Peripheral vascular disease I & II

Question 1

What is intermittent claudication?

Answer 1

blood reaching exercising muscle is insufficient

Question 2

Define claudication

Answer 2

Muscle ischaemia

Question 3

What are the symptoms of intermittent claudication

Answer 3

patient is pain-free at rest, but after periods of exercise pain develops in affected limb, relieved by further rest

Question 4

What are the risk factors of intermittent claudication?

Answer 4

> male gender
> age (per 10 years)
> diabetes
> smoking
> hypertension
> hypercholesterolaemia
> fibrinogen
> alcohol

Question 5

What are the non-invasive investigations of PVD?

Answer 5

o measurement of ABPI

o duplex ultrasound scanning

Question 6

What is the normal ranges of ABPI?

Answer 6

> normal 0.9-1.2
claudication 0.4-0.85 (-1.0)
0-0.45

Question 7

What are the invasive investigations of PVD?

Answer 7

> magnetic resonance angiography
CT angiography
catheter angiography

Question 8

What are the guardian therapies of PVD?

Answer 8

o SMOKING
o lipid lowering
o antiplatelets
o hypertension Rx
o diabetes Rx
o life-style
o walking will develop collateral circulation

Question 9

What are the guidelines for exercise for improvement of symptoms?

Answer 9

1 hour per day to 30 mins 3 times per week for a minimum of 6 months

Question 10

Which drugs are used in PVD?

Answer 10

cilostozol

Question 11

What are some invasive modes of PVD treatment?

Answer 11

o angioplasty/stenting
o surgery
- endartectomy
- bypass
- anatomic 
- extra-anatomic 
> prosthetic (dracon, ePTFE)
> vein

Question 12

What are some symptoms of critical limb ischaemia?

Answer 12

rest pain= toe/fore foot ischaemia
o	lying
o	sleeping
-worse at night
-helped by sitting and putting the leg in a dependant position
-helped by getting up and walking about

Question 13

What is a side effect of ischaemia?

Answer 13

Ulcers/gangrene

Question 14

What are the two major risk factors for critical limb ischaemia?

Answer 14

Smoking

Diabetes

Question 15

What are the 4 treatments of critical limb ischaemia?

Answer 15

• Realistic Expectations
• Analgesia
• Angioplasty / Stenting
• Surgical reconstruction / amputation

Question 16

Why should limbs be amputated and where?

Answer 16

• a life or a limb
• where
  > healing
  > function
  > conversion rate from below to above knee amputation id approx. 15%