Peripheral Vascular Disease

Question 1

What is intermittent claudication?

Answer 1

Pain in the back of the calves after exertion, relieved after a while by rest

Question 2

What causes intermittent claudication?

Answer 2

Insufficient blood reaching the exercising muscle, i.e. muscle is starved of oxygen

Question 3

What classification/staging is used to grade claudication?

Answer 3

Fontaine staging

Question 4

Name two non-invasive investigations for lower limb ischaemia

Answer 4

Ankle brachial pressure index (ABPI)

Duplex ultrasound scan

Question 5

Name three invasive investigations for lower limb ischaema

Answer 5

Magnetic resonance angiography
CT angiography
Catheter angiography

Question 6

How is ABPI measured?

Answer 6

Ankle pressure / Brachial pressure (mm Hg)

using systolic pressures

Question 7

What range for ABPI would indicate claudication?

Answer 7

0.4-0.85

Question 8

Name some non-invasive therapy for limb ischaemia

Answer 8

Stop smoking
Increase exercise
Antiplatelet drugs
Statins

Question 9

Is angioplasty + stenting indicated for lower limb ischaemia?

Answer 9

Yep

Question 10

What is endarterectomy?

Answer 10

Cutting out the inside of an artery (remove plaque and fibrous tissue)

Question 11

Describe critical limb ischaemia

Answer 11

Pain in toes/foot/leg at rest, worse at night (lying down), relieved by walking about for a bit
Can cause ulcers/gangrene

Question 12

What is the general pathogenesis behind AAA?

Answer 12

Defect in collagen-elastin regulation, causing excessive dilation + increase in aortic wall stress

Question 13

What are some typical features of AAA?

Answer 13

Abdo pain
Pulsatile mass
May be asymptomatic unless ruptured

Question 14

What does expansile mean? How does it differ from pulsatile?

Answer 14

Expansile mass pushes hands in opposite directions; pulsatile mass pushes hands up and down

Question 15

What 2 non-invasive investigations are done for AAA?

Answer 15

Ultrasound

CT scan

Question 16

What is the investigation of choice for AAA?

Answer 16

Ultrasound - tells us whether there is an AAA or not

Question 17

What can a CT scan tell us about an AAA?

Answer 17

Whether it is ruptured or not

Question 18

At what size would an AAA be considered/referred for elective repair?

Answer 18

5.5 cm

Question 19

What is involved in endovascular aneurysm repair (EVAR)?

Answer 19

Stent inserted via groin and passed up until the weakened part of the artery aneurysm is reached, where it seals off the aneurysm from inside the artery

Question 20

What are the benefits of EVAR over open surgery?

Answer 20

Less mortality

Faster recovery

Question 21

What are the benefits of open surgery over EVAR?

Answer 21

Possible in almost everyone

Rare further interventions

Question 22

Which veins in the leg make up the deep venous system?

Answer 22

Tibials, popliteals, femorals

Question 23

Which veins in the leg make up the superficial venous system?

Answer 23

Saphenous, perforators

Question 24

How do varicose veins arise?

Answer 24

Back pressure due to incompetent valves causes blood to pool in superficial veins

Question 25

What are secondary varicose veins?

Answer 25

Arise due to DVT

Question 26

What is thrombophlebitis?

Answer 26

Inflammation of veins caused by a clot, causing scarring/fibrosis

Question 27

Name a non-interventional management of varicose veins

Answer 27

Compression stockings | N.B. contraindicated in those with low ABPI

Question 28

Name interventional management of venous insufficiency

Answer 28

``` Foam sclerotherapy (chemical thrombophlebitis) Endovenous ablation ```