Chapter 108 Flashcards
What is the management approach for a claudicant?
1- Recognize the presence of lower extremity ischemia. 2- Quantify the extent of the local and systemic disease.
3- Determine the degree of functional impairment related to PAD.
4- Identify and control modifiable risk factors.
5- Establish a comperhensive treatment plan.
What is the pathophysiology of the ischemic pain?
1- Ischemic neuropathy involving small unmyelinated A delta and C sensory fibers.
2-Local intramuscular acidosis from anaerobic metabolism enhanced by the release of substance P.
What is the definition of Intermittent Claudication?
- It is an ischemia related symptom that varies from fatigue to pain most commonly affecting the calf muscles but it might affect the thigh or the buttock.
- Intermittent in nature.
- Reproducible with the same walking distance.
- Relieved by rest.
What are the major patterns of arterial obstruction/ stenosis?
1- Inflow disease.
2- Outflow disease.
3- combination of both.
What is the definition of Inflow disease?
It refers to lesions in the suprainguinal vessels:
1- Infrarenal aorta.
2- Iliac arteries.
What is the classic presentation of patients with inflow disease?
- Commonly leads to buttock and thigh claudication.
- In men, if the stenosis or occlusions are bilateral and are proximal to the origins of the internal iliac arteries, vasculogenic erectile dysfunction may be present as well.
- Although buttock and thigh claudication may be the first symptoms, with continued ambulation, these patients may exhibit classic symptoms of intermittent calf claudication.
Which group of patients tend to have an inflow disease?
1- Male patients.
2- Smokers.
What is the definition of Outflow disease?
It refers to lesions in the infrainguinal vessels, from the common femoral artery to the pedal vessels.
What is the classic presentation of patients with outflow disease?
- Superficial femoral artery stenosis or occlusion is
associated with intermittent calf claudication with no specific thigh or foot symptoms. - Popliteal and tibial artery occlusions are more commonly associated with limb-threatening ischemia.
What is the most common lesion associated with intermittent claudication of the calf muscles?
Superficial femoral artery stenosis or occlusion.
Why isolated superficial femoral artery occlusion without distal disease is rarely the cause of critical leg ischemia?
Because the deep femoral artery provides
collateral circulation and reconstitution of the popliteal
artery.
Why Popliteal and tibial artery occlusions are more commonly associated with limb-threatening ischemia?
owing to the paucity of collateral vascular pathways beyond these lesions.
Which group of patients tend to have an outflow disease?
1- Elderly.
2- Diabetics.
3- End stage renal disease.
4- Long-term corticosteroid therapy.
What is the classic presentation of patients with a combination of inflow and outflow disease?
- They may have widespread symptoms of IC affecting the buttock, hip, thigh, and calf.
- These symptoms frequently begin in the buttock and thigh and then involve the calf muscles with continued ambulation; however, they may appear in reverse order if the distal disease is more severe than the inflow disease.
- Severe combined inflow-outflow disease may result in limb-threatening ischemia.
What are the Nonatherosclerotic Causes of Claudication?