Peripheral vascular disease (acute & chronic limb ischaemia)

Question 1

Define peripheral vascular disease

Answer 1

Occurs due to atherosclerosis causing stenosis of arteries via a multifactorial process involving modifiable & non-modifiable risk factors

Question 2

Aetiology of peripheral vascular disease

Answer 2

Occurs due to ATHEROSCLEROSIS in peripheral arteries

Question 3

Types of peripheral vascular disease

5

Answer 3

Intermittent claudication - calf pain on exercise
Critical limb ischaemia - pain at rest (MOST SEVERE)
Acute limb ischaemia - sudden decrease in arterial perfusion in a limb, due to thrombotic or embolic causes
Arterial ulcers
Gangrene

Question 4

Risk factors for peripheral vascular disease

6

Answer 4

(same as for any other atherosclerotic disease)
Smoking 
Diabetes
Hypertension
Hyperlipidaemia
Physical inactivity
Obesity

Question 5

Epidemiology of peripheral vascular disease

gender, age

Answer 5

More common in MALES
Incidence increases w/ age
(20% of 70+yr olds)

Question 6

Presenting symptoms of peripheral vascular disease - intermittent claudication
(3)

Answer 6

Cramping pain in the calf/thigh/buttock after walking a given distance (claudication distance) & relieved by rest
Calf = femoral disease
Buttock = iliac disease

Question 7

Presenting symptoms of peripheral vascular disease - critical limb ischaemia
(4)

Answer 7

Ulcers
Gangrene
Rest pain
Night pain (relieved by dangling leg over edge of bed)

Question 8

Presenting symptoms of peripheral vascular disease - leriche syndrome
(3)

Answer 8

Buttock claudication
Impotence
Absent/weak distal pulses

Question 9

Presenting symptoms of peripheral vascular disease - fontaine classification of PVD
(4)

Answer 9

Asymptomatic
Intermittent claudication
Rest pain
Ulceration/gangrene

Question 10

Signs of peripheral vascular disease on physical examination - acute limb ischaemia
(6)

Answer 10

Pain
Pale
Pulseless
Paralysis
Parasthesia
Perishingly cold

Question 11

Signs of peripheral vascular disease on physical examination - other symptoms
(4)

Answer 11

atrophic skin
hairless
punched out ulcers (often painful)
colour change when raising leg (to Buerger’s angle)

Question 12

Investigations for peripheral vascular disease

4

Answer 12

Full cardiovascular risk assessment
Colour duplex US
MRI/CT
ABPI (ankle-brachial pressure index)

Question 13

Investigations for peripheral vascular disease - cardio risk assess
(6)

Answer 13

BP
FBC - anaemia will worsen ischaemia
Fasting blood glucose
Lipid levels
ECG - check for pre existing coronary artery disease
Thrombophilia screen - for patients < 50yrs

Question 14

Investigations for peripheral vascular disease - colour duplex US
(2)

Answer 14

FIRST LINE

Shows site & degree of stenosis

Question 15

Investigations for peripheral vascular disease - MRI/CT

Answer 15

Assesses extent & location of stenoses

Question 16

Investigations for peripheral vascular disease - ABPI

2

Answer 16

Marker of cardiovascular disease

ABPI < 0.8 = do NOT apply pressure bandage as this will worsen ischaemia