Peripheral Arterial Disease

Question 1

Normal Palpable Pulses (5)

Answer 1

• Aorta
• Common femoral artery
• Popliteal artery
• Posterior tibial pulse
• Dorsalis pedis pulse

Question 2

Pathophysiology of CLI

Answer 2

1. atherosclerotic disease of arteries supplying lower limb
2. vasculitis
3. Buerger’s Syndrome

Question 3

Risk Factors of Peripheral Arterial Disease (6)

Answer 3

Male
Age
Smoking
Hypertension
Hyperlipidaemia
Diabetes

Question 4

How many stages of symptoms are there?

Answer 4

4

Question 5

Stage 1

Answer 5

asymptomatic, incomplete blood vessel obstruction

Question 6

Stage 2

Answer 6

Mild claudication
a- greater than 200m travelled
b- less than 200m travelled

Question 7

Stage 3

Answer 7

Rest pain mostly in feet

Question 8

Stage 4

Answer 8

Necrosis and/or gangrene

Question 9

What stages are considered CLI

Answer 9

3 and 4

Question 10

Diagnosi (History) (8)

Answer 10

Claudication
Rest pain
Tissue loss
Risk factors
PMH
Drug history
Occ.H
Surgical history

Question 11

Clinical Examination

Answer 11

Look for: pallor, hair loss and ulceration
Feel: temepature, capillary refill, peripheral sensation, pulses
Auscultate: doppler (dorsal pedis and posterior tibial pulses)

Question 12

Special Examination (2)

Answer 12

Ankle Brachial Pressure Index

Buerger’s Test

Question 13

Imaging invetsigations (3)

Answer 13

1. Duplex
2. CTA/MRA
3. Digital subtraction angiography

Question 14

Pros of Duplex

Answer 14

Dynamic

Does not use radiation or contrast

Question 15

Cons of duplex

Answer 15

Cannot be used on abdomen
Operator dependent
Time consuming

Question 16

pros of CTA/MrA

Answer 16

Detailed- allows planning for treatment

Question 17

Cons to CTA/MRA

Answer 17

Contrast and radiation

can overestimate calcification

Question 18

Conservative management (3)

Answer 18

• Best medical therapy: antiplatelets and statin (inhibits platelet activation and thrombosis, endothelial and inflammation activation, plaque rupture
• Risk factor controls: BP target (<140/85), smoking cessation, diabetic control
• Exercise

Question 19

Revascularisation (2)

Answer 19

•	Open surgery
-Bypass and/or
-Endarterectomy 
•	Endovascular intervention
-Balloon angioplasty
-Stent placement
-Atherectomy

Question 20

BASIL Trial (2)

Answer 20

Angioplasty is preferred strategy for short term results

Surgery is a better alternative for long term durability and if the patient is in good health

Question 21

Embolus

Answer 21

: a blood clot, air bubble, piece of fatty deposit or other object which has been carried in the bloodstream to lodge in a vessel and cause an obstruction

Question 22

Thrombus

Answer 22

a blood clot formed in situ within the vascular system of the body impeding blood flow

Question 23

Pathophysiology of Peripheral Artery Disease (5)

Answer 23

• Arterial embolus (MI, AF, proximal atherosclerosis (NOT DVT/PE))
• Thrombosis
• Trauma
• Dissection
• Acute aneurysm thrombosis i.e. popliteal

Question 24

Clinical presentation of ALI (6)

Answer 24

Pain
Pallor
Pulse deficit
Pins and needles (Paresthesia)
Paralysis
Poikilothermia (cold)

Question 25

What is Compartment Syndrome

Answer 25

pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells

Question 26

Consequences of compartment syndrome (2)

Answer 26

Renal failure | Creatinine rise

Question 27

Embolectomy

Answer 27

Surgical removal of embolus

Question 28

Pathophysiology of Diabetic Foot Disease (6)

Answer 28

``` Microvascular peripheral artery disease Peripheral neuropathy Mechanical imbalance Foot deformity Minor trauma Infection ```

Question 29

Foot care to prevent DFU (5)

Answer 29

``` Always wear shoes Check fit of footwear Check pressure points Prompt and regular would care of skin breaches Glycaemic Control ```

Question 30

Management of DFD

Answer 30

Revascularisation (distal stent or bypass) | Amputation

Question 31

Adjunctive Measures (4)

Answer 31

Dressings Debridement Negative pressure wound closure Skin grafts

Question 32

Amputation locations (7)

Answer 32

``` Hip Above knee Through knee Below Knee Symes Trans-metatarsal Digit ```