH

Question 5

Investigations

Answer 5

Bedside: glucose
Bloods: FBC, lipid profile
Imaging: Doppler US +/- duplex scan
Special tests: ABPI

Question 6

How to interpret ABPI result

Answer 6

<0.9 means peripheral vascular disease

>1.2 means artery calcification due to less artery compliance

Question 7

What is a duplex scan

Answer 7

Colour represents blood flow

Question 8

What do you expect in a Doppler US of someone with PVD

Answer 8

Increased velocity through a stenosed area

Question 9

What is neurological claudication

Answer 9

Dermatomal pain on movement due nerve compression in a spinal stenosis

Question 10

Management

Answer 10

Modify risk factors
Encourage exercising through pain - build up collateral circulation
Statins - despite cholesterol level 
Clopidogrel
Surgery

Question 11

What are the options for surgery

Answer 11

Bypass grafting - GSV, cephalic or synthetic in that order of preference
Percutaneous transluminal angioplasty using seldinger technique

Question 12

Signs of critical leg ischaemia

Answer 12

Pain on rest

Gangrene or ulceration

Question 13

Describe venous ulcers

Answer 13

Sloping

Lower leg/behind medial malleolus

Question 14

Describe arterial ulcers

Answer 14

Punched out

Usually on bony prominences on foot and ankle

Question 15

How to relieve nocturnal rest pain

Answer 15

Hang leg out of bed

However causes fluid retention = ulcers

Question 16

Special test for critical leg ischaemia

Answer 16

Buergers test - foot pale when elevated, foot red when put back down

Question 17

What do you see on examination in critical leg ischaemia

Answer 17

Cold
Pallor
Pain
Pulseless
Ulcers
Positive beurgers test

Question 18

Management of critical leg ischaemia

Answer 18

Angioplasty of bypass if salvageable (mottling blanches under pressure)
Amputation if mottling doesn’t blanch under pressure or extreme pain