Peripheral Vascular Disease

Question 1

What is intermittent claudication?

Answer 1

Pain in the back of the calves after exertion, relieved after a while by rest

Question 2

What causes intermittent claudication?

Answer 2

Insufficient blood reaching the exercising muscle, i.e. muscle is starved of oxygen

Question 3

What classification/staging is used to grade claudication?

Answer 3

Fontaine staging

Question 4

Name two non-invasive investigations for lower limb ischaemia

Answer 4

Ankle brachial pressure index (ABPI)
Duplex ultrasound scan

Question 5

How is ABPI measured?

Answer 5

Ankle pressure / Brachial pressure (mm Hg)
using systolic pressures

Question 6

What range for ABPI would indicate claudication?

Answer 6

0.4-0.85

Question 7

Name some non-invasive therapy for limb ischaemia

Answer 7

Stop smoking
Increase exercise
Antiplatelet drugs
Statins

Question 8

Is angioplasty + stenting indicated for lower limb ischaemia?

Answer 8

Yep

Question 9

What is endarterectomy?

Answer 9

Cutting out the inside of an artery (remove plaque and fibrous tissue)

Question 10

Describe critical limb ischaemia

Answer 10

Pain in toes/foot/leg at rest, worse at night (lying down), relieved by walking about for a bit
Can cause ulcers/gangrene

Question 11

What is the general pathogenesis behind AAA?

Answer 11

Defect in collagen-elastin regulation, causing excessive dilation + increase in aortic wall stress

Question 12

What are some typical features of AAA?

Answer 12

Abdo pain
Pulsatile mass
May be asymptomatic unless ruptured

Question 13

What does expansile mean? How does it differ from pulsatile?

Answer 13

Expansile mass pushes hands in opposite directions; pulsatile mass pushes hands up and down

Question 14

What 2 non-invasive investigations are done for AAA?

Answer 14

Ultrasound
CT scan

Question 15

What is the investigation of choice for AAA?

Answer 15

Ultrasound - tells us whether there is an AAA or not

Question 16

What can a CT scan tell us about an AAA?

Answer 16

Whether it is ruptured or not

Question 17

At what size would an AAA be considered/referred for elective repair?

Answer 17

5.5 cm

Question 18

What is involved in endovascular aneurysm repair (EVAR)?

Answer 18

Stent inserted via groin and passed up until the weakened part of the artery aneurysm is reached, where it seals off the aneurysm from inside the artery

Question 19

What are the benefits of EVAR over open surgery?

Answer 19

Less mortality
Faster recovery

Question 20

What are the benefits of open surgery over EVAR?

Answer 20

Possible in almost everyone
Rare further interventions

Question 21

Which veins in the leg make up the deep venous system?

Answer 21

Tibials, popliteals, femorals

Question 22

Which veins in the leg make up the superficial venous system?

Answer 22

Saphenous, perforators

Question 23

How do varicose veins arise?

Answer 23

Back pressure due to incompetent valves causes blood to pool in superficial veins

Question 24

What are secondary varicose veins?

Answer 24

Arise due to DVT

Question 25

What is thrombophlebitis?

Answer 25

Inflammation of veins caused by a clot, causing scarring/fibrosis

Question 26

Name a non-interventional management of varicose veins

Answer 26

Compression stockings
N.B. contraindicated in those with low ABPI

Question 27

Name interventional management of venous insufficiency

Answer 27

Foam sclerotherapy (chemical thrombophlebitis/injecting the vein with an irritant foam that causes closure of the vein)

Endovenous ablation- inserting a catheter into the vein to apply radiofrequency ablation