Peripheral Vascular Disease

Question 1

Staging of intermittent claudication

Answer 1

Fontaine Staging

Question 2

Exertional discomfort in calves, relieved by rest

Answer 2

Intermittent claudication

Question 3

Fontaine stages

Answer 3

1. Asymptomatic
2. a) >200m b) <200m
3. Pain at rest
4. Necrosis/gangrene of tissue

Question 4

Causes of intermittent claudication

Answer 4

smoking, diabetes, hypercholesterolaemia, HT

Question 5

S/S of intermittent claudication

Answer 5

Pain, ulceration, hair loss, diminished/absent pulses, dry skin

Question 6

Investigation of intermittent claudication

Answer 6

ABPI - 0.4-0.85
Duplex US
Mag res/CT/catheter angiography

Question 7

Treatment of intermittent claudication

Answer 7

1. Lifestyle advice
2. Antiplatelets to increase walking distance
3. Surgery if severe + high risk
   - Angioplasty +/- stent via femoral artery
   - Bypass grafts
   - Amputation

Question 8

5 Ps of acute limb ischaemia

Answer 8

Pain, pallor, paraesthesia, paralysis, perishing cold

Question 9

Cold limb with diminished pulses, reduced sensation + movement

Answer 9

Acute lower limb ischaemia

Question 10

Causes of acute lower limb ischaemia

Answer 10

Embolic disease - cardiac, rheumatic fever, atherosclerosis

Thrombotic disease - more common, atherosclerosis in IC patients, hypercoaguable, prosthesis/grafts

Question 11

Treatment of acute limb ischaemia

Answer 11

1. Heparin mod/Warfarin severe

2. Angioplasty, graft thrombolysis, bypass surgery, surgery (embolectomy)

Question 12

Excessive dilation of the aorta

Answer 12

AAA

Question 13

Mechanism behind an AAA

Answer 13

Defect in collagen-elastin regulation resulting in excessive dilation of the aorta

Question 14

Where do most AAAs occur?

Answer 14

Infra-sternal

Question 15

Ratio of male:female effected in AAA

Answer 15

5:1

Question 16

Causes of AAA

Answer 16

Atherosclerosis, infection, trauma, genetic

Question 17

Man with pulsatile/expansile mass

Answer 17

AAA

Question 18

S/S AAA

Answer 18

Aysmp if non-ruptured, severe pain –> back, can mimic colic, diveriticulitis, abdo pain, HT, tachcardia, anaemia, transmitted/peripheral pulses, pulsatile/expansile mass

Question 19

Investigations of AA

Answer 19

Duplex US only shows AP diameter

CT scan first line - shows shape, size and iliac involvement and allows for management planning

Question 20

Treatment of AAA only if…?

Answer 20

Symptomatic
Size: >5.5 cm AP diameter
Expanding: >0.5cm/6m or 1cm/year

Question 21

Treatment of AAA

Answer 21

1. Lifestyle advice
2. Fitness testing
3. EVAR (via peripheral artery)
4. Open surgery

Question 22

Describe DVT

Answer 22

Thrombus in vein due to atherosclerosis/vascular events, causing inflammation

Question 23

S/S of DVT

Answer 23

PE-like features, calf-pain, redness, swelling, ankle oedema, cyanotic discolouration

Question 24

Investigations of DVT

Answer 24

Well’s score, rGeneva score
D-dimers (if low-rule out DVT)
Doppler US

Question 25

Treatment of DVT

Answer 25

1. Anticoagulation 2. TED stockings 3. If phlegmasia dolens then caval filters

Question 26

Why do varicose veins form?

Answer 26

Bad valves --> back pressure --> pooling in superficial veins

Question 27

Treatment of varicose veins

Answer 27

1. Stockings 2. Foam sclerotherapy 3. Endovenous ablation

Question 28

What is thrombophlebitis?

Answer 28

Local superficial inflam secondary to thrombus and varicose veins

Question 29

Treatment of thrombophlebitis

Answer 29

1. Analgesics 2. Elevation of limb 3. Fondaparinux