Peripheral Vascular Disease (Claudication, Critical Ischaemia)

Question 1

What is the pathophysiology of PVD?

Answer 1

Pathology arises from plaque:

• instability and rupture, occurring at rest
• stenosis or occlusion and supply/demand issues, occurring with exercise; clinically significant is >50%

Systemic vascular disease is a significant predictor of cardiovascular disease - 85% or more (the relationship is less the other way around)

Most common sites
- 1-2cm ICA, L subclavian, LAD coronary artery, renal artery origins, aortic bifurcation, EIA, SFA

Question 2

Recurrent angina following CABG?

Answer 2

Have developed left subclavian disease (esp. If white middle aged heavily smoking female) - stopping smoking will be amazing

Question 3

What is the most important drug for someone with vascular disease to be on? And what are the key side effects?

Answer 3

Statins!

Myalgia (continue, with more monitoring) - Myositis (with some raise CK - stop) - Rhabdomyolysis (very high CK - stop and manage)

Question 4

What are the key imaging modalities in vascular medicine?

Answer 4

ABPI

• getting the ankle and brachial systolic pulses
• in normal patients, ankle pulse will be greater, so normal should be >1.1 (though can also be high in some diabetes)
• 0.7-0.8 = typical of claudication
• 0.3-4 = gangrene…

Hand-held Doppler ultrasound

• same thing used for babies heartbeats
• one large pulse followed by 2-3 short pips afterwards = healthy
• one long, slow, wooshinh monophasic pulse = stenosis

Vascular ultrasound - duplex

CT, MRI

Angiography