ARTERIAL DISEASES OF THE EXTREMITIES Flashcards
(31 cards)
The most typical symptom of PAD is
intermittent claudication, which is defined as a pain, ache, cramp, numbness, or a sense of fatigue in the muscles. It occurs during exercise and is relieved by rest.
ABI that is diagnostic of PAD
<0.90
- 1.00–1.40 in normal individuals.
- 0.91–0.99 are considered “borderline”
- <0.90 are abnormal and diagnostic of PAD
- > 1.40 indicate non-compressible arteries secondary to vascular calcification
A non-invasive test that allows the physician to assess functional limitations objectively in patients with PAD
Treadmill testing
TRUE OR FALSE: Patients with claudication should be encouraged to exercise regularly and at progressively more strenuous levels.
TRUE
- Supervised exercise training programs for 30- to 45-min sessions, at least three per week for 12 weeks, prolong walking distance.
It is a phosphodiesterase inhibitor with vasodilator and antiplatelet properties, increases claudication distance by 40–60% and improves measures of quality of life.
CILOSTAZOL
It is a protease activated receptor-1 antagonist that inhibits thrombin mediated platelet activation
VORAXAPAR
- When added to other antiplatelet therapy, this drug decreases the risk of adverse cardiovascular events in patients with atherosclerosis, including PAD.
- Reduces the risk of acute limb ischemia and peripheral revascularization
What limb arteries are most likely to be affected by fibromuscular dysplasia
Iliac arteries
* Identified angiographically by a “string of beads” multifocal appearance caused by thickened fibromuscular ridges contiguous with thin, less-involved portions of the arterial wall, or less commonly, as a focal tubular stenosis
TRIAD of thomboangitis obliterans
- Claudication of the affected extremity
- Raynaud’s phenomenon
- Migratory superficial vein thrombophlebitis
TRUE OR FALSE: There is no specific treatment except abstention from tobacco
TRUE
TRUE OR FALSE: Buerger’s disease is an inflammatory occlusive vascular disorder involving small and medium-sized arteries and veins in the distal upper and lower extremities
TRUE
TRUE OR FALSE: Once the diagnosis of ALI is made, the patient should be anticoagulated with intravenous heparin to prevent propagation of the clot and recurrent embolism.
TRUE
- Occurs when arterial occlusion results in the sudden cessation of blood flow to an extremity
- Principal causes of acute arterial occlusion include embolism, thrombus in situ, arterial dissection, and trauma
What is the most effective therapy for ALI when acute arterial occlusion is recent (<2 weeks)
Intra-arterial thrombolytic therapy with recombinant tissue plasminogen activator, reteplase, or tenecteplase is most effective when acute arterial occlusion is recent (<2 weeks)
It is preferred when restoration of blood flow must occur within 24h to prevent limb loss or when symptoms of occlusion have been present for >2 weeks.
Surgical revascularization
What is the ideal management when the limb is not viable, as characterized by loss of sensation, paralysis, and the absence of Doppler
Amputation
Another cause of limb ischemia due to multiple small deposits of fibrin, platelets, and cholesterol debris that embolize from proximal atherosclerotic lesions or aneurysmal sites.
Atheroembolism
- Large protruding aortic atheromas are a source of emboli that may lead to limb ischemia
- Neither surgical revascularization procedures nor thrombolytic therapy is helpful because of the multiplicity, composition, and distal location of the emboli.
It is a symptom complex resulting from compression of the neurovascular bundle (artery, vein, or nerves) at the thoracic outlet as it courses through the neck and shoulder
THORACIC OUTLET COMPRESSION SYNDROME
- Thoracic outlet compression syndrome is divided into arterial, venous, and neurogenic forms.
The term for venous compression that may cause thrombosis of the subclavian and axillary veins that is often associated with effort
Paget-Schroetter syndrome
It is an abnormal communication between an artery and a vein, bypassing the capillary bed
ARTERIOVENOUS FISTULA
- Congenital arteriovenous fistulas are a result of persistent embryonic vessels that fail to differentiate into arteries and veins.
- Acquired arteriovenous fistulas either are created to provide vascular access for hemodialysis or occur as a result of a penetrating injury such as a gunshot or knife wound or as complications of arterial catheterization or surgical dissection
Compression of a large arteriovenous fistula may cause reflex slowing of the heart rate also known as
Nicoladoni-Branham sign
Characterized by episodic digital ischemia, manifested clinically by the sequential development of digital blanching, cyanosis, and rubor of the fingers or toes after cold exposure and subsequent rewarming.
RAYNAUD’S PHENOMENON
Drugs that have been causally implicated in Raynaud’s phenomenon.
Ergot preparations
methysergide
β-adrenergic receptor antagonists
chemotherapeutic agents bleomycin, vinblastine, cisplatin, and gemcitabine.
Which drug treatment for severe cases of Raynaud’s is incorrectly matched:
A. Dihydropyridine calcium channel antagonists (nifedipine, isradipine, felodipine, and amlodipine) - decrease the frequency and severity of Raynaud’s phenomenon.
B. Postsynaptic α1-adrenergic antagonist (prazosin) - used with favorable response
C. Phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, and vardenafil) - may improve symptoms in patients with secondary Raynaud’s phenomenon
D. None of the above
All are correctly matched
Characterized by arterial vasoconstriction and secondary dilation of the capillaries and venules with resulting persistent cyanosis of the hands and, less frequently, the feet.
Acrocyanosis
TRUE OR FALSE: Secondary acrocyanosis can be associated with anorexia nervosa syndrome and postural orthostatic tachycardia syndrome
TRUE
