PAD Flashcards
main artery between the hip and knee below the inguinal ligament is the
superficial femoral
atherosclerosis is often
eccentric, progressive
where does atherosclerosis occur?
in subintimal space - media
Risk factors for PAD
- Smoking, diabetes biggest RF
- Age
- hypertension
- hypercholesterolemia
why does PAD happen?
because of atherosclerosis
SUDDEN pain in leg
SEVERE SEVERE pain
Acute ischemia
Acute ischemia is often due to
an embolus
thrombosed artery - popliteal aneurysm
- trauma -
- acute on chronic, thrombosis of a diseased artery
2 P’s that are most important of the 6P’s
paralysis and paresthesias
when is an extremity threatened?
disruption to movement or sensation
2 main presentations of chronic PAD
claudication
critical ischemia
3 features of critical ischemia
- night pain
- rest pain (of feet)
- non-healing wounds
3 features of claudication
- pain with exercise (calves)
- predictable - after same amount each time
- disappears with rest
5 year survival with claudication
30%
with critical ischemia - 50%
if its chronic then dont use the 6Ps (acute) - instead what will you see?
muscle atrophy hair loss cold feet rubor - not cellulitis - ulceration
Acute ischemia -
6Ps
ABI is
highest tibial pressure / Highest brachial pressure
Arterial disease when ABI is
Claudication
Critical ischemia
Duplex U/S is useful for
identifying disease and following patients, but not for planning procedures
In CT angio where is the contrast injected?
arm vein
MR angio uses
gadolinium
Digital angio or conventional angio gives
CT angio
great resolution but invasive
used more frequently, same with MR
good for larger arteries but not small ones
which level involved in critical ischemia for PAD?
more than one level!! need > 2
treating acute PAD often involves
clot removal
treating acute ischemia (embolus)
mechanical thrombectomy - or embolectomy
treating acute on chronic ischemia
Thrombolysis and stenting/angioplast
Sx: Bypass
Treating chronic critical ischemia
Angioplasty and stenting
- Sx: Bypass
treating claudication
consider RF medication only
In acute ischemia what sort of resuscitation needed?
Heparin
Disadvantages of thrombolysis
- can take up to 24 hours!
- Risk of bleeding and stroke
how do you treat chronic lesions?
these are PLAQUES not clots
-
higher rates of healing occur in ulcers when
- revascularize the correct angiosome
how does angioplasty work?
makes the normal part of the artery bigger
what is used for the bypass surgery?
- Saphenous vein
when does a bypass work?
when you have a long section of a damaged artery
angioplasty - short section
