Peripheral vascular disease

Question 1

Name and define the two types of peripheral vascular disease

Answer 1

1) occlusive- Caused by atherosclerosis which leads to occlusion of the peripheral arteries
↳ e.g. Intermittent claudication
2) vasoplastic- reversible localised or diffuse vasoconstriction of arteries or smaller blood vessels
↳ e.g. Raynaud’s syndrome

Question 2

what is Intermittent claudication and why does it occur?

Answer 2

1) cramping leg pain that develops when walking and is relieved with rest
2) occurs as a result of muscle ischaemia during exercise caused by obstruction to arterial flow

Question 3

what is Raynaud’s syndrome?

Answer 3

1) small blood vessels in the extremities such as hands and feet, fingers or toes are over-sensitive to even the slightest changes in temperature, the cold and sometimes stress

Question 4

peripheral arterial occlusive disease is associated with an increased risk of CV events. Outline what measures can be taken to reduce this risk (6)

Answer 4

1) Smoking cessation
2) Effective control of BP
3) Regulating blood lipids
4) Optimising glycaemic control in diabetes
5) Taking aspirin 75mg od
6) weight reduction in obesity

Question 5

what non-pharmacological treatments can be used to improve symptoms of intermittent claudication?

Answer 5

1) Exercise training can improve symptoms

2) Revascularisation procedures

Question 6

outline the pharmacological management of intermittent claudication

Answer 6

1) naftidrofuryl oxalate can alleviate symptoms and improve pain free walking distance in moderate disease
↳ assess for improvement after 3-6 months
2) Cilostazol- 2nd line treatment when lifestyle modifications have failed to improve symptoms
↳ assess for improvement after 3m

Question 7

outline how Raynaud’s syndrome is managed

Answer 7

1) Avoidance of exposure to cold and stopping smoking
2) in those with severe symptoms vasodialator treatment may be required.
↳ Nifedipine is useful for reducing the frequency and severity of vasoplastic attacks. Inositol nicotinate and naftidrofuryl are alternatives

Question 8

Can vasodialator therapy be used in chilblains

Answer 8

it is not established as being effective in chilblains

Question 9

what drug is indicated for spider veins in legs and varicose veins?

Answer 9

Sodium tetradecyl sulfate (sclerosant)