Peripheral vascular disease

Question 1

What is peripheral vascular disease?

Answer 1

A condition characterised by narrowing, and in final stages occlusion, of the peripheral arteries due to atherosclerotic plaques; most commonly affects the legs

Question 2

What are the 2 main stages of peripheral vascular disease?

Answer 2

Intermittent claudication
Chronic limb threatening ischaemia

Question 3

What are some risk factors of peripheral vascular disease?

Answer 3

Smoking
Diabetes
Hypercholesterolaemia
Hypertension

Question 4

What is meant by intermittent claudication?

Answer 4

This is intermittent muscle ischamia in the lower legs during exercise

Question 5

How will intermittent claudication usually present?

Answer 5

Cramping in the lower legs that comes on when walking, but is relieved by rest

Question 6

What is chronic limb threatening ischaemia?

Answer 6

This occurs when there is insufficient blood reaching the limb to maintain viability

Question 7

What are some clinical signs of chronic limb threatening ischaemia?

Answer 7

Limb cold to touch
No peripheral pulse
Hairless
Thick nails
Shiny skin
Venous guttering
Ulcer
Gangrene

Question 8

What is meant by venous guttering?

Answer 8

Veins will with blood when foot is down but empty when foot is raised as arterial supply cannot move blood back into veins

Question 9

What causes hairlessness, thick nail and shiny skin in CLTI?

Answer 9

Poor tissue nutrition

Question 10

How might someone with chronic limb threatening ischaemia present?

Answer 10

Lower limb pain that still occurs at night
Pain is relieved by reducing metabolic activity of the leg (Placing it on a cold floor)

Question 11

What are some investigations required in CLTI?

Answer 11

Check pulses
ABPI
Duplex ultrasound
MRI / CT angiography / catheter - Digital subtraction angiogram (DSA)

Question 12

What is ABPI?

Answer 12

Ankle Brachial Pressure Index

Question 13

How do you calculate ABPI?

Answer 13

Ankle BP ÷ Brachial BP

Question 14

What is a normal ABPI value?

Answer 14

0.9 - 1.2

Question 15

What ABPI would suggest claudication?

Answer 15

0.5 - 0.85

Question 16

What ABPI would suggest CLTI?

Answer 16

0 - 0.5

Question 17

What condition could give a false normal ABPI value?

Answer 17

Calcification of the blood vessels

Question 18

How will ABPI be effected by exercise in a normal person?

Answer 18

It will increase

Question 19

How will ABPI be effected by exercise in a person in IC or CLTI?

Answer 19

It will drop

Question 20

What peripheral pulses should be checked in suspected peripheral vascular disease?

Answer 20

Femoral pulse
Popliteal pulse
Posterior tibialis pulse
Dorsalis pedis pulse

Question 21

What are some lifestyle modification that should be recommended in peripheral vascular disease?

Answer 21

Weight loss
Blood pressure control
Diabetes control
Exercise
Smoking cessation

Question 22

What are some pharmacological management options in peripheral vascular disease?

Answer 22

Statins
Naftidrofuryl oxalate (Vasodilator) used in patients who do not want surgery
Analgesics

Question 23

What are some surgical options used in peripheral vascular disease?

Answer 23

Endovascular angioplasty + Stent
Bypass grafting
Amputation

Question 24

What are the 2 main forms of bypass grafting in peripheral vascular disease?

Answer 24

Inflow bypass
Outflow bypass

Question 25

What are the 3 forms of inflow bypass grafting in peripheral vascular disease?

Answer 25

Graft from aorta to lower limb Graft from contralateral lower limb Graft from ipsilateral arm to lower limb

Question 26

What occurs in outflow bypass grafting?

Answer 26

The great saphenous vein is used to bypass the blockage

Question 27

What are the 4 main classes of lower limb amputation?

Answer 27

Below Knee Amputation (BKA) - Trans-tibial Above Knee Amputation (AKA) - Trans-femoral Through knee amputation Hip disarticulation - Through hip