PAD & AAA

Question 1

What is peripheral artery disease (PAD)?

Answer 1

Blockage of the arteries, mostly to the legs, which prevents blood flow to the periphery.

Patients have decreased QOL due to leg discomfort and limitations to mobility.

Question 2

What conditions is contained within the umbrella disease of Atherothrombosis?

Answer 2

Cerebral arterial disease (TIA)

Coronary artery disease

Renal arterial disease

PAD

Question 3

What is claudication?

Answer 3

a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.

Question 4

2 most important risk factors for PAD?

Answer 4

Smoking and diabetes

Others: age, dyslipidemia, HTN

Question 5

What are the clinical presentations of Intermittent, Critical limb, and Acute limb claudication/ischemia?

Question 6

Symptoms of PAD?

Answer 6

60% can be ASYMPTOMATIC

Typical claudication (30%)

Leg pain on exertion

Leg fatigue

Heaviness

All of the symptoms typically occur at a given set walking distance

Question 7

Where is the pain from aorta and iliac occlusions?

Answer 7

Hip and buttock claudication

Question 8

Where is the pain from femoral occlusion?

Answer 8

Thigh claudication

Question 9

Where is the pain from tibio-peroneal occlusion?

From pedal occlusion?

Answer 9

Calf claudication

Foot claudication

Question 10

PE signs of PAD?

Answer 10

Diminished pulses

Hair loss

Smooth, shiny, thin skin

Dystrophic nail changes

Odd color: white, pink, blue, purple, bright red, black –>

Buerger test: foot turns white when raised

Ulcers or sores

Odd foot shape

Listen for bruits

Question 11

Who should be tested with ABI (screening test for PAD)?

Answer 11

Less than 50 with more than one risk factor

50-70 with one risk factor

Everyone over 70

Symptoms of claudication

Abnormal lower extremity exam

Question 12

What is the ABI?

Answer 12

Ankle-Brachial Index

ABI = Ankle BP/Brachial BP

Normal ABI is between 0.9 and 1.3

(over 1.3 if severe PAD with calcified vessels)

Critical limb ischemia below 0.4-0.5

Question 13

What is an exercise ABI?

Answer 13

Do the ABI right after exercise

Question 14

What are the treatment options for PAD?

Answer 14

Majority don’t need surgery, instead they need:

• Supervised exercise into pain
• Smoking cessation
• ASA and statins
• DM management
• Foot care

Those who do need surgery can get:

• PCI
• bypass surgery

Exercise improves walk distance better than does surgery, so long as the patient continues to exercise.

Question 16

What is CLI?

Answer 16

Critical Limb Ischemia

Non-healing ulceration, gangrene, ABI < 0.4, toe pressure < 30

50% amputation rate, 25% mortality in 12 months

Pain at rest; pain relieved with dangling leg over bed, to use gravity to improve blood flow

Treatment: endovascular stents, balloons, bypasses, amputations

Question 17

FINISH CARDS