PVD/Chronic Limb Ischaemia

Question 1

What is PVD/chronic limb ischaemia?

Answer 1

PVD or chronic limb ischaemia is a long term reduction in blood supply to a limb

Question 2

What limbs are most commonly affected by PVD?

Answer 2

Legs

Question 3

What causes PVD?

Answer 3

Exposure to a number of risk factors over time increases likelihood of PVD

Question 4

What are some risk factors for PVD?

Answer 4

• Diabetes
• Hyperlipidaemia
• Hypertension
• Smoking
• Obesity
• Lack of exercise

Question 5

What is the most important risk factor for PVD?

Answer 5

Smoking

Question 6

How can the clinical presentation of PVD be classified?

Answer 6

Fontaine’s Classification

Question 7

How many stages are there in Fontaine’s classification of PVD?

Answer 7

4

Question 8

What is the presentation of a person with Stage 1 PVD?

Answer 8

Asymptomatic

Question 9

What is the presentation of a person with Stage 2 PVD?

Answer 9

Intermittent claudication

Question 10

What is the presentation of a person with Stage 3 PVD?

Answer 10

Ischaemia at rest (critical limb ischaemia)

Question 11

What is the presentation of a person with Stage 4 PVD?

Answer 11

Ulceration or gangrene

Question 12

What bedside test can be used to assess the extent of PVD?

Answer 12

Buerger’s Test

Question 13

How is Buerger’s test performed?

Answer 13

The patient lays supine and their leg is rasied until the leg goes pale.

Question 14

What result of Buerger’s tests indicates severe ischaemia?

Answer 14

Pale at <20º

Question 15

What is critical limb ischaemia?

Answer 15

An advance form of PVD

Question 16

How is critical limb ischaemia defined?

Answer 16

Any one of:

• Ischaemic rest pain >2 weeks
• Ischaemic lesions/gangrene
• ABPI <0.5

Question 17

How will a patient’s limb appear if they have critical limb ischaemia?

Answer 17

• Lack of pulses
• Cold to the touch

Question 18

How is a diagnosis of critical limb ischaemia confirmed?

Answer 18

Using ABPI (ankle brachial pressure index)

Question 19

How is ABPI calculated?

Answer 19

ABPI = Pressure leg/Pressure arm

Question 20

What does an ABPI of >0.9 mean?

Answer 20

Normal

Question 21

What does an ABPI of <0.9 mean?

Answer 21

Diseased arteries

Question 22

What does an ABPI <0.5 mean?

Answer 22

Severely diseased arteries

Question 23

How else should PVD be investigated?

Answer 23

• Doppler or CT angiogram
• If young get a clotting screen
• Do a cardiovascular risk assessment

Question 24

How is PVD managed?

Answer 24

Mostly medically but can be surgically in more severe cases

Question 25

What is the medical management of PVD?

Answer 25

• Antiplatelets
• Blood pressure management
• Diabetes management
• Statin
• Manage other risk factors via lifestyle modification e.g. quit smoking

Question 26

How can PVD be managed surgically?

Answer 26

• Angioplasty
• Arterial bypass

Question 27

What is intermittent claudication?

Answer 27

Cramping pain that appears upon exertion and disappearing upon rest (including standing rest)

Question 28

How can intermittent claudication be differentiated from neurogenic claudication?

Answer 28

Neurogenic claudication is releieved by sitting and not by resting in a standing position

Question 29

What is Leriche Syndrome?

Answer 29

Bilateral buttock claudication and erectile dysfunction

Question 30

What causes Leriche Syndrome?

Answer 30

Atheromatous plaque of the aortic bifurcation

Question 31

What are the complications of PVD?

Answer 31

• Sepsis
• Amputation (1%)
• Further progression
• 5yr mortality of 50%