Peripheral Vascular Disease

Question 1

Causes

Answer 1

Atherosclerosis

Embolic

Vasculitis

Question 2

Risk factors for atherosclerosis

Answer 2

Non modifiable: age, gender, family history

Modifiable: smoking, diabetes, hypertension, hypercholesterolaemia, obesity, poor diet

Question 3

Fontaine PAD classification

Answer 3

1. Asymptomatic
2. Intermittent claudication
3. Rest pain or paraesthesia
4. Gangrene or ulcer

Question 4

Intermittent Claudication Management

Answer 4

CONSERVATIVE
General lifestyle changes to reverse modifiable risk factors (diet, smoking, exercise etc)

MEDICAL
Optimise medical treatment of comorbidities (hypertension, diabetes etc)
Medical treatments:
- Atorvastatin 80mg
- Clopidogrel 75mg once daily (alternatively aspirin plus dipyridamole)
- Naftidrofuryl oxalate (peripheral vasodilator)

SURGERY
Angioplasty and stenting
Bypass Surgery

Question 5

Define:

Peripheral Arterial Disease

Critical Limb Ischaemia

Intermittent Claudication

Answer 5

Peripheral Arterial Disease results from atherosclerosis and narrowing of the arteries supplying the limbs and periphery

Critical Limb Ischaemia is the end stage of peripheral arterial disease, where there is inadequate supply of blood to a limb to allow it to function normally at rest.

Intermittent Claudication is the symptom of having ischaemia in a limb during exertion that is relieved by rest. It is typically a crampy, achy pain in the calf muscles associated with muscle fatigue when walking beyond a certain intensity.

Question 6

Leriche’s Syndrome

What is it?
Clinical triad

Answer 6

Associated with occlusion in the distal aorta or proximal common iliac artery

A clinical triad:
Thigh / buttock claudication
Absent femoral pulses
Male impotence

Question 7

Peripheral Vascular disease

Investigation

Answer 7

Ankle-Brachial Pressure Index (ABPI)
Arterial Doppler
Angiography (CT or MRI)

Bloods: FBC and glucose

Question 8

How do you measure ABPI?

Answer 8

The ratio of systolic blood pressure in the ankle (around the lower calf) vs the arm
E.g. an ankle SBP of 80 and an arm SBP of 100 gives a ratio of 0.8

Question 9

What do the results of ABPI mean?

Answer 9

> 0.9 is normal
0.6 – 0.9 is mild disease
0.3 – 0.6 is moderate to severe disease
<0.3 is severe disease to critical ischaemic

Question 10

Clinical Features of Critical Limb Ischaemia

Answer 10

Pain
Pulselessness
Paraesthesia 
Paralysis 
Perishingly cold 
Pale

Question 11

Critical Limb Ischaemia

Management

Answer 11

Urgent referral to vascular team

Analgesia

Urgent revascularisation by:

• Angioplasty and stenting
• Bypass surgery