Peripheral Vascular Disease

Question 1

define acute limb ischaemia

Answer 1

this is sudden loss of blood supply to a limb caused by a blockage in the artery suppling it

Question 2

presentation of acute limb ischaemia

Answer 2

6P's
- pain
- pallor
- parathesia
- paralysis
- perishingly cold
- pulseless
hairlessness, thick nails, shiny skin and venous guttering can also be seen

Question 3

diagnosis of acute limb ischaemia

Answer 3

• ankle/brachial index
• US to see flow through vessels
• angiography (dye injected)
• bloods (cholesterol and TAGs)

Question 4

management of acute limb ischaemia

Answer 4

• pharmacological e.g. cholesterol, BP lowering
• lifestyle
• angioplasty (balloon and stent)
• bypass (graft for new artery)
• thrombolytic therapy and anticoagulation

Question 5

define diabetic foot sepsis

Answer 5

this is a septic injury to the foot caused by peripheral neuropathy and an inability to heal

Question 6

presentation of diabetic foot sepsis

Answer 6

pyrexia
tachycardia
confusion
Kussmaul's breathing (diabetic ketoacidosis)-JVP rising of inspiration 
swollen, tender foot with pus
pulse may not be present

Question 7

diagnosis of diabetic foot sepsis

Answer 7

• history of diabetes control
• ankle/brachial index
• peripheral neuropathy examination

Question 8

management of diabetic foot sepsis

Answer 8

• antibiotics
• amputation
• prevention=footwear and diabetes management

Question 9

define claudication

Answer 9

this is muscle ischaemia on exercise

Question 10

presentation of claudication

Answer 10

pain on exercise

reduced exercise tolerance

Question 11

diagnosis of claudication

Answer 11

• ankle/brachial pressure index
• duplex ultrasound scanning
• CT angiography and catheter angiography

Question 12

ankle-brachial pressure index indications

Answer 12

normal = 0.9-1.2
claudication = 0.4 - 0.85 (1.0)
severe = 0 - 0.4

Question 13

management of claudication

Answer 13

• lifestyle
• exercise training beyond pain and compression
• aspirin
• angioplasty (stent)
• amputation if ischaemic

Question 14

define varicose veins

Answer 14

these are dilated, tortuous superficial veins due to abnormal venous circulatory pressure

Question 15

presentation of varicose veins

Answer 15

• thrombophlebitis
• haemosiderin deposits
• ulceration

Question 16

diagnosis of varicose veins

Answer 16

doppler ultrasound scan

Question 17

management for varicose veins

Answer 17

• if asymptomatic then not required
• patients may request intervention for aesthetic reasons
• foam sclerotherapy or endovenous ablation (radio frequency) these close the vein so blood flow is redirected to a healthy vein