PAD Flashcards
What are the 2 types of PAD?
Atherosclerotic and Nonatherosclerotic
What is the leading cause of PAD in pts >40 yo?
Atherosclerosis
What are other causes of PAD?
Thrombosis, Embolism, Vasculitis, Fibromuscular Dysplasia, Entrapment, and Trauma
What is the most modifiable risk factor of PAD?
Cigarette Smoking
What are large risk factors for PAD?
DM, Hypercholesterolemia, HTN, Hyperhomocycsteinemia
What are the most common sites of PAD?
Aorta/Iliac, tibial/peroneal, femoral/popliteal(Most Common) arteries
What is the most common Sx of PAD? Where does it occur? When does it occur? How to you relieve it?
Claudication –> include pain, ache, cramp, numbness, and muscle fatigue. Sx of claudication are DISTAL to the site of lesion. It occurs during exercise/activity. Relieved with REST
What Sx’s are associated with severe PAD?
Hair loss, Thickened nails, smooth/shiny skin, reduced Temp, Pallor and cyanosis.
What is the ABI (Ankle:Brachial Index)? What MAY the values indicate? What do you use in addition to ABI?
Noninvasive testing in which a BP ratio from arm is compared to lower extremity. Normal >1; <.5 may indicate severe PAD.
You also want to do a waveform analysis with Doppler U/S. This can show you the extend of PAD and where it is.
When would you use a MRA or CTA?
Serious cases that you may suspect need revascularization.
Aortoiliac AD shows Sx where? What is Tx? When do you refer them?
Sx occur in calves, thighs, or buttocks. Tx is conservative or surgical based on severity. Refer when walking distance is reduced or it is limiting their ADLs.
What is most common artery affected in Femoral/Popliteal AD? What change occurs in Femoral Pulse? What are m/c Tx? When do you refer?
Superficial Femoral Artery. No change in Femoral Pulse. Bypass surgery is most common, but Thromboendarterectomy is used, but limited to common femoral artery Dz. Refer when Sx progress, short distance Claudication, ulcerations, or rest pain.
What is the m/c vessels involved in leg/foot AD. What is a major risk factor for it? What is goal of Tx for it? What happens to pedal pulses? When to refer?
Tibial Vessels; DM is MAJOR risk factor; Tx goal is to prevent tissue loss. Pedal Pulses may be decreased or absent; See previous and if ulcerations are present
What are the conservative Txs for all pts with PAD?
SMOKING CESSATION; Control BP in HTN; Lower Cholesterol; Weight Loss; Treat DM aggressively. Keep feet clean and wear shoes. **DO NOT use compressive stockings.
What are the NON atherosclerotic PADs?
Fibromuscular Dysplasia
Beurger’s Dz (thromboangitis Obliterans)
Vasculitis - Takayasu’s Arteritis and Giant Cell Arteritis
What size arteries does Fibromuscular Dysplasia affect? Which are most common? Who does it usually affect? What is the Classic Sign?
Medium to Small Arteries
Renal and Carotid Arteries
Women >50 yo
“String of Beads” on angiography.
What else is thromboangitis obliterans called? What does it typically affect? Who does it typically affect? What is main cause of it?
- Buerger’s Dz
- Affects small/medium arteries; DISTAL upper/lower extremities
- Men >40; More common in Asians and E. European
- Cigarette Smoking is main cause
What is TRIAD of Buerger’s Dz (thromboangitis obliterans)? How is diagnosis confirmed? What is Tx?
- Claudication of affected extremity; Migratory superficial vein thrombophlebitis; and Raynaud’s Phenomenon
- Dx confirmed with biopsy
- No specific Tx except Smoking Cessation
What size arteries does Takayasu’s Arteritis affect? Who does it affect most commonly?
- inflammation and stenosis of large/medium arteries
- Most common in adolescent girls and young women. Most common in Asians
When would you suspect Takayasu’s Arteritis? What is the Tx?
- Suspect in young women who develop decreased or absent pulses, BP changes, or bruits.
- Tx- glucocorticoid therapy may alleviate acute Sx; However, Surgery to decrease mortality rate
What else do they call Giant Cell Arteritis? What artery(s) are typically involved? Who does it occur in almost exclusively
- “temporal arteritis”
- Branches of Carotid, but ESPECIALLY temporal artery
- Seen exclusively in pts >50 yo
What are Sx of Giant Cell Arteritis? How do you confirm the Dx of it? What is Tx?
- Sx include fever, anemia, high ESR, and HA’s, fatigue, etc.
- Dx confirmed by Biopsy
- Tx is Glucocorticoids. High dose prednisone for 1 mo, followed by tapering
What are the arterial blood vessel disorders?
- Acute Arterial Occlusion of Limb
- Thoracic Outlet Compression Syndrome
- Peripheral Artery Aneurysm
- Raynaud’s phenom
- Acrocyanosis
- Livedo Reticularis
- Chilbain’s Syndrome
