PVD

Question 1

Causes/ risk factors of PVD

Answer 1

• smoking
• diabetes
• hypertension
• hyperlipidaemia
• Old age

Question 2

Name the arteries of the leg

Answer 2

Question 3

Stages of chronic limb ischaemia

Answer 3

• *Intermittent claudication:** Cramp like pain in the legs relived by rest. Pain develops distal to the obstruction. Causes calf pain, but blockage of the aorta causes buttock pain and impotence
• *Rest pain -** Implies that the ischaemia is critical and the viability of the leg is threatened. The pain is severe and requires opioid analgesia.
• *Gangrene** – in dry gangrene, ischaemia results in death of tissue

Question 4

Acute limb ischaemia features

Answer 4

6 P’s

• Pain
• parasethesia
• pulseless
• pallor
• perishingly cold
• paralysis

Question 5

Diagnosis of PVD

Answer 5

1. History – symptoms as above, risk factors
2. Examination (see below)
3. Arterial/brachial pressure index
4. Angiogram (digital subtraction/MRI)
5. Doppler ultrasound

Question 6

Management of chronic limb ischaemia

Answer 6

• Conservative – stop smoking, exercise, BP control, anti-platelet drugs.
• Angiography + angioplasty, stent
• Surgical – bypass – vessel above obstruction to vessel below (aorto-femoral, femoral-popliteal, axillo-femoral, femoralfemoral)
• Amputation – after above measures have failed and rest pain or tissue loss

Question 7

How to treat acute ischaemia?

Answer 7

• Anticoagulation – IV heparin
• Urgent embolectomy/thrombectomy/bypass
• Thrombolysis
• If above fails or delay in diagnosis leading to dead tissue amputation may be required