PAD Flashcards
Causes of arterial oclusive leasions in lower extremities
Atherosclerosis
Emboli
Trauma
Persistent sciatic artery
Buerger
Cystic adventitial disease
PopA entrapment
Arteritis
Congenital aorta coarctation
Primary vascular tumors
Cystic Adventitial Disease
Cystic adventitial disease is caused by a cystic abnormality of the adventitial layer of the arterial wall. The condition is com- mon in young men between 20 and 50 years of age and typi- cally affects the popliteal artery, although cases involving the iliac and femoral arteries have also been reported. The cysts are typically unilocular or multilocular with mucinous or gelatinous contents. These contents resemble that of a gan- glion, and occasionally the cysts may be in communication with the synovium of an adjacent joint.3
Fibromuscular Dysplasia
Fibromuscular dysplasia is a condition of unknown etiology that typically affects the medium- to large-sized arteries in 20- to 50-year-old females. Although it primarily tends to affect the renal and carotid arteries, it can also involve the iliac and other arterial segments.
Popliteal Artery Entrapment Syndrome
Popliteal artery entrapment results from an aberrant rela- tionship between the gastrocnemius muscle and the popliteal artery and commonly affects young athletes. The artery is compressed on flexing the knee joint and eventually, aneu- rysmal degeneration, distal embolization, and thrombosis occur.
The Trans-Atlantic Inter-Society Consensus (TASC II) for the management of peripheral arterial disease (PAD) defines IC as
muscle discomfort in the lower limb reproducibly produced by exercise and relieved by rest within 10 minutes
Fontaine classification
1Asymptomatic
Mild claudication
Moderate to severe claudication
3Ischemic rest pain
4Ulceration or gangrene
Rutherford classification
0Asymptomatic
Mild claudication
Moderate claudication
Severe claudication
Ischemic rest pain
Minor tissue loss
6Major tissue loss
Smoking influence on PAD
2-6 x increase in the risk of developing PAD.
The association of smoking with PAD is thought to be stronger than its association with coronary artery disease.
The severity of PAD appears directly proportional to the number of cigarettes smoked.
Smoking cessation has been associated with a decline in the incidence of IC.
Diabetes influence on pad
2x increase in the risk of developing PAD.
This risk is directly proportional to the severity and duration of the diabetes. For every 1% increase in hemoglobin A1C, a corresponding 26% increase has been suggested in the risk of developing PAD.
PAD in diabetics is also more aggressive, with early involvement of large vessels and distal neuropathy. Diabetic patients suffer from sensory neuropathy and have a reduced resistance to infection that contributes to a five- to tenfold increase in the rate of major amputations compared to nondiabetics.
Dyslipidemia influence on PAD
increased risk of developing PAD.- This risk is thought to increase by 5% to 10% for every 10 mg/dl rise in total choles-terol.
Hypertension influence on PAD
Hypertension is associated with an increased risk of developing
PAD, although the association is considered to be weaker than for cerebrovascular and coronary disease. The risk is also less when compared to smoking and diabetes. The Framingham heart study found a 2.5-fold increase in the incidence of PAD in patients with hypertension, and this risk was proportional to the severity of the hypertension. 35
MI and stroke in PAD patents
20% to 60% increased risk of having a myocardial infarction, and the risk of having a stroke is increased by 40% in patients with PAD.
A total of …. of patients with IC deteriorate with time by the clinical stage, most in the first year after diagnosis (7% 9%) compared to 2% to 3% per year thereafter,
Reviews suggest that only ….of patients with IC need a major amputation over the next 5 years.
25%
1% to 3%
CLI is associated with a generally poor prognosis for patients. The TASC II document suggests that approximately 50% of patients with CLI undergo revascularization as primary treatment. At 1 year, …. about 25% of these patients have resolution of their symptoms, 20% continue to have symptoms, 30% have undergone an amputation, and 25% are dead..
about 25% of these patients have resolution of their symptoms, 20% continue to have symptoms, 30% have undergone an amputation, and 25% are dead.
Ile % chromaczy pogarsza się do CLI jeśli nie ma istotnych innych czynników ryzyka jak cukrzyca
5%
