peripheral vascular disease

Question 1

aneurysm

Answer 1

dilation of a vessel by more than 50% of its normal diameter

Question 2

true aneurysm

Answer 2

vessel wall is intact

Question 3

false aneurysm

Answer 3

breach in vessel wall

Question 4

mycotic aneurysm

Answer 4

arises secondary to an infectious process

Question 5

AAA presentation

Answer 5

75% are asymptomatic, identified on imaging

symptomatic - pain, thrashing, rupture

Question 6

AAA rupture

Answer 6

sudden onset apigastric/central pain 
a radiate through to back 
may mimic renal colic 
collapse 
examination - hypo/hypertensive, pulsatile expansive mass, tender, transmitted pulse, peripheral pulses, tachycardia

Question 7

AAA imaging

Answer 7

duple ultrasound

CT

Question 8

AAA management

Answer 8

open repair - laparotomy, clamp aorta and iliacs, Dacron graft, tube vs bifurcated graft
endovascular aneurysm repair EVAR - exclude AAA from inside the vessel, inserted via peripheral artery, x-ray guided, modular component

Question 9

plaque formation

Answer 9

activated platelets
LDL cholesterol
inflammatory response

Question 10

intermittent claudication

Answer 10

when insufficient blood reaches exercising muscles
pain free at rest
after variable periods of exercise ischaemic pain in affected limb
relieved by further rest

Question 11

ABPI

Answer 11

ankle brachal pressur index
normal 0.9-1.2
claudication 0.4-0.85
severe <0.4

Question 12

intermittent claudication investigations

Answer 12

non invasive - ABPI, duplex ultrasound scanning

invasive - magnetic resonance angiography, CT, catheter angiography

Question 13

intermittent claudication treatment

Answer 13

slow progress - smoking, lipid lowering, antiplatelet, hypertension Rx, diabetes Rx,
information/realistic expectation
exercise training and drugs - 30 min 3 times a week, cilostozol, pentoxifylline, naftidrofuryl
angioplasty +/- stent
surgery - inflow and outflow bypass

Question 14

critical limb ischaemia

Answer 14

rest pain - toe/foot ischaemia
ulcers/gangrene - severe ischaemia and damage
requires strong analgesia
worse at night
helped by sitting and putting the leg in a dependent position and getting up and walking about
results inn lower limb amputation

Question 15

critical limb ischaemia clinical exam

Answer 15

cool to touch, no peripheral pulses, colour change, poor tissue nutrition, venous guttering, ulcers, gangrene

Question 16

varicose veins

Answer 16

dilated, tortuous superficial veins, due to abnormal transmission of deep vein pressure
caused by deep vein obstruction and valve incompetence

Question 17

varicose veins risk factors

Answer 17

age
pregnancy
obesity

Question 18

chronic venous disease clinical features

Answer 18

varicose veins, venules, significant, recurrent, thrombophlebitis

Question 19

chronic venous ulceration

Answer 19

ulceration, long history, relapsing
usually on the inside of leg
investigation - duplex scan

Question 20

chronic venous management

Answer 20

non-interventional - information, graduated compression
interventional - endovenous: foam sclerotherapy, ablation
surgical - high tie, distal foam ablation
complications of interventions - thrombophlebitis, skin staining, ulceration, wound infection, nerve damage, recurrence