137 Peripheral Vascular Disease Flashcards
Peripheral arterial disease (PAD)
•Refers to stenotic or occlusive arterial disease caused by atherosclerosis outside the heart (“coronary artery disease”)
•Manifestations:
–Asymptomatic
–Intermittent claudication
–Critical limb threatening ischemia (CLTI); AKA critical limb ischemia (CLI)
–Acute limb ischemia
–Overall mean annual prevalence: 10.3-13.5%
•Patients with incident PAD have greater long-term risks of overall and cardiovascular mortality than patients with incident myocardial infarction
Rutherford Class PAD
Natural History of PAD
Treatment of PAD
•Medical
–Walking therapy
–CV risk factor modification
•Surgical (with maximal medical therapy)
–Endarterectomy
–Bypass graft
–Endovascular (balloon angioplasty, atherectomy, stenting)
Aortic Dissection Classifications & Tx
Type A
• Emergency surgery
Type B
• No ischemic complications – medical therapy
üLower blood pressure
üDecrease contractility
üDecrease heart rate
üPain control
- Complicated (with malperfusion) - surgery
- Rupture - surgery
- Pseudoaneurysm formation - surgery
Aortic Dissection
Epidemiology
- Male:female 5:1
- Incidence is higher in African-Americans
- 50-60 years of age – Type A
- 60-70 years of age – Type B
- Connective tissue disorder in young patients
- Aneurysmal degeneration in 20-50%
Pathophysi
•Medial degeneration
–Deterioration of medial collagen and elastin
–Loss of vascular smooth muscle cells
•Intimal thickening
–Fibrosis, calcifications, fatty acid deposition
Presentation
•Severe excruciating pain
–Anterior chest
–Back
•Malperfusion syndrome
–Stroke
–Intestinal ischemia
–Lower extremity ischemia
–Paralysis
–Cardiac tamponade / coronary ostia compromise
–Hypotension/shock
AAA
- The term aneurysm is derived from the Greek word aneurysma, meaning “a widening”
- An aneurysm is defined as at least a 50% increase in diameter compared with the expected normal diameter
–≥3 cm diameter for abdominal aorta
