17: Vascular Assessment Flashcards
arteries that can be affected by PAD
abdominal aorta, iliac, femoral, popliteal, tibial, peroneal
appearance of PAD ulcers vs venous stasis ulcers
PAD: well demarcated, dry, “punched out” looking
Venous stasis: irregular border, pink base covered with yellow fibrinous tissue, wet, exudative, can be large
most common artery for a CVA due to carotid stenosis
MCA
MCA stroke sx
contralateral hemiplegia, contralateral hemisensory loss, aphasia, neglect (non-dominant hemisphere)
ophthalmic artery stroke sx
ipsilateral amarosis fugax (recurrent transient monocular blindness; looks like a curtain over field of vision)
how to check pulses for ABI
pt should be supine, check systolic pressure using doppler probe and ultrasound gel**
how to calculate ABI
highest pressure in right foot / highest pressure in both arms
what can cause ABI > 1.4, or incompressible vessels?
pts with DM or ESRD due to vesel calcification - is inconclusive for PAD
DVT on US
vessels are not compressible
USPSTF recommendation for asymptomatic carotid stenosis US***
grade D: no benefit
two pts that should get a carotid ultrasound
- pt with carotid bruit
2. pt with CVA/TIA in vascular distribution that could be due to carotid stenosis
three medications for smoking cessation + mechanism
- varenicline: nicotine R partial ag
- buproprion: NE/dopamine reuptake inhibitor
- nicotine replacement (gum, patch): nicotine
what type of disease is PAD
ASCVD
mechanism of cilostazol
phosphodiesterase inhibitor; has anti-platelet properties
best wound dressings for venous stasis ulcer
low adherent absorbent dressing - takes up exudate while maintaining moiste environment
purpose of surgery for venous insufficiency
venous occlusion/fibrosis/obstruction
two reasons why surgery is better than medical therapy alone for carotid stenosis
- symptomatic stenosis >70%
2. patient life expectancy >5 years
what causes pseudoclaudication - pain worse with sstanding/walking and improved with sitting/flexing at waist
DDD / lumbar spinal stenosis
three indications for revascularization surgery in PAD
- disabling/progressive sx of claudication despite medical therapy
- critical limb ischemia
- acute limb ischemia
what causes pigment changes in venous stasis dermatitis
venous HTN -> RBCs extravasate -> Hb breaks down to hemosiderin -> brown pigment staining skin
