Peripheral Vascular Disease

Question 1

What is intermittent claudication?

Answer 1

Pain in the back of the calves after exertion, relieved after a while by rest

Question 2

What causes intermittent claudication?

Answer 2

Insufficient blood reaching the exercising muscle (via collaterals), i.e. muscle is starved of oxygen

Question 3

What classification/staging is used to grade claudication?

Answer 3

Fontaine staging

Question 4

Name two non-invasive investigations for lower limb ischaemia

Answer 4

Ankle brachial pressure index (ABPI)

Duplex ultrasound scan

Question 5

Name three invasive investigations for lower limb ischaema

Answer 5

Magnetic resonance angiography
CT angiography
Catheter angiography

Question 6

How is ABPI measured?

Answer 6

Ankle pressure / Brachial pressure (mm Hg) using systolic pressures

Question 7

What range for ABPI would indicate claudication?

Answer 7

0.4-0.85

Question 8

Name some non-invasive therapy for limb ischaemia

Answer 8

Stop smoking
Increase exercise (EXERCISE THROUGH PAIN)
Antiplatelet drugs
Statins
Antihypertensives

Question 9

Is angioplasty + stenting indicated for lower limb ischaemia?

Answer 9

Yep

Question 10

What is endarterectomy?

Answer 10

Cutting out the inside of an artery (remove plaque and fibrous tissue)

Question 11

Describe critical limb ischaemia

Answer 11

Pain in toes/foot/leg at rest, worse at night (lying down), relieved by walking about for a bit
Can cause ulcers/gangrene

Question 12

What is the general pathogenesis behind AAA?

Answer 12

Defect in collagen-elastin regulation, causing excessive dilation + increase in aortic wall stress

Question 13

What are some typical features of AAA? What can it mimic?

Answer 13

Abdo pain/ Back pain
Collapse
Pulsatile mass
May be asymptomatic unless ruptured

Renal colic

Question 14

What does expansile mean? How does it differ from pulsatile?

Answer 14

Expansile mass pushes hands in opposite directions; pulsatile mass pushes hands up and down

Question 15

What 2 non-invasive investigations are done for AAA?

Answer 15

Duples US scan

CT scan

Question 16

What is the investigation of choice for AAA?

Answer 16

Ultrasound - tells us whether there is an AAA or not

Question 17

What can a CT scan tell us about an AAA?

Answer 17

Whether it is ruptured or not

Question 18

At what size would an AAA be considered/referred for elective repair?

Answer 18

5.5 cm

Question 19

What is involved in endovascular aneurysm repair (EVAR)?

Answer 19

Stent inserted via groin and passed up until the weakened part of the artery aneurysm is reached, where it seals off the aneurysm from inside the artery

Question 20

What are the benefits of EVAR over open surgery?

Answer 20

Less mortality

Faster recovery

Question 21

What are the benefits of open surgery over EVAR?

Answer 21

Possible in almost everyone

Rare further interventions

Question 22

Which veins in the leg make up the deep venous system?

Answer 22

Tibials, popliteals, femorals

Question 23

Which veins in the leg make up the superficial venous system?

Answer 23

Saphenous, perforators

Question 24

How do varicose veins arise?

Answer 24

Back pressure due to incompetent valves causes blood to pool in superficial veins

Question 25

What are secondary varicose veins?

Answer 25

Arise due to DVT

Question 26

What is thrombophlebitis?

Answer 26

Inflammation of veins caused by a clot, causing scarring/fibrosis

Question 27

Name a non-interventional management of varicose veins

Answer 27

Compression stockings | N.B. contraindicated in those with low ABPI

Question 28

Name interventional management of venous insufficiency

Answer 28

``` Foam sclerotherapy (chemical thrombophlebitis) Endovenous ablation ```

Question 29

What are some risk factors for intermittent claudication or AAA?

Answer 29

``` Smoking High BP DM High cholesterol Male Age (>55) Alcohol ```

Question 30

What is the treatment for critical limb ischaemia?

Answer 30

Analgesia Angioplasty/stenting Surgical reconstruction Amputation

Question 31

The risk of limb loss is increased by...

Answer 31

Smoking

Question 32

What is acute limb ischaemia? What are the two types?

Answer 32

Sudden loss of blood supply to limb | Acute or acute on chronic

Question 33

What is the cause of acute limb ischaemia?

Answer 33

``` Embolism Atheroembolism Arterial dissection Trauma Extrinsic compression ```

Question 34

What are the signs of acute limb ischaemia?

Answer 34

6Ps: pain, pallor, perishingly cold, pulseless, paraesthesia, paralysis

Question 35

If a limb is blanching it is reversible. True/False?

Answer 35

True. Non-blanching is irreversible.

Question 36

What is the management for acute limb ischaemia if the limb is salvageable or not?

Answer 36

SALVAGEABLE: embolectomy, thrombolysis, fasciotomy NOT: amputation, palliation

Question 37

What post-op complication is associated with acute limb ischaemia? How is it managed?

Answer 37

Compartment syndrome due to re-perfusion injury | Fasciotomy

Question 38

What are the three types of aneurysm?

Answer 38

Saccular Fusiform Myocytic (all 3 layers of artery)

Question 39

What are some likely causes of aneurysms?

Answer 39

``` Atheroma Trauma Endocarditis Syphilis CT disorder - Marfans Inflammatory ```

Question 40

What veins are involved in varicose veins?

Answer 40

Long saphenous | Short saphenous

Question 41

What are some risk factors for varicose veins?

Answer 41

``` Prolonged standing Age Obesity Contraceptive pill Pregnancy Family history ```

Question 42

What are some signs/symptoms of varicose veins?

Answer 42

Pain, cramps, tingling, heavy or restless legs Signs of chronic venous insufficiency - oedema, ulcers, thrombophlebitis, lipodermatosclerosis (hardening of skin)

Question 43

What is the first line investigation for varicose veins?

Answer 43

Duplex US scan

Question 44

What are some complications of varicose veins?

Answer 44

``` Thrombophlebitis Skin staining Local ulceration Wound infection Nerve damage ```