PAD

Question 1

main artery between the hip and knee below the inguinal ligament is the

Answer 1

superficial femoral

Question 2

atherosclerosis is often

Answer 2

eccentric, progressive

Question 3

where does atherosclerosis occur?

Answer 3

in subintimal space - media

Question 4

Risk factors for PAD

Answer 4

• Smoking, diabetes biggest RF
• Age
• hypertension
• hypercholesterolemia

Question 5

why does PAD happen?

Answer 5

because of atherosclerosis

Question 6

SUDDEN pain in leg

SEVERE SEVERE pain

Answer 6

Acute ischemia

Question 7

Acute ischemia is often due to

Answer 7

an embolus
thrombosed artery - popliteal aneurysm
- trauma -
- acute on chronic, thrombosis of a diseased artery

Question 8

2 P’s that are most important of the 6P’s

Answer 8

paralysis and paresthesias

Question 9

when is an extremity threatened?

Answer 9

disruption to movement or sensation

Question 10

2 main presentations of chronic PAD

Answer 10

claudication

critical ischemia

Question 11

3 features of critical ischemia

Answer 11

• night pain
• rest pain (of feet)
• non-healing wounds

Question 12

3 features of claudication

Answer 12

• pain with exercise (calves)
• predictable - after same amount each time
• disappears with rest

Question 13

5 year survival with claudication

Answer 13

30%

with critical ischemia - 50%

Question 14

if its chronic then dont use the 6Ps (acute) - instead what will you see?

Answer 14

muscle atrophy
hair loss 
cold feet
rubor - not cellulitis
- ulceration

Question 15

Acute ischemia -

Answer 15

6Ps

Question 16

ABI is

Answer 16

highest tibial pressure / Highest brachial pressure

Question 17

Arterial disease when ABI is
Claudication
Critical ischemia

Question 18

Duplex U/S is useful for

Answer 18

identifying disease and following patients, but not for planning procedures

Question 19

In CT angio where is the contrast injected?

Answer 19

arm vein

Question 20

MR angio uses

Answer 20

gadolinium

Question 21

Digital angio or conventional angio gives

CT angio

Answer 21

great resolution but invasive
used more frequently, same with MR
good for larger arteries but not small ones

Question 22

which level involved in critical ischemia for PAD?

Answer 22

more than one level!! need > 2

Question 23

treating acute PAD often involves

Answer 23

clot removal

Question 24

treating acute ischemia (embolus)

Answer 24

mechanical thrombectomy - or embolectomy

Question 25

treating acute on chronic ischemia

Answer 25

Thrombolysis and stenting/angioplast

Sx: Bypass

Question 26

Treating chronic critical ischemia

Answer 26

Angioplasty and stenting

- Sx: Bypass

Question 27

treating claudication

Answer 27

consider RF medication only

Question 28

In acute ischemia what sort of resuscitation needed?

Answer 28

Heparin

Question 29

Disadvantages of thrombolysis

Answer 29

• can take up to 24 hours!

- Risk of bleeding and stroke

Question 30

how do you treat chronic lesions?

Answer 30

these are PLAQUES not clots

-

Question 31

higher rates of healing occur in ulcers when

Answer 31

• revascularize the correct angiosome

Question 32

how does angioplasty work?

Answer 32

makes the normal part of the artery bigger

Question 33

what is used for the bypass surgery?

Answer 33

• Saphenous vein

Question 34

when does a bypass work?

Answer 34

when you have a long section of a damaged artery

angioplasty - short section