Peripheral Vascular Disease

Question 1

What causes intermittent claudication?

Answer 1

This occurs when insufficient blood reaches exercising muscle

Question 2

Investigations of lower limb ischaemia - non-invasive and invasive

Answer 2

Non-invasive = measurement of ABPI, duplex ultrasound scanning
Invasive = magnetic resonance angiography, CT angiography, catheter angiography

Question 3

Equation for ABPI

Answer 3

Ankle pressure/brachial pressure

Question 4

Normal ABPI

Answer 4

0.9-1.2

Question 5

ABPI indicating claudication

Answer 5

0.4-0.85

Question 6

Severe ABPI values

Answer 6

0-0.4

Question 7

‘Guardian’ therapy in the treatment of lower limb ischaemia

Answer 7

Slowing progression - stop smoking, lipid lowering, anti-platelets, treat hypertension, treat diabetes, discuss lifestyle issues
Give information and realistic expectations to the patient

Question 8

Exercise training in treatment of lower limb ischaemia

Answer 8

30 mins, 3x a week for 6+ months beyond pain

Question 9

Which drugs can be given in the treatment of lower limb ishaemia?

Answer 9

Cilostozol, pentoxifyline, naftidrofuryl

Question 10

What does rest pain indicate?

Answer 10

Toe/foot ischaemia

Question 11

Describe rest pain

Answer 11

Nerve ending pain worse when lying or sleeping

Question 12

What do ulcers/gangrene indicate?

Answer 12

Severe ischaemia and damage

Question 13

Critical limb ischaemia symptoms

Answer 13

Pain at rest (rest pain), involves toes and forefoot, requires strong analgesia, worse at night, helped by sitting and putting leg in dependent position and by getting up and walking about

Question 14

Clinical examination in critical limb ischaemia

Answer 14

Cool to touch, absence of peripheral pulses, colour change, poor tissue nutrition, venous guttering, ulcers, gangrene

Question 15

Signs indicating poor tissue nutrition

Answer 15

Hairless, shiny skin with thick nails

Question 16

Risk factors for amputation in critical limb ischaemia

Answer 16

Smoking and diabetes

Question 17

Pathogenesis of abdominal aortic aneurysm

Answer 17

Regulation of elastin/collagen in aortic wall →
Aneurysmal dilatation →
Increase in aortic wall stress →
Progressive dilatation →

Question 18

How much does the diameter increase in a true arterial aneurysm?

Answer 18

50%

Question 19

Risk factors for abdominal aortic aneurysm

Answer 19

Male, age, family history, smoking, peripheral vascular disease, cardiovascular disease, cerebrovascular disease, hypertension, hypercholesterolaemia, diabetes

Question 20

Symptomatic AAA

Answer 20

Pain (abdominal, back), ‘trashing’, collapse

Question 21

Clinical examination findings for symptomatic AAA

Answer 21

Patients may look ‘well’, may have tachycardia, may be hypotensive, pulsatile expansile mass +/- tenderness, transmitted pulse, peripheral pulses

Question 22

Investigations for AAA

Answer 22

US scan, CT scan

Question 23

What does an ultrasound scan tell us about AAA?

Answer 23

Whether or not there is one and its AP diameter

Question 24

What does a CT scan tell us about AAA?

Answer 24

Shape, size and iliac involvement

Question 25

Elective aneurysm repair

Answer 25

Prophylactic operation to reduce the risk of rupture balanced against the risk of the procedure

Question 26

Emergency aneurysm repair

Answer 26

Therapeutic procedure balancing the expectation of death against the risk of the procedure

Question 27

Management for elective aortic aneurysm

Answer 27

Actively watch (surveillance), actively intervene (EVAR, Open)

Question 28

Endovascular aneurysm repair (EVAR) procedure

Answer 28

Exclude AAA from ‘inside’ the vessel
Inserted via peripheral artery
X-ray guided

Question 29

Open repair for AAA procedure

Answer 29

Laparotomy
Clamp aorta + iliacs
Dacron Graft
Tube vs Bifurcated graft