Peripheral Vascular Disease

Question 1

Define Peripheral Vascular Disease

Answer 1

range of arterial/vascular syndromes causes by atherosclerotic obstruction of the lower-extremity vessels

Question 2

Aetiology of Peripheral vascular disease

Answer 2

Atherosclerosis -> insufficient tissue perfusion

May be due to aortic coarctation, arterial fibrodysplasia, arterial tumours, arterial dissection, embolism, thrombosis, vasospasm, trauma
Takayusu’s arteritis, temporal arteritis, thoracic outlet obstruction, Buerger\s disease

Question 3

Risk factors for Peripheral vascular disease

Answer 3

Smoking
Diabetes
Hypertension
Hyperlipidaemia
Age >40 
Sedentary lifestyle

Question 4

What are the stages of Peripheral vascular disease

Answer 4

Fontaine stages
I	Asymptomatic
IIa	Mild claudication
IIb	Moderate to severe claudication
III	Ischaemia rest pain
IV 	Ulceration or gangrene

Question 5

Symptoms of Peripheral vascular disease

Answer 5

Asymptomatic (50%)

Intermittent claudication (pain, cramps, parasthesia distal do occlusion)
thigh or buttock pain with walking, relieved by rest
Sudden onset severe leg pain + numbness, weakness, pale and cold leg
Erectile dysfunction
Non-healing wound/ulcer

Question 6

What are the symptoms of critical limb ischaemia

Answer 6

Resting pain
Ulcer
Tissue loss (gangrene)
Night pain - burning pain relieved by hanging legs over the side of the bed

Question 7

Signs of Peripheral vascular disease

Answer 7

Diminished or absent pulses
Muscle atrophy 
pallor on leg elevation
Loss of hair over the dorm of the foot 
Thickened toenails
Shiny/scaly skin
gangrene, ulcers, necrosis 
Pale extremities

Question 8

6 P’s of Peripheral vascular disease

Answer 8

Pale
Pulseless
Painful
Paralysed
Paraesthesia
Perishingly cold

Question 9

Investigations for Peripheral vascular disease

Answer 9

Ankle-brachial index (ABI): <0.9 = PAD
Toe brachial index: <0.6

CK: check for muscle damage

Duplex USS: peak systolic velocity ratio >2 (stenosis)
Continuous wave Doppler USS: Pulsatility index decrease

Catheter angiography, CT angiogram, MR angiography: anatomical detail of stenoses or occlusion

Question 10

What is Leriche syndrome

Answer 10

peripheral vascular disease at the level of aortic bifurcation.
Triad of:
Bilateral buttock, hip or thigh claudication
Erectile dysfunction
Absent/diminished femoral pulses