Vascular

Question 1

PAD results in claudication. ID consequences

Answer 1

Ischaemia:

Intermittent claudication - symptom of ischaemia in a limb, occurring during exertion and relieved by rest

Critical limb ischaemia is the end-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest. The features are pain at rest, non-healing ulcers and gangrene.

Acute limb ischaemia refers to a rapid onset of ischaemia in a limb. Typically, this is due to a distal thrombus (clot)

Question 2

Comorbidities for PAD

Answer 2

Diabetes
Hypertension
Chronic kidney disease
Inflammatory conditions such as rheumatoid arthritis
Atypical antipsychotic medications

Question 3

End Results of Atherosclerosis

Answer 3

Angina
Myocardial infarction
Transient ischaemic attack
Stroke

Peripheral arterial disease
Chronic mesenteric ischaemia

Question 4

Features of Critical Care

Answer 4

Pain
Pallor
Pulseless
Paralysis
Paraesthesia (abnormal sensation or “pins and needles”)
Perishing cold

*worse at night when the leg is raised

Question 5

Leriche Syndrome

Answer 5

occlusion in the distal aorta or proximal common iliac artery.

Thigh/buttock claudication
Absent femoral pulses
Male impotence

Question 6

Chronic Mesenteric Ischaemia

Answer 6

celiac and superior mesenteric arteries
- pain on eating

• bruits
• dt AF = clots

Question 7

Signs of arterial disease on inspection are:

Answer 7

Skin pallor
Cyanosis
Dependent rubor (a deep red colour when the limb is lower than the rest of the body)
Muscle wasting
Hair loss
Ulcers
Poor wound healing
Gangrene (breakdown of skin and a dark red/black change in colouration)

Question 8

Buerger’s Test

Answer 8

assess for peripheral arterial disease in the leg

1) supine
patient’s legs to an angle of 45 degrees at the hip. Hold them there for 1-2 minutes, looking for pallor

Buerger’s angle refers to the angle at which the leg is pale due to inadequate blood supply.

2)
sitting the patient up with their legs hanging over the side of the bed. Blood will flow back into the legs assisted by gravity. In a healthy patient, the legs will remain a normal pink colour. In a patient with peripheral arterial disease, they will go:

Blue initially, as the ischaemic tissue deoxygenates the blood
Dark red after a short time, due to vasodilation in response to the waste products of anaerobic respiration