Peripheral Vascular Disease

Question 1

Give examples of peripheral vascular disease

Answer 1

Intermittent Claudication (IC) &Chronic Limb Threatening Ischaemia (CLTI)

Question 2

What do all patients with CLTI get(secondary prevention) ?

Answer 2

An antiplatelet

Question 3

Go; arteries of lower limb

Answer 3

Question 4

What is intermittent claudication ?

Answer 4

Cramp-like pain due to lack of oxygen/blood supply for muscle demand on exersion
-Pain distal to occlusion/narrowing/blockage on walking etc
-Quickly relived at rest, no paina at night/with rest

Causes: SMOKING (makes atherosclerosis), OA, spinal canal stenosis, lumbar nerve root irritation

OA = osteoarthritis

Question 5

What is claudication ?

Answer 5

Claudication = muscle ischaemia on exercise

Question 6

What is the aim of treatment of IC ?

Answer 6

Treating IC will not prevent limb loss
-May improve quality of life, can only treat symptoms

Question 7

What is CTLI ?

Answer 7

Chronic Limb Threatening Ischaemia
-insufficient blood reaching a limb to maintain
-may be acute or chronic.

Symptoms: Constant ishcemic pain (inc rest/night), ulcers and gangrene (lack of damge healing due to ischcaemia)

Goes weird usually in mosy distal oart e.g. toes/fingers

4-7% of IC over 5 years becomes CTLI

Question 8

What is seen on clinical examination of CTLI ?

Answer 8

-Cool to touch
-Absence of peripheral pulses
-Colour change; Burghers, pale when raised/v red when low
-Poor tissue nutrition; hairless, thick nails, shiny skin
-Venous guttering
-Ulcers
-Gangrene

Question 9

Which investigations are used for CLTI ?

Answer 9

Pulses; lots of these patients have oedema so hard to find, 10% of adults missing at least one pulse

Question 10

What is ABPI

Answer 10

Ankle BP should be greater than brachial
-CLTI causes low ankle BP

Question 11

How can diabetes/chronic renal failure affect ABPI ?

Answer 11

Causes calcification of vessels so a higher ABPI than is present
-Can mask CLTI/PAD

If suspect these conditions of ABPI >1.3 or normal despite symptoms needs Doppler waveforms

Tri -> bi -> mono phasic; getting worse

Question 12

What is assessed for arterial reconstruction in PAD ?

Answer 12

Inflow
-Adequate blood getting into the affected segment?

Outflow/Runoff
Beyond the blockage, do the arteries open up?

Conduit
-Vein (long saphenous common choice for below groin grafts)
-Prosthesis (used more above groin/heart stuff as not many vessels in body which can handle those pressures)

This is just meaning like for bypas

Question 13

Can also just cut off leg if really sore and/or is cooked

Answer 13

yea