Peripheral Vascular Disease

Question 0

Coarctation of aorta

Answer 0

Congenital
Usually just distal to ductus arteries us
Reduced pulse distal to coarctation
Radio radial delay

Question 1

Types of vascular disease

Answer 1

Blocked lumen
Diameter expansion
Vessel rupture
Wall inflammation

Question 2

False arterial aneurysm

Answer 2

Extra vascular connective tissue
Extravasation of blood
Forms haematoma

Question 3

Types of true aneurysm

Answer 3

Atherosclerotic
Degenerative - dissection
Congenital - berry
Mycotic - infective origin
Vasculitic, or syohillitic

Question 4

Atherosclerotic aortic aneurysm

Answer 4

Smoking risk factor!

Presents silent, pain, haemorrhage, shock, bowel/renal impairment

Question 5

Management of atherosclerotic aortic aneurysm

Answer 5

Screen, if over 5cm diameter offer operation
Open endo-graft
Endo vascular graft

Question 6

Hyaline arteriosclerosis

Answer 6

Caused by hypertension
Affects small arterioles - kidney, retina, heart
Impaired blood, O2 distribution
Diabetes accelerates atherogenesis

Question 7

Accelerated / malignant hypertension and vasculature

Answer 7

Rapid intimal hyperplasia, with/without vessel necrosis

Acute renal failure, cerebral haemorrhage

Question 8

Vasculitis

Answer 8

Inflammation of vessel wall

Artery, vein, capillary can be affected

Question 9

Giant cell (temporal) arteritis

Answer 9

Medium size arteries, painful inflammation
Involvement optic artery and cerebral arteries
Urgent steroids
Diagnose with temporal artery biopsy

Question 10

Polyarteritis nodosa

Answer 10

Medium to small arteries
Petechial haemorrhages
Renal failure
Multi system! Pancreas, liver etc

Question 11

Wegener’s granulomatosis

Answer 11

Small vessel vasculitis
Necrosis, granulomas, URT - nose bleed, lungs - sob, pain, haemoptysis, kidney - renal failure, haematuria
Anti-Neutrophil Cytooplasmic Antibodies
Treat with steroids, immunosuppressive drugs

Question 12

Takayasu’s disease

Answer 12

Large and medium size artery vasculitis
Narrowing lumen, distal ischaemia
Brain, Arms

Question 13

Buerger’s disease

Answer 13

Inflammatory vasculitis with polymorphs
Arteries, veins, nerves involved
Lower limb ischaemia and gangrene
Jewish, Male

Question 14

Peripheral arterial disease - cause, epidemiology

Answer 14

Commonly caused by atherosclerosis
Affects aorto-iliac or infra-inguinal arteries
In middle age - about 7% men, 5% women

Question 15

Chronic lower limb ischaemia - symptoms

Answer 15

Claudication - calves, thighs, buttocks
On exertion - especially walking up hill = intermittent claudication
Associated with male impotence

Question 16

Pain in foot at rest

Answer 16

Severe, unremitting
Partially relieved by dangling over edge of bed / standing on cold floor
May also be gangrene

Question 17

Signs of chronic lower limb ischaemia

Answer 17

Cold, dry, hairless, pale or pink (reactive hyperaemia)
Pulses diminished or absent
Ulceration, dark discolouration of toes
Gangrene

Question 18

Risk factors for PVD, CVA, CAD

Answer 18

Smoking
Diabetes
Hypercholesterolaemia
Hypertension
Family history

Question 19

PVD differentials

Answer 19

Spinal canal claudication
Osteoarthritis hip/knee
Peripheral neuropathy
Popliteal artery entrapment (young)
Buerger's disease

Question 20

PVD investigations - ABPI

Answer 20

ABPI - less than 1 suggests intermittent claudication
Less than 0.4 associated with critical limb ischaemia
Falsely elevated if arteries are calcified

Question 21

Imaging - PVD

Answer 21

Diagnostic angiograms less common now

Doppler and duplex ultrasounds assess level and degree disease

Question 22

Medical management PVD

Answer 22

Modifiable risk factors
Statins
Aspirin
Exercise for claudication

Question 23

Surgical treatment chronic lower limb ischaemia

Answer 23

Only if risk factors addressed and still disabled by symptoms
Percutaneous transluminal angioplasty - first option
Bypass procedures
Severe - amputation

Question 24

Acute lower limb ischaemia - 5 Ps

Answer 24

Pain, pallor, paraesthesia, paralysis, perishingly cold

Often need opioid analgesia

Question 25

Acute lower limb ischaemia signs

Answer 25

Cold, mottled skin, diminished/absent pulses, reduced sensation/movement
Can develop compartment syndrome - calf

Question 26

Causes of acute limb ischaemia

Answer 26

Embolic secondary to cardiac / aneurysm thrombus
Thrombotic disease - more common, thrombus forms on atherosclerotic stenosis in patient with history claudication
Popliteal aneurysms can thrombose or embolise

Question 27

True aneurysms

Answer 27

Permanent dilatation of artery to twice normal diameter
Arterial forms wall of aneurysm
Most common - AA, iliac, popliteal, femoral artery, thoracic aorta

Question 28

False aneurysms (pseudoaneurysms)

Answer 28

Surrounding tissues form wall of aneurysm

Eg following femoral artery puncture - haematoma forms

Question 29

Abdominal aortic aneurysm incidence

Answer 29

Mostly infrarenal
Incidence increases with age (5% of over-60s)
Male:female 5:1

Question 30

Abdominal aortic aneurysm causes

Answer 30

Atherosclerosis
Infection - syphillis, e-coli
Trauma
Genetic - Marfans

Question 31

Ruptured AAA symptoms

Answer 31

Severe epigastric pain radiating to back

Hypotension, tachycardia, anaemia, death

Question 32

Ruptured AAA differentials

Answer 32

Renal colic
Diverticulitis
Severe lower abdominal/testicular pain

Question 33

AAA signs

Answer 33

Pulsatile expansile mass in abdomen

Also possibility of popliteal aneurysms

Question 34

AAA investigations

Answer 34

First assessed by ultrasound

CT more accurate, and shows location