Peripheral Vascular Disease

Question 1

Pathology of PVD

Answer 1

damage to the artery wall

plaque formation

Question 2

describe how damage to the artery wall occurs?

Answer 2

Endothelial cell damage - cigarette smoke,↑BP, ↑glucose, ↑cholesterol, ↑homocysteine, ↑free radicals

Question 3

Describe how plaque forms

Answer 3

Activated platelets – PDGF, Vascular Smooth Muscle Cell division / migration
LDL cholesterol – oxidized LDL
Inflammatory response – WBC → macrophages → foam cells

Question 4

How does intermittent claudication occur?

Answer 4

insufficient blood reaches the exercising muscle

Question 5

How is intermittent claudication relieved?

Answer 5

rest

Question 6

What makes claudication worse?

Answer 6

when you go farther, faster, steeper, heavier

Question 7

d:claudication

Answer 7

muscle ischaemia ON exercise

Question 8

How does claudication vary with age?

Answer 8

gets worse with age

Question 9

Name 2 non-invasive investigations for lower limb ischaemia?

Answer 9

measurement of ABPI
-ankle brachial pressure index
Duplex US scanning

Question 10

Name 3 invasive investigations for lower limb ischaemia

Answer 10

MR angiography
CT angiography
Catheter Angiography

Question 11

What is ABPI?

Answer 11

Ankle pressure/brachial pressure

Question 12

What is the ABPI normally?

Answer 12

0.9-1.2

Question 13

What is the ABPI Claudication?

Answer 13

0.4-0.85

Question 14

What is the ABPI Severe?

Answer 14

0-0.4

Question 15

Treatment of Lower limb Ischaemia

Answer 15

slowing progression: lessoning RF
ensuring other diseases controlled eg HT, diabetes, lipids antiplatelets etc
exercise
drugs: dont need to know

Question 16

Treatment of extreme ischaemia in limb ie if the limb it at risk of dying

Answer 16

angioplasty/stent

Question 17

Name some surgical procedures to relive ischaemia in limb

Answer 17

bypass surgery

Question 18

Critical Limb ischaemia at rest is

Answer 18

toe/foot ischaemia
nerve ending pain
lying/sleepinh

Question 19

What are ulcers/gangrene an example of?

Answer 19

severe ischaemia and damage

Question 20

What can severe ischaemia cause?

Answer 20

trauma

cant wear footwear?

Question 21

Symptoms of crtitical limb iscahemia

Answer 21

pain at rest
worse at night
sitting helps in toes and foot
requires strong anaglesia

Question 22

Examination findings ischaemia

Answer 22

cool to touch
absence of peripheral pulses
colour change
poor tissue nutrition
-hairless
-thick nails
-shiny skin
venous guttering
ulcers/gangrene

Question 23

Risk factors of Critical leg ischaemia

Answer 23

smoking

diabetes

Question 24

when do you amputate?

Answer 24

life or limb

grim

Question 25

epidemiology of limb ischaemia

Answer 25

males >55yrs

Question 26

What is lower limb ischaemia a marker for?

Answer 26

atherosclerosis elsewhere in the body