Peripheral Arterial Disease

Question 1

Risk factors for Peripheral Arterial DIsease?

Answer 1

Smoking
Diabetes Mellitus
Hypertension
Hyperlipidaemia
Obesity
Physical inactivity
Old
CKD
Previous MI

Question 2

Symptoms of peripheral arterial disease?

Answer 2

Intermittent claudication, cramping pain worse on exertion and relieved by rest.

Question 3

What is Chronic limb threatening ischaemia?

What are the symptoms?

Answer 3

Late stage PAD causing chronic insufficient perfusion of limb

Aching, burning, cramping pain at rest - worse at the knee
Pale cold leg
Hanging leg off bed relieves symptoms
Poorly healing wounds
Arterial ulcers
Weak/absent peripheral pulses
Hair loss
Muscular atrophy
Gangrene

Question 4

Arterial vs Venous ulcers presentation?

Answer 4

Arterial ulcers:
- More distal
- Associated with PAD
- Smaller
- Deeper
- Well defined border, punched out appearance
- Pale ulcer
- Less likely to bleed
- More painful on elevation of leg, less on lowering leg
-

Venous ulcers:
- Occur in gaiter area
- Associated with chronic venous insufficiency
- Larger, more superficial
- Irregular gently sloping border
- Hyperpigmentation of skin
- Venous eczema
- Lipodermatosclerosis
- Less painful than arterial ulcers
- More painful on lowering leg, less painful on elevating leg

Question 5

Investigations for Peripheral Arterial Disease?

Answer 5

ABPI (between 1-4 = normal. > 1 means PAD possible
Hba1c for diabetes
Lipid profile
FBC for anaemia
Duplex ultrasound to assess patency and flow in arteries

Question 6

How to manage the risk factors in Peripheral arterial disease?

How to manage pain in Peripheral arterial disease?

When is surgery indicated?

Answer 6

Supervised exercise programme
Smoking cessation
Weight loss
Hypertension management
Control of diabetes
Statins in hyperlipidaemia
Footcare

Pain manegement with naftidrofuryl oxalate

Surgery indicated when risk factor management + exercise has not helped

Question 7

What