PAD #1 Flashcards
Common PE finding of renal artery stenosis
Bruits
Peripheral ischemia is ____ threatening
Limb threatening
What is the pathophys of PAD
Segmental lesions typically localized to large or medium-size vessels
Pathology →
Atherosclerotic plaques with calcium deposits
Thinning of the media
Patchy destruction of muscle and elastic fibers
Fragmentation of internal elastic lamina
Thrombus development
same as atherosclerosis
Why sized vessels are occluded by PAD?
medium or large - which is why it is important to treat, might lose a limb
Where do you typically see a blockage at a bifurcation?
More traffic, strain, pressure
more turbulent blood flow
What does renal insufficiency let us know?
Order BNP
Smoking makes you at the same risk of arterial disease as someone ____ years older
20
Who should you screen for PAD
≥70 y/o
50-69 y/o with h/o smoking or DM
40-49 with DM and ≥ 1 other risk factor for atherosclerosis
Known atherosclerosis at other sites (coronary, carotid, renal, mesenteric or AAA)
What is the MC location for PAD
Femoral-popliteal disease (80-90% of patients)
white male smokers often have aorta proximal iliac disease
goal of PAD management
stop limb
mortatlity of PAD
15-25%
even if we treated them :(
presentation of PAD
20-50% have no symptoms :(
atypical leg pain - are not an athlete (cramping, aching, gnawing)
intermittent claudication (calf pain is severe after walking, so they need to stop)
Pain related to where the clot is
intermittent claudication
the more you work, the more your limbs hurt (like stable angina for your legs)
critical limb ischemia
No blood flow to the lower extremity
When does pain resolve after exertion with PAD?
typically after rest for 10 minutes
how to tell the difference between arterial blockage and psedoclaudiation
Pseudoclaudication will have NORMAL pulses because it is d/t nerve pain, not a clot
arterial blockage will have decrased pulses
How long does it take pain to resolve after exertion for pseudoclaudication?
30 minutes (much longer than arterial blockage!)
Why does hanging a limb relieve pain in PAD?
Gravity pulls blood to the extremities
Where are ulcers for PAD?
Typically at pressure points
critical limb ischemia
no BF to lower extremity
wet gangrene (turns to sepsis)
dry gangrene (eschars)
what are the three classifications we use for ulcers of foot?
Wound
Ischemia
and foot infection
WIFI
what is a bruit?
turbulent bloodflow heard over thrombis or plaque
PE for PAD
bruits
lungs
heart
pulses (should be very specific)
less hair growth
thicker
calf atrophy (less oxygen)
charcoot foot, look like a rocker foot (d/t poor blood flow to plantar aspect of the foot)
arterial ulcer
no distal hair on legs
what is a bedside doppler used for?
listen for sound
handheld
helps identify where a lesion is
burger’s test positive
Go against gravity by lifting the foot in the air, and it will turn white
hanging leg back down, it becomes red and shiny (the longer it takes to go back the worst)
Good positive
arterial ulcer look
thick, scab-looking, black
different area and appearance then bed sores!
different procedures for PAD
stress test
nuclear imaging
CT/angiogram
first line test of PAD
ankle brachial index (ABI) FIRST LINE
if false negative (presents with PE of PAD but normal ABI)
often can diagnose them with this alone!
ABI
get BP in all the extremeties and calculate the differences
When do you need to order an ABI?
risk factors
PE
Positive ABI for PAD
<0.9 is diagnostic
Calculating ABI
Highest brachial
Highest of the LE (Posterior tibial or dorsalis pedis)
Most sensitive and specific screening for PAD
ABI test
What is a toe branchial index
TBI
test brachail reading in both extremeties and then the two big toes
What is a positive TBI?
<75
is an arterial duplex used for screening?
NO
used for planning surgery
when do you do an MRA
screening for surgical planning
first line vs gold standard of PAD
First line = ABI
Gold standard = distal subtraction angiography
goal of PAD
improve functionality
gradual exercise improvement
risk factor modification of PAD
Antiplatelet therapy
Smoking Cessation
Lipid-lowering therapy
Glycemic control
Blood pressure control
Diet and exercise
Obesity
