PAD Flashcards
what is a TIA?
reversible ischemia in the brain
collateral flow reestablishes perfusion
increased risk of stroke
what is the clinical presentation of carotid stenosis?
amaurosis fugax (vision loss)
TIAs
ischemic stroke on the same side as the lesion
what are risk factors for CAS?
HTN heart disease age smoking male HLD DM
when should you screen a patient for CAS?
cervical bruit
OR
known atherosclerotic disease
what is the best imaging tool to diagnose CAS?
US
what is an abdominal aortic aneurysm?
aorta with diameter > 3 cm
at what diameter is an AAA likely to rupture?
> 5 cm
where are AAA most likely to occur?
below the renal arteries
what else is commonly involved in AAA?
aortic bifurcation
iliac arteries
HY: what is AAA most often associated with?
atherosclerosis
HY: what is aortic dissection most often associated with?
HTN
what is the clinical presentation of a ruptured AAA?
abdominal pain that radiates to the back
hypertension before rupture
hypotension after rupture
what is the clinical presentation of symptomatic AAA?
mild to severe abdominal pain that may radiate to lower back
constant or intermittent
exacerbated by gentle pressure on the aneurysm sack
what are inflammatory aneurysms?
inflammatory peel that surrounds the aneurysm and encases adjacent retroperitoneal structures
what lab findings are associated with a ruptured aneurysm?
normal hct
what is the best imaging tool to diagnose a ruptured AAA?
abd US
what is the treatment for a ruptured AAA?
emergency repair
when is surgery contraindicated in an AAA?
an inflammatory aneurysm is present
*unless retroperitoneal structures are compressed
what is the best imaging tool to diagnose an AAA?
CT with or without contrast
what peripheral artery is most often occluded by atherosclerosis?
superficial femoral artery
when does claudication occur?
2-4 blocks when there is occlusion or stenosis of the superficial femoral artery with good collaterals
what is claudication?
pain during exercise due to ischemia of peripheral muscles
besides angiography, what diagnostic tool can predict the presence of PAD?
ankle-branchial index
< 0.9 = PAD
what does an ABI < 0.4 indicate?
chronic limb-threatening ischemia
when can is ABI contraindicated?
patients with DM, CKD and older adults where vessels may be calcified
what should be used instead of ABI when it is contraindicated?
toe-branchial index
< 0.7 = PAD
what is the treatment for PAD?
statin
lifestyle changes
when is surgery indicated for PAD?
claudication is progressive, incapacitating or interferes with daily activities
mandatory for ischemic rest pain or ischemic ulcers
what surgeries can be utilized to treat PAD?
fem-pop bypass
angioplasty
stenting
thromboendarterectomy
what medications can treat PAD?
statins anti-HTN insulin for DM ASA clopidogrel cilostazol
what are the risk factors for PAD?
50-69 with hx of smoking or DM
< 50 with DM + HTN/HLD/smoking
> 65
abnormal LE pulses
known atherosclerosis
what are the screening steps for suspected PAD?
- screen with ABI
2. if negative and still suspicious –> exercise stress test with post-exercise ABI
what is the most common cause of chronic venous insufficiency?
venous HTN secondary to venprogressive superficial venous reflux
what are common clinical of venous insufficiency?
pitting edema of LE brawny skin hyperpigmentation subcutaneous lipodermatosclerosis large ulcerations at or above the medial ankle varicose veins cellulitis
what are common clinical complaints of venous insufficiency?
itching
dull discomfort made worse by standing long periods
ulcers
what imaging is used to diagnose venous insufficiency?
duplex US
what is the first-line treatment for venous insufficiency?
fitted, graduated compression stockings
intermittent elevation of the legs
sleeping with legs above the heart
what is the treatment for severe venous reflux or obstruction?
venous stenting
