Actual Peripheral Arterial Disease

Question 1

What are the 3 types of presentations of PAD?

Answer 1

Intermittent claudication

Critical Ischaemia

Acute limb threatening ischaemia

Question 2

Intermittent Claudication Features

Answer 2

Pain in leg muscle after walking a certain distance

Pain relieved by rest

NOT PRESENT AT REST

Question 3

Critical Limb Ischaemia Features

Answer 3

Rest pain in foot for longer than 2 weeks

Gangrene

Ulcer

Question 4

Acute limb-threatening ischaemia features

Answer 4

Pain 
Pulselessness 
Paraesthesia 
Paralysis
Pale 
Perishingly Cold

Question 5

Investigations

Answer 5

Vascular exam: particularly feeling for AAA, femoral pulse, popliteal pulse, posterior tibial pulse, dorsalis pedis

Ankle Brachial Pressure Index

Duplex Ultrasound

MR Angiography should be done before any intervention

Question 6

ABPI Interpretation

Answer 6

1 = normal

0. 6 - 0.9 = Claudication
1. 3 - 0.6 = Resting pain

<0.3 = impending

<0.5 = Critical limb ischaemia

Question 7

Management

Answer 7

Manage co-morbidities:

• Stop smoking
• Manage Diabetes, cholesterol and HTN

Medications:

• Statin (80mg Atorvastatin)
• Clopidogrel

Exercise Training

Severe PAD / Critical Limb Ischaemia

• Angioplasty
• Bypass surgery
• Stenting

Amputation is for when none of the above work

Question 8

In acute limb ischaemia what does definitive management depend on?

Answer 8

Definitive management depends on whether there is complete or incomplete limb ischaemia, and whether the cause is thrombotic or embolic.

In thrombotic causes:

• If ischaemia is incomplete (and the limb is likely to remain viable for 12-24 hours)= angiography to map the occlusion site and plan endovasclar intervention (e.g. angioplasty, thrombectomy)
• Complete ischaemia: urgent bypass

If embolic cause:

• Immediate embolectomy
• Angiography can be used and thrombolysis on the table can be considered