Peripheral Vascular Disease

• What is Peripheral Arterial Disease (PAD)?


  It is a condition characterized by significant narrowing of the arteries distal to the aorta arch.
• What is the most common cause of PAD?

  Atherosclerosis is the most common cause of PAD.
• What are the main symptoms of PAD?


  Main symptoms include walking impairment and pain in the buttocks and thighs, relieved at rest.
• What physical signs are associated with PAD?

  Signs include pale, cold legs, hair loss, ulcers, and poorly healing wounds.
• What key investigations are used for PAD?


  Key investigations include a full cardiovascular risk assessment and the Ankle-Brachial Pressure Index (ABPI).
• What does the Ankle-Brachial Pressure Index (ABPI) measure?


  ABPI measures the systolic brachial blood pressures of the arms compared to the ankle blood pressures.
• What is the formula for calculating the ABPI?


  ABPI = Ankle pressure (on side of interest) / Brachial pressure (on side of interest)
• What does an ABPI of 0.9 - 1.2 indicate?


  An ABPI of 0.9 - 1.2 indicates normal vascular health.
• What does an ABPI of $0.5$ suggest?


  An ABPI of $0.5$ suggests severe disease.
• Why might a normal ABPI in diabetic patients not exclude PAD?


  Diabetic patients may still have PAD despite a normal ABPI and may need further investigation.
• What imaging investigations may be used for PAD?


  Imaging investigations include Duplex arterial ultrasound, MR arteriogram, CT arteriogram, and digital subtraction angiography.
• What are the non-surgical management strategies for PAD?


  • Risk factor modification (smoking cessation, weight management)
  • Supervised exercise program
  • Medical management:
  • Antiplatelet therapy (clopidogrel or aspirin)
  • Lipid-lowering therapy (atorvastatin)
  • Glycaemic control in diabetics
  • Management of high blood pressure
• What are the surgical management options for PAD?

  • Endovascular revascularisation
  • Surgical revascularisation
  • Amputation (in critical limb ischaemia cases)
• When should patients with intermittent claudication be referred for surgical options?


  They should be referred if risk factor modification and supervised exercise do not improve symptoms.
• What characterizes critical limb ischaemia?


  It is characterized by rest pain, tissue loss, and ankle artery pressure of $<50 \text{ mmHg}$.
• What are the selected vascular surgeries and their related scars?

  • Femoro-popliteal bypass: vertical groin scar and distal lower limb scar
  • Femoral-femoral bypass: two vertical groin scars
  • Axillo-femoral bypass: scar over left pectoral region and left groin
  • Ileo-femoral bypass: oblique scar to access iliac arteries and vertical groin scar
• What percentage of individuals aged 55-70 years are affected by PAD?


  Approximately 4-12% of individuals aged 55-70 years are affected by PAD.
• What percentage of individuals over 70 years are affected by PAD?


  Approximately 15-20% of individuals over 70 years are affected by PAD.
• What are the risk factors for PAD?


  • Smoking
  • Diabetes mellitus
  • Hypertension
  • Hyperlipidaemia (high total cholesterol, low HDL)
  • Physical inactivity
  • Obesity
• What are the symptoms of PAD?


  Symptoms include impaired ability to walk and pain in the buttocks and thighs, relieved at rest.
• What are the signs of PAD?


  Signs include pale, cold legs, hair loss, presence of ulcers, poorly healing wounds, and weak or absent peripheral pulses.
• What differential diagnoses should be considered for PAD?


  • Lumbar spinal stenosis: neurogenic claudication, numbness, tingling, lower back pain
  • Deep vein thrombosis: swelling, pain, warmth, redness in the affected leg
  • Diabetic neuropathy: burning pain, increased sensitivity, numbness