Surgery

Question 1

Symptoms of Peripheral Arterial Disease

Answer 1

1. Cramping pain (calf, thigh, buttock) after walking a certain distance (the claudication distance) relieved by rest.
2. Ulceration.
3. Gangrene.
4. Foot pain at rest, eg burning pain at night (relieved by hanging foot of bed).

Question 2

Signs of Arterial Peripheral Disease

Answer 2

1. Absent pulses
2. Cold
3. White
4. Atrophic skin
5. Punched out ulcers (usually painful)
6. Postural dependent colour change
7. Buerger’s angle <20, CRT > 15; in severe is ischaemia

Question 3

Tests for Peripheral Arterial Disease

Answer 3

1. Exclude DM
2. Arteritis (ESR/CRP)
3. FBC (anaemia, polycythaemia)
4. U&E (renal disease)
5. Lipids (dyslipidaemia)
6. ECG (cardiac ischaemia)
7. If <50; thrombophilia test, serum homocysteine
8. ABPI; normal 1-1.2, PAD 0.5-0.9, critical limb ischaemia <0.5

Question 4

Imaging for Peripheral Arterial Disease

Answer 4

1. Colour duplex US; First line

2. MR/CT angiography; if considering intervention

Question 5

Risk factor modification in Peripheral Arterial Disease

Answer 5

1. Quit smoking
2. Treat hypertension
3. Treat high cholesterol
4. Prescribe an anti-platelet agent; clopidogrel 1st-line

Question 6

Management of claudication in PAD

Answer 6

1. Supervised exercise programmes
2. Vado active drugs; naftidrofuryl oxalate
3. Percutaneous transmural angioplasty
4. Surgical reconstruction
5. Amputation

Question 7

6 Ps of Acute Limb Iscaemia

Answer 7

Pale
Pulseless
Painful
Paralysed
Paraesthetic 
‘Perishingly cold’

Question 8

Management of Acute Limb Ischaemia

Answer 8

1. Urgent open surgery or angioplasty
2. If in doubt; urgent angiography
3. If embolic; surgical embolectomy (Fogarty catheter) or local thrombolysis (eg tissue plasminogen activator)
4. Anticoagulate with herparin after procedure
5. Be aware of post-op repercussion injury and compartment syndrome