Peripheral Arterial Disease

Question 1

How do we classify arterial diseases

Answer 1

1. Occlusive - leads to rupture and necrosis

2. Aneurysmal- rupture or hemorrhage. Thrombosis or emolism

Question 2

Define PAD

Answer 2

It is an atherothrombotic disorder affecting the peripheral arteries typically lower limbs and it is associated with a higher risk of MI, stroke, and vascular death

Question 3

What are the 3 typical presentations

Answer 3

1. Asymptomatic
2. Intermittent claudication
3. Critical limb ischemia

Question 4

How is the pain classified

Answer 4

1. Acute - implies complete occlusion of a major vessel
2. Chronic- implies atherosclerotic disease
3. Acute on chronic : an underlying arterial stenosis that occludes

Question 5

Which pulses are to be palpated in the upper and lower limb and what’s the grading

Answer 5

1. Upper limb: Brachial and Radial
2. Lower limb : femoral, politeal, posterior tibialis and dorsalia pedis

Grading : 4+ normal
                 3+ slightly reduced
                 2+ markedly reduced
                 1+ barely palpable 
                  0 absent

Question 6

What are signs you would look for in the hands and fingers and also the feet and toes

Answer 6

1. Signs of thoracic outlet syndrome: distal embolism leads to ulceration or gangrene of the digits
   Nb : temperature
2. Signs of chronic ischemia: pallor on elevation and rubor at rest or when bearing weight
   - nail changes or hair loss
   - gangrene and ulceration
   - temperature

Question 7

Why would diabetics and patients with end stage renal failure have ABPI of more than 1.4

Answer 7

Their vessels are difficult to compress

Question 8

List 5 useful imaging modalities

Answer 8

1. Duplex doppler ( ultrasound)
2. Chest xray
3. Arteriography
4. Venography
   5 CT- angiography
5. MR- angiography