Vascular station

Question 1

3 types of Peripheral artery disease

Answer 1

1. Intermittent claudication
2. Critical limb ischaemia – ankle artery pressure <40mmHg, symptoms for 2w, rest pain, ulceration, tissue loss due to poor vascular supply
3. Acute limb ischaemia – pain, pulseless, perish cold, parathesia, paralysis, pallor

Question 2

Critical limb ischaemia ABPI

Answer 2

<0.5

Question 3

Peripheral vascular disease (chronic venous insufficiency) signs

Answer 3

Lipodermatosclerosis
Venous ulcers
Haemosiderin deposition
Venous eczema

Question 4

Varicose veins management

Answer 4

Conservative =
Lose weight, avoid prolong standing, compression stockings, emollients

Medical =
Injection scleropathy
Radiofrequency ablation

Surgery =
ligation

Question 5

what are venous ulcers & investigations

Answer 5

Venous HTN
Due to chronic venous insufficiency

Oedema, brown pigment, lipodermatosclerosis
eczema Above the ankle
Painless

ABPI (exclude arterial)
Doppler USS

Question 6

Venous ulcer management

Answer 6

1st
Graded compression stockings
Severe = lifelong graded compression stockings

2nd
Skin grafting

Moisturiser, oral pentoxifylline

Question 7

what are arterial ulcers

Answer 7

Toes and heel
Painful
Cold
pulseless
paraesthesia
paralysis

ABPI reduced

Question 8

arterial ulcer management

Answer 8

Pain management
IV prostaglandins
RF = statin + clopidogrel
Chemical lumbar sympathectomy

Question 9

what are neuropathic ulcers

Answer 9

Due to pressure and loss of sensation of pain in neuropathy Plantar surface of metartarsal head

Cushioned shoes to reduce callous formation

Question 10

AAA

Answer 10

• Dilation to more than 50% normal or >3cm
  -Screening for Males >65 = single USS
• 3-4.5 = 12m
• 4.5-5.5 = 3 months
• > 5.5 = 2ww referral to vascular

Mx
Elective EVAR (endovascular aneurysm repair)
Emergency = only for perforated AAA

Question 11

normal vascular examination presentation

Answer 11

Today I performed a vascular examination of X year old Y.
On general inspection the patient was normal body habitus, was comfortable at rest and did not have any walking aids or monitoring attached.
On closer inspection of the legs, there were not stigmata of vascular disease.
Extremities were warm with normal capillary refill. No ulcers or varicose veins were noted.
Abdominal aortic pulse was present and all lower limb pulses were palpable.
No peripheral oedema or calf tenderness was identified.
No bruits were audible on auscultation of the iliac, femoral and popliteal arteries.
Buerger angle was >45° and there was no variation in perfusion of the foot.
In conclusion this was a normal vascular examination. To complete my examination, I would like to take full history and perform a cardiovascular examination.
I would like to take a full set of observations, including lying and standing BP and ABPI, perform an ECG reading as well as capillary glucose. I would like to take bloods, including FBC, U&Es and LFTs for baseline, and perform a Doppler US if indicated.