EMQs in Clinical Medicine.pdf - Peshawar Medical College

Treatment of peripheral vascular disease 155
67 Treatment of peripheral vascular disease
A
B
C
D
E
F
intravenous heparin
femoral–popliteal bypass
conservative management
sympathectomy
femoral–femoral crossover graft
thrombolysis
G
H
I
J
K
Fogarty catheter
percutaneous transluminal
angioplasty
aortobifemoral bypass
above-knee amputation
below-knee amputation
For each clinical scenario below, suggest the most appropriate management. Each
option may be used only once.
1 A 75-year-old smoker presents with severe rest pain in her right leg. On examination
there is advanced gangrene of the right foot with absent pulses distal to
the popliteal pulse.
2 A 55-year-old overweight smoker presents with pain in his legs after walking
half a mile, which is relieved immediately by rest. Ankle brachial pressure index
is 0.8.
3 A 62-year-old man presents with severe bilateral pain in the legs. He is known to
suffer from impotence and buttock claudication. Femoral pulses are weak.
Arteriography shows stenosis in both common iliac arteries with good distal
run-off.
4 A 65-year-old man complains of left calf claudication of 50 m. Angiography
reveals a 10-cm stenosis of the superficial femoral artery.
5 A 74-year-old man with atrial fibrillation who suffered a stroke a week ago
presents with an ischaemic cold foot. Arteriography reveals that there is an
occlusion at the popliteal artery.
Answers: see page 181.