PAD Case 4 Flashcards
Diminished pulses, smooth hairless legs that are cooler to touch, thickened toenails, color changes, +Buerger test are signs of what?
PAD
What is a Bueger test?
What does a + test mean?
- Buerger’s test is used in an assessment of arterial sufficiency. The vascular angle, which is also called Buerger’s angle, is the angle to which the leg has to be raised before it becomes pale, whilst lying down.
- Elevate both legs to a 45 degree angle, hold for 1-2 minutes. Pallor in feet/lower extremities indicates ischemia (+ sign)
After a Bueger test, the patient’s feet should turn what color?
Skin generally becomes blue then red
Leriche syndrome/triad?
- Claudication
- Absent or diminished femoral pulses
- Erectile dysfxn
Buttocks and hips correlates with what claudication site?
Aortoiliac disease
Aching, may have weakness of thigh or hip with walking. Diminished pulses in 1 or both groins
The thigh correlates with which site of claudication?
Common femoral artery
The upper 2/3 Calf correlates with which site of claudication?
Upper 2/3: superficial femoral artery
The lower 1/3 Calf correlates with which site of claudication?
Lower 2/3: Popliteal
The foot correlates with which site of claudication?
Tibial & peroneal
What is the acute limb ischemia triad?
Cold, pale, pulseless
Sudden, severe pain
Also paresthesias “the P’s”
What is the treatment for acute limb ischemia?
Start heparin immediately & immediate revascularization
What type of ulcer is located over bony prominences, warm or cool to the touch, variable sensation, and loss of hair? And associated with pain?
Arterial ulcer
What type of ulcer is above bony prominences, warm to the touch, associated with pain, has pulses, and varicose veins?
Venous ulcer
Which type of ulcer is on the plantar surface of the foot, is warm to the touch, is NOT painful, involves foot deformities and has ABSENT reflexes?
Neuropathic ulcer
Diabetic foot ulcers are due to which two ulcer types?
Arterial and neuropathic
Which ulcer is NOT associated with pain?
Neuropathic
Arterial pulses are only present in which type of ulcer?
Arterial ulcer
Which ulcer is the only one that has foot deformities?
Neuropathic (think Charcot foot)
Which type of ulcer is the only one with ABSENT reflexes?
Neuropathic
Which ulcer is located ON the bony prominences?
Arterial ulcer
Which ulcer is located ABOVE the bony prominences?
Venous ulcer
Which ulcer is on the plantar surface of the foot and mc on the feet?
Neuropathic ulcers
Which ulcer is NOT associated with calluses?
Venous ulcer
A “punched out” ulcer is characteristic of which one?
Neuropathic ulcer
How to calculate an ABI?
Ankle systolic divided by arm (brachial) systolic
What is normal ABI?
0.91 - 1.3
What is diagnostic for PAD? (the number)
Less than or equal to 0.9
An ABI of _______ indicates calcified vessels and hardening
> 1.3
An ABI that decreases ______% is diagnostic of arterial obstruction
20%
What imaging is done for PAD?
CT ang is initial study and conventional arteriography = GOLD STANDARD for vascular imaging
Antithrombolytic treatment for PAD?
ASA or Clopidogrel (Plavix)
Lipid lowering therapy for PAD?
at least a moderate statin (rousuvastatin)
Treatment for claudication and contraindications?
Cilostazol (Pletal)
*Contraindicated in any patient with CHF, patients with CAD have increased risk of angina and MI
Patients with significant/disabling symptoms unresponsive to lifestyle modifications and medication should undergo what tx for claudication?
Revascularization
- For life threatening ischemia
- undergo vasc imaging to determine anatomy and extent of disease
- stenting or bypass
What are three predictors of PAD to critical ischemia?
Diabetes, smoking, lower ABI
