Peripheral vascular disease

Question 1

What is the underlying cause of PVD

Answer 1

atherosclerosis causing stenosis of the arteries

Question 2

What are the sx of intermittent claudication

Answer 2

cramping in calf, thigh, or buttock after certain distance and relieved by rest

Question 3

How can critical limb ischaemia present

Answer 3

i. foot pain at rest e.g. at night relieved by hanging foot over bed
ii. ulceration
iii. gangrene

Question 4

How can acute limb ischaemia present

Answer 4

1 or more of the 6 Ps

• Pale
• Painful
• Pulseless
• Paralysed
• Paraesthetic
• ‘Perishing with cold’ - extremely cold

Question 5

What are the signs of acute limb ischaemia

Answer 5

• absent femoral, popliteal or foot pulses
• cold white legs
• atrophic skin
• punched out ulcers
• postural colour change
• Buergers angle <20
• CRT >15s (severe)

Question 6

What classification is used to clinically classify PAD? Explain it

Answer 6

Fontaine

1. Asymptomatic
2. Intermittent claudication
3. Ischaemic rest pain
4. Ulceration/gangrene - critical ischaemia

Question 7

What are the ix for PAD

Answer 7

1. colour DUPLEX US
2. ABPI
3. Check pulses
4. MRI/CT angiography
5. Exclude DM, arteritis (ESR/CRP), FBC (anaemia, polycythaemia) Lipids, ECG

Question 8

How can the results of ABPI be interpreted?

Answer 8

1 - normal
0.6-0.9 - claudication
0.3-0.6 - rest pain
<0.3 - impending

Question 9

What is conservative management of PAD?

Answer 9

RF modification:
i. quit smoking (vital)
ii. Rx comorbidities - HTN, DM, high cholesterol
Exercise training

Question 10

What is the pharmacological management of PAD

Answer 10

1. atorvastatin 80mg
2. clopidogrel
3. +/- vasodilator (naftidrofuryl oxalate)

Question 11

What is the management of severe PAD

Answer 11

i. angioplasty
ii. stenting
iii. bypass

Question 12

When are amputations indicated?

Answer 12

relieve intractable pain and death from sepsis and gangrene