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1
Q

tunica adventitia
- composition
- role

A

connective tissue, collagen, elastin
support vessel walls

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2
Q

tunica media
- composition
- role

A

smooth muscle, collagen, elastin
modulates vessel diameter

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3
Q

tunica intima
- composition
- role / characteristics

A

single layer endothelial cell
direct contact with blood, easily traumatized

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4
Q

how do vessels distal to common femoral artery dilate/constrict in relation to those more proximal

A

distal to common femoral
- more able to rapidly dilate or constrict in relation to perfusion

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5
Q

elastic arteries
- main ones
- role

A

aorta and its branches
maintain blood pressure

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6
Q

muscular arteries
- main examples
- characteristics

A

femoral and brachial
avg lumen is 4 mm

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7
Q

what directly controls arterioles

A

sympathetic vasoconstriction

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8
Q

importance of blood being a thixotropic fluid?

A

meaning it becomes more thick when it is not moving
- thicker, slower moving blood = less perfusion distally

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9
Q

what can cause blood sludging

A

dehydration/polycythemia

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10
Q

causes of arterial insufficiency

A

trauma
acute embolism
DM
rheumatoid arthritis
buerger’s disease
arteriosclerosis

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11
Q

difference between arteriosclerosis / atherosclerosis

A

arterio = thickening/hardening of arterial walls

athero = systemic, degenerative process, lumen is “encroached” upon

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12
Q

what carries cholesterol? what are the primary difference between the two

A

HDL = high density lipoprotein
LDL = low density lipoprotein

HDL = good/protective
LDL = bad/cholesterol deposition

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13
Q

what causes stenosis in arterials? at what layer?

A

lipid deposition
calcium deposition
scar tissue accumulation

intimal layer

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14
Q

explain intermittent claudication

A

activity specific discomfort due to local ischemia

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15
Q

what helps claudication

A

cease of activity

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16
Q

pain description of claudication

A

cramping, burning, fatigue
distal to site of occlusion

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17
Q

iliofemoral artery obstruction would lead to

A

buttock, thigh or calf claudication pain

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18
Q

infrapopliteal artery obstruction would lead to

A

foot claudication pain

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19
Q

explain the sequelae of arterial insufficiency

A

AI
intermittent claudication
ischemic rest pain
ulcer

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20
Q

what is ischemic rest pain

A

more significant arterial disease
categorized by a burning pain with elevation

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21
Q

when O2 requirements exceed local tissue perfusion, _______ occurs and can lead to _______

A

ulceration
- can lead to gangrene

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22
Q

Fontaine Stage 1

A

asymptomatic
- may have paresthesias, cold extremities, other “subclinical” indications of PAD

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23
Q

Fontaine Stage 2 vs 2a vs 2b

A

2 = intermittent claudication
2a = after more than 200m of walking
2b = after less than 200m of walking

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24
Q

Fontaine Stage 3

A

rest pain
- more so during the night

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25
Fontaine Stage 4
ischemic ulcers / gangrene
26
Rutherford Stage 0
asymptomatic normal response to activity
27
Rutherford Stage 1
mild claudication ankle pressure <20mmHg than resting value -- greater than 50 mmHg overall
28
Rutherford Stage 2
moderate claudication
29
Rutherford Stage 3
severe claudication cannot complete treadmill test ankle pressure <50mmHg after exercise
30
Rutherford Stage 4
ischemic rest pain resting ankle pressure <40mmHg resting toe pressure <30 mmHg
31
Rutherford Stage 5
minor tissue loss nonhealing ulcer of digits - may have focal gangrene
32
Rutherford Stage 6
major tissue loss gangrene extending past proximal TMT joint
33
risk factors leading to AI ulcer
hyperlipidemia / elevated LDL smoking DM HTN trauma aging
34
of the risk factors for AI ulcer, which are modifiable vs nonmodifiable
smoking is only modifiable risk factor
35
how does hyperglycemia affect arterials
decreased: collagen synthesis angiogenesis fibroblast proliferation tensile strength
36
which form of HTN can be more damaging to intimal layer of arteries
systolic = > diastolic = <
37
test and measures for AI
pulses doppler ABI rubor of dependency venous filling time
38
most common site of artery occlusion
bifurcation of common femoral
39
main foot blood supply vs main dorsal foot blood supply
posterior tibial doraslis pedis
40
what does a doppler US test
arterial patency testing
41
ABI grade of 1.1 or higher indicates
vessel calcification
42
when should a toe-brachial index be used
pts with diabetes or abnormally high ABI's due to calcifcation
43
if an ABI indicates vessel calcification, what should be used
pulse volume waveforms
44
ABI formula
systolic pressure of LE divided by systolic pressure of UE
45
interpretation of ABI of 0.9-1.1
normal
46
ABI indication of mild-mod AI
0.7-0.9
47
ABI indication of mod AI
0.5-0.7
48
ABI indication of severe AI
<0.5
49
ABI indication of intermittent claudication vs ischemic rest pain
claudication = 0.5-0.7 rest pain = <0.5
50
role of segmental pressure measurements - significant findings
helps localize areas of decreased arterial flow /occlusion drop of > 20mmHg indicates arterial occlusion
51
significant time for capillary refill
>3 sec
52
what does rubor of dependency measure
indirect measure of LE arterial flow
53
how to conduct rubor of dependency test
elevate LE 60° for a minute - note foot color return leg to surface - not time to return original color
54
indication of mild arterial insufficiency in rubor of dependency test
pallor after 45-60 seconds of elevation
55
indication of mod arterial insufficiency in rubor of dependency test
pallor after 30-45 sec of elevation
56
indication of severe arterial insufficiency in rubor of dependency test
pallor within 25 seconds dependent rubor
57
normal arterial flow time for rubor of dependency test
15-20 sec after elevation
58
what is venous filling time test protocol
supine, - note superficial dorsal foot veins elevate the limb 60° for a minute lower limb and note the time it takes to fill veins
59
venous filling time and interpretations
<5 sec = VI 5-15 sec = normal >20 sec = AI
60
when to do segmental pressure measurement
suspected AI in ulcer proximal to ankle decreased / absent proximal pulses
61
when to do rubor of dependency test
unable to tolerate ABI ABI > 1.1 history of DM / vessel calcification
62
when do to venous filling time test
unable to tolerate ABI ABI > 1.1 history of DM or vessel calcification suspected concomitant VI
63
pain of AI
severe increased with elevation
64
position of AI
distal toes dorsal foot area of trauma
65
wound presentation of AI
pale granulation punched out / round dry black eschar / gangrene
66
periwound characteristics of AI
thin, shiny, anhydrous skin loss of hair thickened nails pale, dusky or cyanotic skin
67
pulse and temperature presentation of AI
decreased
68
what pulses may be altered in those with AI
dorsalis pedis posterior tibial popliteal femoral
69
local tissue perfusion characteristics that indicate positive healing
ABI > 0.5 toe pressure > 50 mmHg tpO2 > 30 mmHg
70
precautions of AI ulcers
avoid compression avoid sharp debridement of dry eschar with low ABI -- gangrenous tissue may be removed surgically
71
how to protect surrounding skin of an AI ulcer
moisturize dry skin avoid adhesives reduce friction between toes provide padding
72
surgical interventions for AI
debridement revascularization percutaneous balloon angioplasty amputation

Integ (13 decks)

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