peripheral vascular disease

Question 1

what is intermittent claudication (what causes it, symptoms)

Answer 1

insufficient blood reaching muscle during exercise caused by atherosclerosis, cramp in legs

Question 2

what can intermittent claudication lead to

Answer 2

critical limb ischaemia (constant lack of blood and O2)

Question 3

what is the ankle brachial pressure index

Answer 3

ankle pressure/ brachial pressure

Question 4

what are normal, claudication and severe values

Answer 4

normal 0.9-1.2, claudication 0.4-0.85, severe 0-0.4

Question 5

what non-invasive investigations can be done of ischaemia

Answer 5

measure ABPI and duplex ultrasound

Question 6

what invasive investigations can be done of ischeamia

Answer 6

magnetic resonance angiography, CT angiography, catheter angiography (V invasive)

Question 7

what non invasive treatment can be done (lifestyle and meds) of ischaemia

Answer 7

smoking cessation, diet, walking!!, antiplatelets, statins, lipid lowering

Question 8

treatment of limb of limb ischaemia

Answer 8

stent, angioplasty, bypass

Question 9

what is critical limb ischaemia

Answer 9

toe and leg pain, worse when lying down. can cause gangrene and ulcers. more likely in diabetics and smokers

Question 10

what is the treatment for critical limb ischaemia

Answer 10

amputation, analgesia, angioplasty/ stenting

Question 11

what is an aneurysm

Answer 11

dilation of a vessel by more than 50% of it’s norm

Question 12

what is the difference between a true and false aneurysm

Answer 12

true, wall is still intact, false, wall is breached

Question 13

what can cause AAA

Answer 13

degeneration: defect in elastin, dilation, aortic wall stress,

Question 14

what are the symptoms of AAA

Answer 14

mainly asymptotic, pain in abdomen if ruptures

Question 15

what are symptoms of ruptured AAA

Answer 15

sudden epigastric pain, can radiate through back, collapse, transmitted pulse and odd BP

Question 16

what can you do to investigate AAA? what is gold standard and why?

Answer 16

ultrasound as tells if ruptured. Also duplex ultra and CT scan

Question 17

what is the treatment for AAA

Answer 17

under 5.5cm = regular USS, over 5.5 cm = EVAR, ruptured = emergency open repair

Question 18

what is acute limb ischaemia

Answer 18

sudden loss of blood supply to a limb with no prior claudication

Question 19

what can diabetic food sepsis cause

Answer 19

ischaemia and limb loss from infection

Question 20

how to varicose veins arise

Answer 20

blocked veins leading to increased pressure

Question 21

what is the difference between primary and secondary varicose veins

Answer 21

primary = spontaneous, secondary = known cause eg DVT

Question 22

what are the deep veins in lower limbs

Answer 22

tibials, popliteals, femorals

Question 23

what are the superficial veins in the lower limbs

Answer 23

saphenous, perforators

Question 24

what are the increasingly severe clinical features

Answer 24

bleeding, thrombophlebitis (inflamed vein), hemosiderin deposits, lipodermatosclerosis, ulceration

Question 25

how do you investigate varicose veins

Answer 25

duplex scans

Question 26

what non-interventional management of varicose would you do

Answer 26

pressure stockings - contraindicated with low ABPI

Question 27

what interventional management of varicose would you do

Answer 27

foam sclerotherapy, mechanical laser, surgically tie it off.