Peripheral Vascular Disease

Question 1

What is intermittent claudication?

Answer 1

Pain in the back of the calves during exertion

Question 2

What causes intermittent claudication?

Answer 2

Atherosclerosis of the femoral artery

Question 3

What classification/staging is used to grade claudication?

Answer 3

Fontaine staging

Question 4

Name two non-invasive investigations for lower limb ischaemia?

Answer 4

Ankle brachial pressure index (ABPI)

Duplex ultrasound scan

Question 5

Name the main invasive investigation for lower limb ischaemia?

Answer 5

Angiography

Question 6

How is ABPI measured?

Answer 6

Ankle pressure / brachial pressure (mm Hg)

Question 7

What range for ABPI would indicate claudication?

Answer 7

0.4-0.85

Question 8

Name 4 non-invasive therapies for intermittent claudication?

Answer 8

Stop smoking
Increase exercise
Antiplatelet drugs (cilostazol)
Statins

Question 9

Treatment for worsening limb ischaemia?

Answer 9

Angioplasty

Question 10

What is endarterectomy?

Answer 10

Cutting out the inside of an artery to remove plaque

Question 11

Describe critical limb ischaemia + main treatment?

Answer 11

Resting toe and foot pain worse at night with ulcers and gangrene + amputation

Question 12

What are some typical features of a ruptured AAA?

Answer 12

Epigastric pain that radiates to the back

Pulsatile mass

Question 13

Typical patient with AAA?

Answer 13

Male, smoker and hypertensive

Question 14

What 2 non-invasive investigations are done for AAA (+ 1st line) ?

Answer 14

Ultrasound (1st line)

CT scan

Question 15

What can a CT scan tell us about an AAA?

Answer 15

Whether it is ruptured or not

Question 16

2 criteria for an optional AAA repair?

Answer 16

> 5.5 cm or increasing > 1 cm a year

Question 17

2 surgical options for AAA + which has less mortality/faster recovery?

Answer 17

Open repair and EVAR (better)

Question 18

What is the main superifical vein of the leg?

Answer 18

Saphenous

Question 19

How do varicose veins arise?

Answer 19

Increased venous pressure causes incompetent valves and pooling of blood

Question 20

What do secondary varicose veins arise from?

Answer 20

DVT

Question 21

What is thrombophlebitis?

Answer 21

Inflammation of veins caused by a clot

Question 22

Name a non-interventional management of varicose veins + CI?

Answer 22

Compression stockings + low ABPI

Question 23

Name 2 interventional management of venous insufficiency?

Answer 23

Foam sclerotherapy or ablation

Question 24

Diabetic foot sepsis is a … problem?

Answer 24

Pressure

Question 25

Biggest factor for limb loss?

Answer 25

Diabetes

Question 26

How do diabetics get foot sepsis?

Answer 26

Ulcers get infected and cause necrosis and gangrene

Question 27

Treatment for diabetic foot sepsis?

Answer 27

Urgent surgery and abx

Question 28

Cause of acute lower limb ischaemia?

Answer 28

Acute occlusion by embolism, rupture etc.

Question 29

0-4 hours occlusion with pallor?

Answer 29

Salveagable

Question 30

4-12 hours occlusion with mottling?

Answer 30

Partly reversible

Question 31

> 12 hours occlusion with redness and paralysis?

Answer 31

Non-salveagable

Question 32

Smoking decreases chance of limb amputation by?

Answer 32

10%

Question 33

Treatment for persistent DVTs?

Answer 33

IVC filter