Vascular

Question 1

What causes peripheral arterial disease?

Answer 1

Atherosclerosis => stenosis of arteries

CVS risk factors

Question 2

What are symptoms of PAD?

Answer 2

Intermittent claudication - cramping exacerbated by exercise and relieved by rest
Calf pain indicates femoral disease, buttock pain indicates iliac

Question 3

What symptoms would suggest critical ischaemia?

Answer 3

Ulceration, gangrene

Rest pain

Question 4

What is LeRiche syndrome?

Answer 4

Buttock claudication +/- impotence

Question 5

What are signs of PAD?

Answer 5

Absent pulses
Cool, white legs - postural change in colour of skin, buerger’s angle
Prolonged cap refill

Question 6

What investigations are done for PAD?

Answer 6

FBC - anaemia, polycythaemia 
U&E - renal disease
Lipids - dyslipidaemia 
ECG - cardiac ischaemia 
ABPI

Question 7

How is ABPI measured?

Answer 7

Measure BP in arm and leg - using doppler
Normal - 1-1.2, BP should be same in arm and leg
PAD - 0.5-0.9
Severe ischaemia - <0.5
High results with calcified artery, in DM

Question 8

What are the risk factor modification for PAD?

Answer 8

Stop smoking
Treat HTN and hypercholesterolaemia
Clopidogrel is first line

Question 9

What is included in the management for intermittent claudication?

Answer 9

Supervised exercise programme - 2hrs a wk for 3 months, exercise to point of pain
Angioplasty and stenting