peripheral vascular disease

Question 1

what is most commonly affected with peripheral vascular disease

Answer 1

legs

Question 2

what are the 4 stages of chronic limb ischaemia

Answer 2

Stage I - asymptomatic
Stage II – intermittent claudication
Stage III – rest pain/nocturnal pain
Stage IV – necrosis/gangrene

Question 3

risk factors for pvd

Answer 3

same as atherosclerosis

Smoking
Diabetes
Dyslipidaemia
HTN

Question 4

what causes pvd

Answer 4

Blockage – atherosclerosis
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Question 5

which artery is affected if pain is in hip or buttocks

Answer 5

aorta or iliac arteries

Question 6

which artery is affected if pain is in thigh

Answer 6

common femoral artery

Question 7

which artery is affected if pain is in upper 2/3rd of calf

Answer 7

superior femoral artery

Question 8

which artery is affected if pain is in lower 1/3rd of calf

Answer 8

popliteal artery

Question 9

which artery is affected if pain is in foot

Answer 9

tibial or peroneal artery

Question 10

what is Intermittent Claudication

Answer 10

nerve pain caused by release of adenosine in response to muscle ischaemia

Question 11

symptoms of pvd

Answer 11

Cramping pain in calves, thighs and buttocks when walking

Pain relieved by rest

Question 12

signs of pvd

Answer 12

1. Absent pulses
2. Punched out ulcers
3. Postural colour change (Buerger’s Test) – foot turns white when elevated, red when lowered
4. 6 P’s of limb ischaemia

Question 13

what are the 6 P’s of limb ischaemia

Answer 13

Pain
Pallor
Pulseless
Perishing cold
Paraesthesia
Paralysis

Question 14

how to carry out Buergers test

Answer 14

1. keep patient supine
2. elevate both legs to an angle of 45 degrees and hold for one to two minutes.
3. Observe colour of the feet.
   - Pallor indicates ischaemia.
4. sit the patient up and ask them to hang their legs down over the side of the bed at an angle of 90 degrees.

Question 15

when does pallor occur

Answer 15

it occurs when the peripheral arterial pressure is inadequate to overcome the effects of gravity.

.

Question 16

impact of poor arterial supply on pale legs

Answer 16

The poorer the arterial supply, the less the angle to which the legs have to be raised for them to become pale

Question 17

impact of gravity on blood flow

Answer 17

Gravity aids blood flow and colour returns in the ischaemic leg.

The skin at first becomes blue, as blood is deoxygenated in its passage through the ischaemic tissue, and then red, due to reactive hyperaemia from post-hypoxic vasodilatation.

Question 18

what are investgations used to exclude

Answer 18

to exclude
- DM
- arteritis
- anaemia
- renal disease
- lipids

Question 19

what investgations for pvd

Answer 19

1. Ankle Brachial Pressure Index (ABPI)
2. Colour Duplex USS
3. MRI/CT angiography
4. Bloods
5. Auscultation

Question 20

how does ankle brachial pressure change with pvd

Answer 20

Normal is 1-1.2
Peripheral Arterial Disease is 0.5-0.9

Question 21

describe colour duplex USS

Answer 21

Quick and non-invasive

Can show vessels and blood flow within them

Question 22

What are MRI and CT angiography used for

Answer 22

to identify stenosis and quality of vessels

Question 23

how are bloods used for pvd

Answer 23

raised CK-MM shows muscle damage

Question 24

management of pvd

Answer 24

risk factor modiciaton

medications

excercise programmes

Percutaneous transluminal angioplasty or surgery

Question 25

what risk factors can you modify

Answer 25

Quit smoking
Treat hypertension
Lower cholesterol
Improve diabetes
Improve diet

Question 26

what medications for pvd

Answer 26

anti-platelet therapy

Clopidogrel is 1st line

Question 27

what do excercise programmes do

Answer 27

reduce claudication by improving blood flow

Question 28

when is Percutaneous transluminal angioplasty or surgery needed

Answer 28

if severely stenosed

Question 29

4 causes of critical leg ischaemia

Answer 29

Thrombosis (in vasculopaths)
Emboli
Graft occlusion
Trauma

Question 30

symptoms of critical leg ischaemia

Answer 30

Pain in thighs, calves, feet and/or buttocks

Ulcers

Question 31

where are ulcers more likely to form

Answer 31

more likely on limb with a poor blood supply

healing takes longer due to poor perfusion of limb and therefore hampers the healing process

Question 32

signs of critical leg ischaemia

Answer 32

• Foot pain at rest
• Relieved by hanging out the side of the bed at night
• 6 P’s
• Deep duskiness of limb and sudden deterioration shows arterial occlusion, NOT gout or cellulitis

Question 33

treatment of critical leg ischaemia

Answer 33

• Surgical embolectomy
• Local thrombolysis with t-PA

Question 34

risk associacoted with treatment of critical leg ischaemia

Answer 34

Risk of reperfusion injury or compartment syndrome post-surgery